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!

What has never been got across is the 'about'ness of it, and that individual babies may differ on either side of that date, and we should 'watch the baby' not the calendar.

I think it's mad, frankly, that mothers are ticking off the days to 6 mths and awarding themselves Brownie points the nearer they get to the magic day....and then panicking if the baby shows no interest at 6 mths plus a day! Mad, but understandable, because of the way the message has (not) been put across.

But this is exactly what happens,unfortunately. Or in my experience, more often people wean earlier and then feel terribly guilty about it because it is a 'Bad Thing' even when it is clearly the right time.

I think the 'aboutness' is the thing that is maybe changing, and I suspect that this this may be what the HVs are talking about whereas before they were advising always six months, probably erroneously. I don't think this is a bad thing.

You don't want people doing it too early. But you also do actually need to recognise in the advice that is being given (ie what is actually said to parents, not what is written in a government statement most will never see) that some if not many babies will need it before then and not make moms feel bad about it. And tell them how to do it properly if they do. You don't want tem doing it too late either, delaying introduction of solids too far causes problems too.

So while the guidance may have said this for some time, it isn't generally what is actually being advised and only one part of the message is getting through. I think that if HVs are now being advised to be a bit more realistic and practical with their advice, this is a good thing.

jimbobsmummy - still waiting for news of the reviews you say have been issued since October 2008. You can say you made a mistake, you know, and that there aren't any.....

HVs, on the whole, have not been saying 'always six months' - I know this, from my contacts with mothers and others all over the UK. Some of them are still pushing mothers to wean their healthy, thriving babies from 16 weeks (and a few suggest it even earlier). They proffer solids as a response to babies who are small ('bf is not enough), babies who are large ('you'll have to wean early - your milk is not enough'), babies who are waking in the night, babies whose weight has plateued...etc etc. It is very, very difficult for them to understand how to support and enable excl bf to 6 mths - it is a question of poor training.

There never has been a reason for HVs to say 'always 6 mths' - the guidance has always allowed for individual variation. Most babies are fine on nothing but bf for 6 mths and this should be supported and encouraged and enabled by the health service. If the HVs in your area have been dogmatic and inflexible, then that is a gap in their training, and not the fault of the guidance per se...which is perfectly clear about 'recommendations'.

This is the other one tiktok. This may have been earlier in the year though.

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 know the paper, jimbobsmummy - it was published in Jan 2008 (9 months before the DH issued a clear denial of plans to revise guidance). I have just looked at the abstract again. The paper is solely about atopic disease, and shows evidence that breastfeeding to 4 mths as a preventive in at-risk infants, compared to feeding with formula, with no discernible benefit (with regard to prevention of atopic disease) in bf beyond 4-6 mths .

In what possible way would this undermine or contradict our own guidance, which is mainly focussed, as you know, on nutritional and developmental readiness for solids?

My daughter started putting anything she could get hold of into her mouth around 21 weeks, so at 22 weeks and a few days we offered her her first meal working on the rationale that if her stuffing newspaper, carpet fluff and in one instance one of her dads dirty socks (yuck!) into her mouth doesn't make her sick, actual food won't hurt either. So we handed her a couple of asparagus spears and she loved it.

If we had followed the guidelines we would have had to wait another month and that strikes me as a silly thing to do just because it's written down, when my baby showed already clear signs of readyness.

In what possible way would this undermine or contradict our own guidance, which is mainly focussed, as you know, on nutritional and developmental readiness for solids

It wouldn't. Nowhere did I say it would. (It is still an interesting paper though, as it seems that one of the main reasons usually given for delayed introduction of solids with breastfeeding is allergy prevention. But this may not be the case, at least beyond 4 months.)

All I was saying was that the corresponence that hunkermunker had from th DoH was nearly a year ago so it isn't impossible that a different response might be given now.

Or maybe all these different health visitors are just finally interpreting the guidance correctly for the first time.

Who knows? I don't!

There must be some HVs on here...

How on earth do you do italics on here BTW? whatever I do it doesn't work!

WidowWadman- you were following the guidelines! They allow for individual babies showing true signs of readiness before 26 werks i.e. grabbing food and eating it, as mentioned by Tiktok a few posts ago.

You have to put the ^ around each word individually - so not good for long quotes like yours!

Like this but without the spaces, obviously.

widow - you were following the guidance. See my post which quoted it.

jimbobsmummy - you said you had seen reviews and papers issued since the DH confirmed there are no plans to review/change the guidance and that therefore 'things may have moved on'. It turns out you have seen one (which says the same as the guidance). And the other was published 9 mths before the DH confirmation (and says nothing that contradicts or undermines it).

And you now say you did not suggest that these newer papers might have preciptated a change.

I can't keep up, sorry. You misquote yourself! You're misquoting the US paper on atopy and solids too, by the way - it does not say that prevention might not be enhanced with solids 'after four months'. It says prevention may not be enhanced 'beyond four to six months'. This is actually an important point because it reflects the research more accurately. They would have to do another study to differentiate between 'after four months' and 'beyond four to six months'.

No, all I said (for the third time now) was that the DoH response was nearly a year ago and things may have changed since, hence it may be worth asking them again.

The ESPGHAN paper was published after that response, I didn't check the date exactly on the other one I thought it was later in the year, sorry about that.

As you know, things change as new evidence becomes available, sometimes in big steps sometimes in barely perceptible shifts and every new publication can change things. Plus in medicine, frequently practice changes well in advance, often years before, 'official' guidance on the issue,. I'm not a HV, but I assume something similar happens in HV practice.

But as I have also said several times, I don't know anymore than you do what, if anything, this is based on or if it is all a case of mixed messages to/from HVs. Just speculating!

I have asked them again, Jimbobsmummy.

I will post the response

Thanks.

Another factor in the mix is that there's very strong evidence that as soon as babies stop being exclusively breastfed, their risk of being hospitalised with infection increases significantly.

And the risk is still apparent up to 8 months or so (hard to tell as so few babies aren't weaned by then.)

There's probably a trade-off between infection risk (delay starting as long as you can) and nutrition (some babies will need food earlier than others), and who knows what other factors.

So for each baby there'll be an optimum time, but as tiktok points out, it's not going to be the stroke of midnight as the baby turns 6 months for every single child in the world.

We need more info on specific risks like infection. That way, we can make good decisions for each individual child. eg if it's the middle of winter and you have a chesty baby, maybe you'd be better off delaying solids until spring - but then you'd have to be confident that they're nutritionally OK and we don't yet have the knowledge to test that.

We do know, though, that 6 months exclusive breastfeeding is safe at population level - so if it's safe and has known advantages, why not? I think starting BLW at around 6 months is a really good way of getting close to the optimum time for a particular baby.

Allergy needs to be taken right out of the equation - it's very complex and the evidence now is that the allergy risk is mostly set by the time a baby is born - so it's not surprising that what you do about weaning would have very little impact.

V interesting you say that about waiting if you have a chesty baby and it's winter, etc, Wellie.

With DS2, he was 6mo in v high summer and it was boiling hot for a good while. I decided to just bf him instead of adding something he'd never had to the mix and risking giving him an upset stomach, etc when he needed not to be dehydrated.

Makes a lot of sense, Hunker, and that's another example of how evidence from good studies can help us make decisions about our own children.

There are lots of potential factors that simply haven't been explored. Diabetes for example. Breastfeeding clearly protects against diabetes and this seems to be a dose-dependent effect, ie the more breastmilk a baby gets the stronger the effect is.

So we really need a study looking at interactions between diabetes risk and exclusive bf (and exclusive ff) and introducing solids, to see if there are implications for weaning. If you know there's diabetes in the family, that info would help you decide when to wean.

Other medical conditions where this could be relevant are bowel diseases like crohns and ulcerative colitis, adult heart disease, obesity... and I'm sure there are more, where there's evidence that early life factors are important: the age you wean, or the type of foods you give, could help protect your child in later life.

But at the moment we just don't know enough facts.

I had gestational diabetes and it was one of the reasons I fought so hard not to give DS2 formula on the postnatal ward, because I couldn't understand why it would be best to give him formula when he was a child who was already at greater risk of developing diabetes later in life. I campaigned hard for antenatal expression of colostrum to be brought in at my hospital and it has been [incredibly happy]

well done you

My elderly child care books advise weaning starting at 9 months, but that you should avoid weaning during the summer so that you minimised the risk of upset tummies. Also if they were ill.

No evidence given at all of course !

Saw the health visitor this week and she told me I should wait until 6 months to wean my son (he's 4 months old but big and eating lots). However I might introduce solids a couple of weeks earlier than that to get him used to different tastes and textures and eating from a spoon. He's bottlefed.

The advice is the same for breastfed babies, it's still 6 months, though sometimes they advise weaning earlier if milk is no longer enough to satisfy the baby. My DS' s cousin was weaned at 5 months - she was exclusively breastfed. So it does vary. I intend to seek advice from my GP if in doubt.

BTW i read somewhere that breastfed babies could get low on iron if they are weaned later than 6 months, because breast milk does not contain iron and the stores of iron the babies have at birth get depleted after 6 months. So there may be an argument for not waiting longer than 6 months. Also the WHO guidelines are always written with the Third World in mind - in the Third World it is crucial that mothers breastfeed for as long as possible because of unclean water, dodgy food, etc. In the developed world weaning earlier may be less of a problem. Sorry to ramble.

Breastmilk does contain iron. Breastfed babies do not run out of iron at 6 months, and the WHO recommend things for all babies, not with the third world in mind.

Weaning is the process of introducing food other than milk - so you don't need to start early to get your DS used to the food - thats what weaning is about.

Uh, was quoting dear Gina Ford on this iron one. Sorry if incorrect. She should change her book then, if that's not true. Confusion might come from the fact that some formula milk is supplemented with iron, so contains more of it.

I'm under antenatal at St Thomas's and they are currently recruiting for a study in which half babies will be exclusively breastfed till six months and half will be given, before six months, foods that are known to be potentially allergenic. This is because there is now a question over whether postponing weaning till six months really protects against allergies or whether small amounts of allergenic foods earlier will actually make babies less likely to become allergic. I've decided not to sign up. I exclusively bfed dd till she was six months and don't want to change what worked for me last time, but interesting anyway...