Apparently the latest advice is NOT to delay introducing solids until 6 months??

[phdlife]

Took dd to be weighed today and the nurse said I could start introducing other foods. I rather snippily said that wasn't the best advice I was aware of, did she have any research?

Surprised (and I must say, impressed) when she dragged out a bulging folder and showed me two articles with sections highlighted etc. Alas, with dd trying to suck my thumbnail off and ds falling asleep on the floor I did not have the wit to take down the references - am rather hoping some MNer with PubMed access can check for me?

Here's all that I can remember: One article was 2008, the other 2007. The 2007 one was a position statement; Peter J. Smith was one of several authors on the 2008 one; they were both about "complementary foods" (or feeding?); iirc one of the journals was something like "Paediatric Immunology and Allergies"???

Am sorry to be so vague - I was pretty floored by this info and a few other things she said, but she seemed pretty cluey, would really like more info if anyone can help!

You can find articles and research to 'prove' whatever you like; but the WHO guidelines are 26 weeks, based on a variety of latest research. A far as I am aware they haven't changed.

ds1 was on solids by 4 months and at the time that was ok. with ds2 who was born 2 years later i was told that i shouldn't try solids till he was 6 months. do what is best for you and baby is what i think!!!

I think 2 not very well known articles from 2 or 3 years ago vs WHO guidelines .... of those 2 I know which I'd take more seriously.

There have been lots of rumours about this it seems. The DofH have confirmed that they have no intention of changing the advice from 6 months. Your nurse hasnt done her research properly nor is she following her own d of healths guidelines.

I was told at ds's weigh in last week that you should introduce solids between 17 weeks and 6 months, whenever the baby is ready.

Allegedly if you delay weaning it can lead to problems with speech and chewing (they were the reasons the HV told me anyway).

The official advice and guidelines have not been changed. I believe there are more in-depth long-term studies going on on the allergy issue, and if those do show a clear pattern then it's possible guidelines will change in the future.

This came up in passing in the webchat with Dr Fox (the consultant paediatric allergist, not the radio presenter) last year.

He said:

By DrAdamFox on Tue 18-Nov-08 13:15:23
Dear Luluvic ? allergy prevention has been the subject of lots of research. Pretty much the only thing shown to help is exclusive breastfeeding for 4 months. Continuing beyond this hasn?t really been shown to help prevent allergies (although may well have other health benefits). Unfortunately diet during pregnancy doesn?t seem to make any difference either way ie eating no nuts or eating lots of nuts.

and then in response to a follow-up question:

By DrAdamFox on Tue 18-Nov-08 13:24:02
VVVVQ - exclusive is as you say. Best age to wean is currently of great research interest and a big study at St Thomas' Hospital, is about to start, looking specifically at this. The theory is that early weaning may well help prevent food allergy but this needs to be looked at in a study. Our current advice is to follow the WHO ie ideally 6 months exclusive but the studies on kids at high risk of allergy show increased problems only if solids are started pre 17 weeks

and then he actually came back the next day to add:

Dear Sophable, popsycal, trixymalixy - just wanted to clarify any confusion caused by what i wrote about weaning. Current best evidence suggest exclusive breast feeding upto 4 months protects against allergic disease. Of course, prevention of allergic disease is not the only reason to breastfeed and many other benefits have informed the WHO advice to advocate exclusive breastfeeding to 6 months. It would, however, be inaccurate to claim that exclusive breast feeding beyond 4 months has been shown to help prevent allergies. There is also evidence to suggest that early introduction of solids (prior to 17 weeks) is associated with higher risk of allergies but this is not based on cast iron data, just the best available. There is mounting evidence that early oral exposure (ie

I can find the 2008 one. It is a discussion paper - ie, that there is no actual evidence for any of the statements, but the authors are kicking some ideas around. No evidence has emerged since (in my limited PubMed research) to back this up.

The speech and chewing thing is nonsense. If babies aren't given anything to chew (ie, just purees) for a loong time, then yes it could cause issues (recent paper based on the Avon study showing differences in food acceptance if lumpy food introduced after 9 months) - but theres no evidence that 4 vs 6 months makes a difference in speech.

It's tiresome, isn't it, this continued casual undermining of current guidance by HCPs? I don't object at all to continued studies and discussion, and it's well-known the allergy thing is unresolved....allergy prevention is not part of the rationale for the 6 mths guidance anyway, and never has been.

From my reading, the discussion in the journals has been around allergies, and about the applicability of the guidance to formula fed babies. I don't know of any new research or new systematic reviews.

The Smith paper is by Prescott, Smith et al, and it is not research, but discussion: 'The importance of early complementary feeding in the development of oral tolerance: Concerns and controversies' and the abstract at least should be on PubMed.

I can't identify a specific paper from 2007.

A baby who's doing well on breastfeeding alone and is under 6 mths has no reason to begin solids at all - on current knowledge.

Nelly's HV spouting the speech and chewing thing is way out of date - specific guidance from the DH in 2004 explained this is a myth, based on old research from decades ago, done on babies who had been tube fed for developmental problems, IIRC.

Breastfeed babies mouths and tongues get loads of exercise. They have no problems developings muscles for speech.

As far as weaning goes a lot of it is opinon. Personally I am going to wait as long as possible as weaning is far too much like hard work. Its also much nicer to change bf nappies.

Nelly, re this crap

'Allegedly if you delay weaning it can lead to problems with speech and chewing (they were the reasons the HV told me anyway)'.

I'd like to act that HVs know next to nothing about speech and chewing. The people who do are SALTs [of which I am one].

thanks PortAndLemon, CMOTdibbler and tiktok for finding those out for me. My dsis knows Smith well (both her dcs are coeliac & allergic) so will see if she can get a copy of the whole paper for me. The only thing I did get from it was that the WHO guidelines were apparently developed based on two studies in Honduras. Skim-reading seemed to suggest there was mounting evidence that allergies in industrialised countries shot up after the introduction of this advice.

The nurse was trying to give us advice to avoid allergies since dh is asthmatic and therefore the dc's have higher risk.

My DS is five months now and I am not intending to start the solids till about middle of 6 months.

I have heard about 'delaying solids affecting speech', but I think it rubbish cos I had started my other babies, 2 DDs on solids 6 mths. My 1st DDs talks like there's no tomorrow from the very beginning! And my 2nd DD hardly ever says a word and still not totally understandable when she's speaks today!

So how would this nurse explain that? That what I would like to understand.

I always understood when a baby is able to grab your food of your table, yep baby's ready to eat!

I was about to come on and post about the webchat with Dr Adam Fox, but it has already been mentioned.

I weaned DS at 6 months following exclusive breastfeeding and he has multiple food allergies. In light of what Dr Fox said, I'm really not sure what I'm going to do next time round .

think that's the issue, trixy. Nobody knows.

The WHO guidance was based on a systematic review carried out for the Cochrane database...this is the gold standard of evidence-based medicine, obv never the last word, but an excellent view taken from robust research existing at the time....Honduras studies were part of this review, but where is the idea that the whole systematic review comes from 'two studies'?

www.cochrane.org/reviews/en/ab003517.html

Read it for yourself there.

No one can say 'allergies in the world shot up after the introduction of this advice' - worldwide, very few babies are exclusively breastfed for 6 mths, so how would they know? Please don't 'skim read' and then post your skim readings on mumsnet

It's so hard to know what to do for the best. With DS I was totally set that waiting until 6 months was the right thing to do, now because DS has allergies everything 2nd time round seems like such a bigger decision.

The jury is out on whether exclusive bf to 4 mths or 6 mths protects best against allergies - one confounding aspect of the whole thing is that babies where allergies are in the family may well be breastfed for longer than other babies, so you get a 'reverse causation' effect.

Here's what this is: you take a bunch of babies of, say, a year, and find the ones with allergies are more likely to have been breastfed. BUT the breastfeeding has not 'caused' the allergies; the allergies have 'caused' the breastfeeding, IYSWIM. These babies' mothers, knowing allergies are in the family, decide to breastfeed because of this tendency. The breastfeeding has not 'wiped out' the tendency to allergy, and so these babies (or a proportion of them) still develop allergies. And they get counted in your survey of them at a year.

It's this, among other things, that the epidemiologists of allergy are trying to figure out, along with the physical, immunological stuff that looks at what happens to the gut, and whether it might be that in at-risk-of-allergy babies may need different care than others....just as Dr Fox was saying.

At the moment, no one knows because there is no decent evidence to inform us.

had a chat to friend this weekend and her hv had also told her that advice is now changed to between 4 and 6 months (like it used to be 6 months but they've had a letter through saying no - we've changed the guidelines). I was really surprised. So what's going on up at HV HQ?

my hv stance is not before 18 weeks but before 26 weeks. i started at 21 weeks

Another important co-factor is that breastfeeding at the time of introduction of foods may lessen the probability of developing an allergy to them - there are a couple of papers on this. It may be that babies who receive food earlier, may be getting more breastmilk alongside than babies weaned later - but again, it's hard to control for that

sorry tiktok, I skim-read because that's all I could do at the time and I'm posting them here because with a tiny dd and a toddler this is the fastest, easiest way for me to find out what's really what. Thought I'd made it pretty clear that I was seeking further information to clarify the little information I'd been given. Apologies if that's not the case.

'S ok, phdlife, sorry for being snippy, and of course you made it clear it was a skim read

Just been thinking about this -

Isn't breastfeeding itself way of introducing small amounts of allergenic foods? That's why there was the concern about breastfeeding mothers eating peanuts wasn't it, that small amounts of the allergen appeared in the milk? And I know of at least one very allergic baby whose Mum couldn't eat dairy products as she would react to the breastmilk.

The bit about chewing and talking seems very strange to me, as DD2 was refusing food on a spoon and tongue-thrusting for weeks after she turned 6 months. But she has baby-led weaned with no problems since 7 months and is babbling away constantly. Obviously she is just one child, but she was almost twice the age suggested for weaning by the HV!

Yes, i've been thinking about that as well mrs tittlemouse. My DS's allergies presented themselves at about 12 weeks, he was reacting to the dairy, egg and soya proteins in my milk.