To expect weaning guidelines to be evidence-based?

[xtinak]

Well, perhaps they are evidence based but I'm having a hard time locating the evidence! Please help. My daughter is now 4 months and I am still so confused.

I know the NHS guideline is based on the WHO guidance, which is to wait until 6 months, or rather to exclusively bf for 6 months before introducing complementary foods.I get that it's a guideline. It seems unlikely that there wouldn't be differences between what exactly is best across, for example, countries, breast/bottle/mixed fed babies and of course for individual babies, but still the WHO guidance has to offer an answer that will do the whole world.

Thing is, I still cannot see a strong argument for the difference between 4 and 6 months when it comes to the UK. For example, the fact that ebf longer might possibly delay the return of my period seems beyond irrelevant!When it comes to increased infection risk, the increased risk seems quite marginal, the types of infection non-serious, and the whole thing is complicated by the fact that formula is defined as a complementary food, so sometimes such infection may be associated with introducing formula rather than solids. And we know that formula introduces this small extra risk and most people accept this small risk quite happily!There doesn't seem to be an adverse effect on weight gain of solids at 4 months, despite the logic of milk being more nutritious than solids.

Often on MN I see an argument is presented that the gut may still be 'open' at 4 months. I had assumed this was true as it is so often cited, but it doesn't seem to be!? I've been searching for a relevant study to no avail and the Science of Mom blog discusses it here:

scienceofmom.com/2016/05/03/whats-up-with-the-virgin-gut-do-babies-really-have-an-open-gut-until-6-months-of-age/

The NHS also gives a mysterious list of foods not to introduce before 6 months if you do start solids early. Fair dos on honey - no one wants botulism. But this list also includes for example, dairy. But why? A majority of babies will have already encountered dairy in formula. Or gluten. Why? Where is the evidence that gluten at 4 months is bad but at 6 months is ok? I can't find it.I'm actually going mad trying to get to the bottom of it all. And if you can show me with science that some of what I've asserted above is false I will be all to happy to learn. Please someone rescue my sanity.

And asking for recipes for pinwheels

Is there any reason you are keen to wean before 6 months?

My DD was born in 2010. I went to a first time parents group which ran over about 6 weeks and when they did weaning they covered a lot-BLW, spoonfeeding etc. There was a lot of discussion about the age to start and what food to give but I don't recall any evidence. Of course there was one mum who thought her boy was so advanced he would need to start way earlier than 6 months. I think she started at just over 3 months and I remember her complaining the HV had told her off and she knew her baby best etc.
We hung on until a few days before 6 months and did BLW. It used to annoy the hell out of me if people would put the food in DD's mouth (SIL and FIL) as she could manage it herself ok.
I think earlier guidelines were introduced years back thanks to baby food companies wanting to sell their products.

Oh yes, the endless pinwheels! There was also a good argument recently over whether 'pizza' made with just flour and yoghurt actually tastes like pizza (I haven't tried it but my bet is no) - people got very insulted on both sides!

Sorry, just seen your post about going back to work. If you are not trusting of the summary evidence given by NHS/WHO, all you can do is read around the evidence that is available and make your own judgment. The WHO and NHS provide generic guidelines that should result in the least harm for the majority. And yes they may not include the most recently published evidence, as they will be basing their guidance on long term systematic reviews and it takes time to update these - new evidence needs to be evaulated before it can be incorporated into guidelines.

Ultimately it is your baby and your decision which evidence to trust.

Don't have babies yet myself, however:

I would be extremely surprised if there is not a decrease in rate of allergies when babies are exposed to a wide range of potential foods at an early (but obviously still age appropriate re: choking etc) age

There is a general belief (and some evidence) in the scientific community that parents who hyper sterilize everything that their children come in contact with increase the risk of their children developing leukaemia.

Babies and children immune systems go through a lot of changes and it is fairly logical to assume that if they are not adequately challenged during fundemental development points that they will either:

1. Recognise completely benign things as threatening because they've never seen it before (e.g. peanuts) and therefore don't know what the heck to do with it

Or

1. Go ballistic because they're not being challenged with perfectly normal & common bacteria in the environment, hence leukaemia develops.

Obviously these are not black and white cases, not all babies that are sterilized to within an inch of their life develop leukaemia but there is a belief amongst many researchers that it there is a link.

Personally I'd love there to be more research into things like this but retrospective research is hard and you can never account for all potential variables, etc

namestheyareachanging I realise your question was aimed at the OP, however answering for myself I don’t want to wean before 6 months but I do want to do it at the time where it’s best for my baby. I bloody hate the weaning process, I’d avoid it permanently if I could (don’t worry I’m not going to!) so I’m personally quite happy to leave it to 6 months when they can feed themselves a bit better and it’s less work for me but if the evidence suggests that introducing potential allergens before 6 months could reduce the chance of my child having a life long potentially dangerous food allergy then I’d like to understand that.
The NHS guidance is still 6 months, some recent studies have suggested 4-6 months might be better at least for breastfed babies, which I have. However, these studies haven’t yet made it into the guidance, I’m still not totally clear on whether that’s just time lag or whether they aren’t applicable to the whole population (but are to me and therefore I should follow them) or aren’t sufficiently compelling and no one should follow them!

Sorry I haven’t RTFT but why do you want to start weaning early? What benefits will it bring?

In the past, before the invention of jars of baby food, people would give their baby milk until 7/8 months before giving them ‘normal food’ I.e. no mush from a jar.

Complementary food introduction methods/timing vary from society to society, but in the majority of traditional societies they are introduced earlier than six months.
When childbirth and breastfeeding practices were surveyed in 186 non-industrial cultures: “Contrary to the expectation of a prolonged period of breast-milk as the sole source of infant nutrition, solid foods were introduced before one month of age in one-third of the cultures, at between one and six months in another third, and was postponed more than six months for only one-third.” scienceofmom.com/2015/05/14/starting-solids-4-months-6-months-or-somewhere-in-between/

And pre masticating (pre-chewing) food for infants is usual in traditional societies, in addition to letting babies thieve food off plates! I think pureeing or grinding things like meat and leafy vegetables makes sense--toothless babies are unlikely to get much nutrition from merely gumming these things and spitting them out, or swallowing them whole.

Regarding the question of why some people want to introduce solid foods before six months:

As discussed in the thread, there is some convincing evidence that this may (somewhat) reduce the risk of allergies developing.

And the WHO itself has actually admitted that babies' iron levels seem to be poorer when people wait until six months to wean (the WHO states that it nevertheless supports waiting till six months because iron deficiency is not life threatening, whereas gastro intestinal infections caused by poor hygiene do indeed kill babies in poor countries. A reasonable point! But not one that would influence me, as someone living in a wealthy developed country).

I decided to introduce some foods from 4.5 months, but there is nothing bad about waiting till 6mo either--the differences are likely to be small in either direction.

Interestingly there's a Finnish study that shows an association between delaying solids particularly potatoes (past 4 months) and fish (past 8 months) is strongly associated with inhalant allergies so hayfever etc.

I say this as someone who has done a sort of BLW: the idea that it is how people 'traditionally' weaned babies is laughable if you've ever done it. Food has been far too precious for most people for most of human history to allow a baby to chuck handfuls of it over the floor. That doesn't make it wrong - the food environment we live in in the developed world is so different to most of human history that there's a strong case that we need to rethink how we teach children about food because techniques that work in scarcity conditions, like enforced finishing of what is available, aren't appropriate - but it's silly to claim it's 'what cavewoman did'.

The confounding factor in a lot of those studies (not EAT, where the subjects were randomly assigned - but that's very unusual) - is that you're going to see better outcomes for the children weaned pretty much according to official guidelines in their country, regardless of what they are, because they have parents who know about and follow health guidelines. I suspect babies weaned at 10 weeks now are in worse health than babies weaned at 10 weeks when it was standard as it's now (often) a marker for parents who aren't using health care professionals and expert guidance as their key source of information.

I don't think there is much hard evidence to it, I read the general guidelines (that change every few years) and used my intuition and common sense.

The fact that DD2 was really interested in pureed veg and practically bit (gummed) the spoon off for it at four months kind of said to me I had done the right thing in introducing solids then. I was a bit more inclined to play by the rules and wait until almost six months with DD1, but looking back I don't think the milk was particularly enough from about 5 months for her and I might have done it slightly earlier (and veg not baby rice) if I had that time again.

A dietician friend with two allergy children did say there's evidence for weaning before 6 mo if there's definitely family histories of allergies but that's under the guidance of dieticians/ consultants.

Oh god the BLW facebook groups are terrifyingly hilarious.

I tried fucking pinwheels.

They were stodgy and gross.

I was the only one who ate them. All.

Seriously bad tummy ache afterwards.

Not worth the effort.

The BLW fb groups are depressing

I'm all in favour of whatever weaning method works for the family in question. Some babies turn up their noses at mushy textures, whilst I've known parents who were desperate to do BLW but had to give up because they had a dedicated finger food refuser on their hands.

I don't quite understand how BLW has turned into the One True Way of weaning, though. It's great if it works for your family but the evidence base strikes me as pretty thin. My friends who were into BLW were prone to speculation about what cavewomen would have done (which always seemed a bit artificial because it probably wouldn't have involved melon and avocado on toast).

would who advice be linked to mothers/babies in developing countries not being able to get safe food? ie increased risk of infection? I remember being told about need for iron being main reason for mixed feeding/weaning after 4months. Traditionally (!!!historically!!) mothers use to pre-chew food to wean babies. Re this scare mongering about leukaemia - & too much sterilization - & for that matter allergies. - please don't make to much of it most of us cant keep a house that clean anyway especially once db is on the floor & moving (a good friend said she stopped sterilizing when she found db eating used tea bags from the rubbish bin!) my peer mum group it was suggested not before 4 months ie nearer to 5 - I started on rice & gradually introduced another food - more than one dc - one didn't have any allergy, one hyperallergic eczema, one asthma didn't seem to be food related. Did not exclude food groups unless child reacted (loose tummy or in case of eczema dc bumps-than rash - than dry cracked skin - it was like watching a photo develop) so believe me - just take your time & introduce food groups slowly & watch what happens

The one that has taken over FB now is Joe Wicks (who? I always feel about a million years old when I accidentally encounter instagram celebs) and "wean in 15"

@Namestheyareachangin yes going back to work is part of it. I'm a bit worried in general about how I'm going to manage expressing milk and whatnot and whilst I know weaning won't change much as milk will still be the main thing at 6 months, it would be good to feel like feeding in general is a bit under control. That may be silly but that's where my thinking began!

But then with further reading I became concerned about allergies because I have several - though none life-threatening - plus IBS and obviously it would be better if my DD didn't.

And I wonder about the issue of iron deficiency because I can imagine that if weaning begins slowly at 6 months then this could be a problem.

And in general I just want to know that I have enough decent information to make a call if I need to!

I'm really grateful to everyone for their contributions. This thread has been good food for thought (ha!).

BLW is literally just the lazy mum's friend. I don't get how there are FB groups about it or special random recipes - literally just whatever was on my plate went on my baby's as well, in grabbable pieces. It's not a religion, just the path of least resistance in getting your child to eat food. It worked fantastically for a year and she stuffed in anything she could get her hands on (beetroot was a mistake though - she loved it but omg the nappies). Then she suddenly became incredibly fussy at home whilst still piling in food at nursery (now 2). I spent almost an hour tonight trying unsuccessfully to get her to eat anything other than bread. But at least I never had to make puree (or pinwheels, whatever the hell they are...) So swings and roundabouts.

Yeah I don't get all the BLW Facebook groups. The basic principle is to offer them normal food albeit with a few tweaks/exceptions so surely all those pinwheels and specially made things go against this???
I read the book and spoke to a couple of people with slightly older babies at a BF group and got on with it.

In traditional societies (I’m familiar with some in East Africa) mums pre chew food for babies without teeth.

I’ve said this to BLW friends who give the “cavewomen didn’t have blenders” speech and they’ve ignored me

I did BLW with my oldest but the problem was that foods that were easy for her to feed herself weren't the healthiest, she wasn't good with cutlery for a long time and eating with her hands mostly involved the floor, she's still not keen on any foods with a sauce. Youngest is traditional weaned and he eats much more healthy and adventurous food but we haven't reached the toddler fussy stage yet (14 months old), he's way better with a fork than my oldest was at a much older age though!

I started weaning at 6 months dd didnt like this and refused to eat food 8 months. Do whars best for you but think the 6 months is due to sitting.

Another great book on the evidence basis of pregnancy and first years is "Expecting Better" by Emily Ostler. I also bought the "science of Mom" book. We weaned at 4 months (baby started stealing food) and based on those two books introduced common allergens at 5 months - peanuts, shrimp, fish, strawberries. DS has a teeny bit of flexural eczema but no food allergies, and is now an omnivorous carb monster