Introduced baby rice to a BF baby ( 20 weeks) - do I need to offer water?

[undomesticatedgoddess]

OK - I know I shouldn't be weaning him yet but he's been showing an interest in food for a while and to be honest I haven't got the guts to go down the BLW route (yet).

He is only having a small amount mixed with about 60-70ml of EBM once a day.

Do I need to give him water or will BF suffice? He is fed on cue and has unrestricted access to breast feeding.

Like i think you said in your previous Starlight, weaning can begin at birth (though i would not do it myself). I did wean my dd at 4 months, at the time that was the age you could wean at, though it was a bit early i think for her and should have waited until 6 months. She was just starting to hold her head up and still had tongue thrust and not really intersted in food.

Well the guidlines are there obviously but they are subject like i think you said subject to individuality. Yes my SIL baby was able to sit upright totally without support and was sitting in a highchair at 4 montns

She was ff not bf and was feeding baby rice, rusks etc. The child was quite advanced for his age and at 6 months looked seriously like a 1.5 year old toddler not a baby in any way shape or form. How can one say whether they are ready or not unless you see the child, just because the guidlines say it is not advisable to wean below 6 months doesnt make it set in stone, its up to the parent to make that assesment based on her baby. If they have any concerns to see their HV or doctor.

That's pretty amazing to look like an 18 month old at 6 months

Yes it is very unusual i have never seen a baby like it before, at that age he was wearing clothes for 1.5-2 year old. i wish i could post a picture on here of him but i dont know if my SIL would like it. he was not fat just big boned at looked a little boy at 6-7 months not a baby. mabey if she was concerned she should have consulted her hv or doctor

. Babies who have anything but breastmilk or formula before 17 weeks are at measurable increased risk of ill health.

really? i mean - where is the study to show bf & formula is preferrable to bf + solids?
there are plenty on ebf vs mixed bf available. there are plenty of studies showing mixed bf to be preferrable to formua alone.

my quick look has found only third world studies where the concerns are rather different.

one, you are misunderstanding me, I think.

I can't envisage a study that could be organised the way you ask - to see if breastfeeding plus formula is better than breastfeeding plus solids.

In any case, individual babies should be managed individually.

However, generally speaking, if we are talking growth only, a baby under 17 weeks who is not doing well on breastmilk alone (ie not growing) and who appears to need more calories will be worse off with supplementary solids - they're poor in terms of 'calorie value' and are likely replace breastfeeding rather than suppplement it (there are studies which show this - the replacement effect).

So if it is really not possible to address an under-17-weeks-old baby's faltering or inadequate growth with more or more effective bf, and it's decided this is something that needs addressing now, then the baby's need for an increase in calorie intake will probably be addressed best with extra formula.

in fairness to piglet, DS was sitting unaided, with excellent head control and could sit without support from 4 months. he did not do anything else for ages, he did not crawl until 11 months, but he sat solid as a rock from 4 months.

oh well. i did wean my dd a bit early though at 4 months and she was not ready so would wait longer next time round i think. My SIL has had a dd and she weaned at 6 months but her dd is a lot smaller than her ds also her dd has exclusive bm.

@tiktok -
the one thing i did find was there was very little research done into solids (as i did heaps of reading before i gave rice to DD) in the first world, possibly only the Belarus study (with its various limitations) showed ebf to be better, though I'm also not sold on Belarus being a first world country. If there was good evidence about sleep, i'd accept it over my personal experience, however i didn't find any (other than that one totalling average hours slept).

at 85% carbs and 3.82 kcals per gram rice is quite calorific - though i also read it was of lower calorific value i coulcn't work out how (as how much rice replaces how much milk? hard to analyse) not least because dfferent booby milk has different fat levels - though certainly booby milk with rice in it = more calorific than just booby milk just how do you work out how much more plain BM baby would have consumed?

and for me, the point was partly that i would feed lo less - that it would replace some of the booby milk that the baby was taking from me at all hours and in particular during the night.

I'm not really interested in the NHS / WHO judgements so much as the information these are based on . MNers routinely subject these guidleines to rigorous slagging examination when it comes to co-sleeping - accepting as gospel without analysis is not necessary on a forum with so many knowledgeable heads.
Quite a lot of the factors considered by the WHO are not ones we would think much of in the UK (eg bf as birth control, relevance to HIV, availability of clean water/utensils)

In a way (though i find this stuff academically interesting) i feel i am letting the side down by questioning EBF vs BF as it seems such a side-issue in a country where only 1 in 5 mums is still BF at all at 6 mo.

one - you're right that rice mixed with breastmilk is more calorific than breastmilk alone, of course - but I was thinking more of the other stuff babies get when first (early) weaned....the fruit and veg purees.

Lets stick with the rice scenario, though - the 1-2 teaspoons of baby rice mixed with ebm that is the on-pack guidance for babies new to solids will give a baby between 1.5 and 3 g of rice. The amount of calories in that is negligible - between 6 and 12 kcal (basing my figures on Hipp baby rice info www.hipp.co.uk/products/1_baby_rice.html ) and I will take a lot of convincing that this is going to make a difference to a baby's growth.

The DARLING study - which is what the British advisory committee (SACN) looked at as part of their consultation and deliberations about solids - found that in breastfed infants, solids given to breastfed infants before 6 mths replaced breastmilk (not the case with ff infants). The suggestion is that the slower digestive time of solids - yes, even the two teaspoons of baby rice - mean the baby may go longer between breastfeeding, and the net impact on his calorie intake was nil as a result. You can look at this study on the web - the authors are Heinig et al.

In your case you wanted to bf less, so again, in an individual case, individual factors apply. But it is not nutritionally better (the opposite, in fact, as no one is gonna argue that the bf baby benefits from the rice instead of the breastmilk, are they?) and to say (as people do) 'my baby needed baby rice at age X' is probably erroneous...'I needed my baby to have baby rice at age X' is a different kettle of fish

That HIPP site actually has quite a neat summary of what it says are the latest evidence based advice, based on a paper published in 'paediatrics' last year.

I suspect this is probably what the health visitor is talking about - it seems sensible, realistic and practical (and also, you will note, states, as I said in my first post, weaning can begin between 17 and 26 weeks)

This is what it says

In fact, because of the lack of published scientific evidence on complementary feeding and lack of consistent messages, there is considerable variation in weaning practices between different countries in Europe. To try to overcome some of the confusion, a group of European child nutrition experts (ESPGHAN) has recently published a paper ¹ which has looked at all the current knowledge and feeding practices in healthy infants, with the aim of providing a list of conclusions and recommendations for health professionals and Governments to follow when communicating with parents so that more consistent advice is given.

Conclusions
So what conclusions did they come to and what recommendations have they given for the best weaning practices to follow? A summary of these is given below, and are considered to benefit infants and young children not just in the short term but also in the medium to long term:

Exclusive or full breastfeeding for about 6 months is a desirable goal
Complementary feeding (introducing any solids or other liquids other than breast milk or formula) should not start in any infant before 17 weeks, and all infants should start by 26 weeks
The same advice on weaning should be applied for breast-fed and formula-fed infants, even though their dietary needs may be different
It is unclear whether earlier introduction of solids or other aspects of complementary feeding influence later obesity risk
Avoiding or delaying the introduction of potentially allergenic foods e.g. fish, eggs, has not been shown to reduce allergies, in either infants considered to be at risk or those that are not (this conclusion has also been reached by the American Academy of Pediatrics in their recent review of dietary influences on the development of atopic disease²). In fact, delayed exposure to high risk foods may be associated with an increased risk of allergy.
Gluten should not be introduced earlier than 4 months, but gluten-containing foods should be introduced before 7 months of age. Small amounts of gluten should be introduced slowly, preferably whilst a baby is still breast fed. It is thought this could reduce the risk of developing coeliac disease, type 1 diabetes and wheat allergy
Babies reach different feeding milestones at a range of ages and so appropriate foods should be given for each baby. However, it is important to remember that there is a critical window for the introduction of lumpy foods, and if these are not introduced by around 10 months of age, it may increase the risk of feeding difficulties later on
During complementary feeding, breast fed babies should receive at least 90% of their iron requirement from complementary foods and this iron should be sufficiently bioavailable.
Cow?s milk is a poor iron source. It should not be used as the main drink before 12 months, although small amounts can be added to weaning foods.
Infants and children receiving a vegetarian diet should have a sufficient amount of milk (about 500ml), breast milk or formula, and dairy products in their diet
Vegan diets are not appropriate for infants and young children.
More research is needed to clarify the effects of different foods and/or nutrients on growth, development, and health during this period of rapid growth and development.
References

Agostini C et al. Complementary Feeding: A Commentary by the ESPGHAN Committee on Nutrition. Journal of Pediatric Gastroenterology and Nutrition 2008; 46: 99-110.
Greer FR et al. American Academy of Pediatrics Committee on Nutrition. Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics, 2008; 121(1): 183-91.

I have read your post but don't see where it says it's okay to wean at 17 weeks. Could you be a bit more specific and perhaps really pinpoint it for me.

Complementary feeding (introducing any solids or other liquids other than breast milk or formula) should not start in any infant before 17 weeks, and all infants should start by 26 weeks

That means don't do it before 17 weeks, but do definitely do by 26 weeks.

In other words, sometime between the two ages. I wouls assume this to mean the exact timing depends on the baby. Bearing in mind the first point though of an ideal goal of full breastfeeding for about 6 months.

Seems clear enough to me.

You see I read it that it should have started no later than 26 weeks and not before 17 but that around 26 weeks is what you should be doing (17 doesnt count as around 26). I dont see how that is the same as saying you can do it fine at 17 weeks.

I dont get where you get the bit about any time between the two ages.

I really hope hvs dont go around now advising it's fine to wean now at 17 weeks.....

It seems quite clear, full breastfeeding for 6 months is a desirable goal, but otherwise do it in between those ages.

Being more specific would not be a good thing as it would take no account of individuals. Plus I would imagine that there isn't the evidence for anything more specific or it would have been mentioned, as other things are.

PS nowhere did I say 'anytime' between the two ages, I said 'sometime' between them, which is something quite different.

You said anytime between 17 weeks and 26 weeks on your earlier post.

All this talk of doing it early.. but I can't see that it would be a terrible thing to wait slightly more than 26 weeks either before weaning. All this "absolutely definitely by 26 weeks" sounds absurd to me. What's going to happen at 26 weeks and 1 day, they keel over from hunger?!

jimbobsmummy - there's nothing in that paper that undermines, let alone contradicts, current UK guidance....if the HV has read this paper, and on those grounds says 'guidance is going to be changed' she (and you!) need to read it again.

Is there a very slight difference in 'tone'? Is '26 weeks is a desirable goal' sightly different from the UK guidance that "Exclusive breastfeeding is recommended for the first six months of an infant's life. Six months is the recommended age for the introduction of solid foods for infants" ? Possibly, very slightly - but one is from a research paper and the other is from a public health statement, so one would expect a slight difference like that.

The 17 weeks or four months 'minimum' (sometimes in govt documents it's four months but this is defined as four calendar mths, ie 17 wees) is clearly a lower limit beyond which parents determined to give solids earlier need to be advised not to go - in both the ESPGHAN paper and the DH guidance.

Check it out here if you want to:

www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4097197 - click on the link to download a PDF.
The relevant bit is here:

"10 What about parents who choose not
to follow the new recommendations?

10.1 Parents should be advised of the risks
associated with weaning before the neuro
muscular co-ordination has developed
sufficiently to allow the infant to eat solids.
Solid foods should not be offered before
four months (COMA 199423). However, if an
infant is showing signs of being ready to start
solid foods before six months, for example,
sitting up, taking an interest in what the rest
of the family is eating, picking up, and tasting
finger foods then they should be encouraged."

I am mystified - where is the difference between ESPGHAN and the current guidance? How could anyone read ESPGHAN and conclude guidance was about to change? Change to what?

The thing about 'no later than 26 weeks' is a bit dogmatic - no other physiological process or developmental stage starts on exactly the same day for everyone! This is an artefact of research, I think - this is what the papers show because this is the question that has been asked. Common sense is enough to support 'about six months' rather than 'exactly on the dot of six months'....and experience shows that plenty of healthy babies do not much more than lick and mess about with solids for a month or so after, anyway. I think the evidence shows that they should have the opportunity to do this, though, at about six months. There is no benefit in deliberately withholding solids after this date.

I think saying that the guidelines are going to change to 17 to 26 weeks is an extreme interpretation.

To me the paper concludes by saying 6 months is still what we should all be aiming for but as we realise lots of people seem to want to wean earlier for whatever reason and there isnt mountains of evidence showing extreme risk then if you are going to take the risk please dont do it before 17 weeks. It also takes into account developmental readiness for solids which has always been the case really - which most babies get at around 6 months.

It would be worrying if they changed it to 'from 17 weeks' as presumably people who wouldnt usually consider doing it at 12 weeks as that was 3 months early would maybe start as it was only 1 month early in their logic.