Bit upset following discussion with HV - apparently bfing past 6 months is not really going to benefit my DD

[wasabipeanut]

Wasn't sure where to post this as involves bf and weaning.

So, I take ebf'd 22 week old DD to be weighed today. All good, tracking 40th centile so no grief re topping up or early weaning.

HV asks about weaning plans and I say I plan to continue ebfing until 26 weeks and then start BLW.

Various comments followed.

1. They recommend vitamins for babies still breast fed at 26 weeks.

2. If you start weaning at 26 weeks you have to really crack on with it as they need all food groups, vitamins, iron etc. A 26 week old will not get what they need from breast milk.

3. A baby has realised all the benefits it ever will by being bf'd for 6 months. The implication being that bfing beyond this point is for my benefit not hers.

Now I know for a fact that 3 is bollocks but points 1 and 2 worry me slightly. I did say, well if it is so crucial they are eating a good amount at 26 weeks then shall I start before and she said, no, the guidelines are 26 weeks. I'm just a bit confused because from what I have seen it takes a good few weeks/months for babies to actually start taking in many calories from solids if they are BLW and I thought milk still remained their main source of nutrition. According to HV she says my DD will probably start dropping feeds quite quickly.

I'm a bit upset about the whole thing really as she seemed quite down on the idea of bfing past 6 months. I had rather got used to the idea and was proud of myself for getting this far after some major difficulties around the 12 week mark. I feel a bit deflated really. I don't need her validation but I am now worried about weaning when I wasn't before.

Can anyone help to clarify?

oh fgs, there is no bloody consistency
my one and only visit to the hv was a nightmare, she was so obnoxious and made me feel completely useless. I have no faith in them whatsover... although i'm sure there are some good ones out there.

Is it me or do some HVs take against mums who trip in merrily saying everything's going fabulously?

I've actually found that bringing up a minor niggle that they can advise you on totally slays the dragon . You can then go on to have a reasonable chat about whatever's really on your mind.

this is an interesting article regarding Vitamin D. I have heard many time (anecdotally) about the 15 mins a day is all you need but in that case why do so many peple have Vitamin D deficiancy .

"The NDNS provides evidence of low vitamin D status in most age groups in the UK, especially in older children and young adults, and in older people in institutions. Young women of childbearing age also have low vitamin D status and are likely to begin their pregnancies with low stores."

There's some interesting stuff in the SACN Position Statement referenced in that article.

A plasma 25(OH)D concentration less than 25nmol/l (10ng/ml) is regarded as an index of suboptimal vitamin D status.

"Mean plasma 25(OH)D concentration for children 1.5-4.5 years was 68.1nmol/l and there was no apparent association with age or sex. [...] Plasma 25(OH)D concentration was below 25nmol/l in 1% of children."

(so 99% of children 1.5-4.5 years are not vitamin D deficient)

"The sporadic incidence of rickets has continued; however, there is no information on the national prevalence of clinically apparent vitamin D deficiency in the UK. An unpublished review undertaken by Kings College, London in the 1990s (at the request of DH) confirmed that the problem of vitamin D deficiency and rickets, when occurring, still remained predominantly a problem in Asian populations. Where rickets was identified it was associated with strict vegetarian diets and breastfeeding exclusively without vitamin D supplementation for periods longer than 6 months. Inadequate maternal status during pregnancy is likely to have been the important antecedent factor in such circumstances."

"Over the past few years there have been several reports of clinically apparent vitamin D deficiency in UK children (infants and
adolescents) [...] Most, though not all, of the cases that occur in the UK are seen in patients of Afro-Caribbean or South Asian origin. Although skin pigmentation is a factor, other factors, such as diet and low exposure to sunlight (either by staying indoors or covering the skin) are also important."

(so of the 1% of children who have vitamin D deficiency, the majority are of Afro-Caribbean or South Asian origin. And it's also associated with a strict vegetarian diet and lack of exposure to sunlight)

While I can entirely see, from a public health point of view, why they are recommending vitamin D supplementation for all pregnant and lactating mothers and for babies over 6 months, all the specifics I read in that document confirm my impression that as a pale skinned mother not in the first flush of youth who is not a vegetarian, eats plenty of oily fish and spends plenty of time outside, my pale skinned children (who are generally eating oily fish themselves pretty soon after 6 months) are not at any significant risk of vitamin D deficiency even if they don't get formula. So, from a me-and-my-family health point of view I have no problem with deciding not to follow the public health advice.

You've already been directed to Kellymom but I personally particularly like this (in response to the no benefit beyond 6 months thing):

"* In the second year (12-23 months), 448 mL of breastmilk provides:
o 29% of energy requirements
o 43% of protein requirements
o 36% of calcium requirements
o 75% of vitamin A requirements
o 76% of folate requirements
o 94% of vitamin B12 requirements
o 60% of vitamin C requirements
-- Dewey 2001"

Benefits of extended bf on Kellymom

I asked my dad (retired GP) about vit drops and he said it was nonsense and not to bother, so I didn't (he does say that about a lot of things though ).

Doh, also forgot to say that DD was BLWed very veeerry slowly - there were whole days when I didn't get round to giving her anything other than bm for quite a few months and she's not a great eater either, even at 21 months, but she is chubby as you like and a pretty active healthy little thing

The incidence of Vit D deficiency is not common in UK breastfed babies, even among ethnic groups with dark skin (who need more Vit D)...and the link you show does not say this, LouAnn.

LouAnn - it may be true that there are groups who are low in Vit D for various reasons, but this is not the same as being deficient.

I'm getting confused about the level of Vitamin D that are considered to be deficient/suboptimal etc.

The SACN says under 25nmol/l but other studies are quoting under 75nmol

this is from a bmj paper

Optimal greater than 75 nmol/l
Sufficient 50-75 nmol/l
Insufficient 25-50 nmol/l
Deficient less than 25 nmol/l

Which would make loads of people suboptimal if not deficient which seems mad if you only have to go outside for 15 minutes a day.

I am not trying to undermine bf by claiming it to be an inadequate source of vitamins but I do think that supplementing young women or pg women would be a good idea, paticularly in winter. My cousin has been diagnosed with MS so I have a bit of an obsessive interest in Vitamin D levels. Maybe the stuff I have reading regarding MS has a higher concentration of Vit D as optimal/sufficient.

There is a big difference between suboptimal and rickets (indicative of clinically deficient). Effects may be seen where levels are still high enough not to lead to something as serious as rickets.

The 15mins a day is with face and arms showing, and in strong daylight (i.e. 10am-3pm). A fully clothed baby in a pram in the shade, or with suncream may not get sufficient exposure. The mum's exposure in pregnancy is more significant than her current levels while bf.

Having said all this, many bf babies will be absolutely fine without supplementation. But, it is worth considering your own individual situation quite carefully. If you were pregnant in winter, worked in an office all day and commuted on the tube you might make a different assessment than someone who was working outdoors all summer while pg .

They're not sure what effect sub-optimal amounts of Vit D have. But recent research shows lots of people are looking into it. Low vitamin D looks like it can cause skeletal problems, and increase the risk of MS and schizophrenia.

I'm very pro-breastfeeding, but this may be a case where our modern indoor and sunscreen-wearing lifestyle causes a problem.

My hv told me to eat more cream cakes last time I saw her! Er....

Your HV sounds like she needs to keep up a bit more with current research.

If she tells you anything else like that, smile sweetly, tell here that you are very interested and ask to be pointed in the direction of the research so that you can read it for yourself. There won't be any of course.

I was going to suggest you gave her a copy of this but the course list hasn't been updated..

Since the WHO recommend BFing for at least two years the third piece of advice is nonsense.

Babies weaned at six months can start eating quite a bit quite quickly (DD1 ate an entire banana for breakfast at 27 weeks) but can also take ages to get started so be prepared for both possibilities. BLW is a great training for you as a parent to trust in your LOs ability to know what they need (I've done it twice now and both girls have a great attitude to food).

As so many others have said, the HV is ignorant. You continue to pass on very useful antibodies to your baby after 6 months and breastfed babies at 8 mo, for example, are less likely to be hospitalised. That said, I supplement my 14 mo DD with Abidec vitamins because there is increasing evidence of a link between low vitamin D levels and multiple sclerosis. Since I was diagnosed with it two years ago, I am simply not prepared to take the risk. If it's summer and your baby is out every day, fine, but the further north you live the less sunshine there will be in winter. We keep babies indoors a lot more than previous generations did, and I see lots of buggies draped with sheets as soon as the sun comes out for fear of sunburn.

I am still BF at 8.5 months and am BLweaning, but confess I am concerned about iron and vit intake so to help compensate for this I give DS vitamin drops. He eats pretty well already but it's such an enormous responsibility as the parent to make sure that they get all that they need so the drops just give me a bit of reassurance.

We are very pale but that in turn makes me quite paranoid about the sun and UV so he is smothered in sun block much of the tile.

www.bda.uk.com/publications/statements/PositionStatementWeaning.pdf

If this link works (?!!) it's the latest advice from the British Dietetics Association re: weaning and it was quite an eye opener when I read it earlier (found on another thread). I felt a little bad that I placed veggies in front of DS at 25 instead of 26 weeks but don't feel too bad now. HV's advice on weaning seems to be quite archaic but actually looking at this it seems as though most have, purely accidentally, been right about starting to wean before 6 months.

It would be impossible for a baby to begin eating well ehough in the early days of weaning to replace all these vits and minerals that breast milk allegedly doesn't contain. Weaning is a process that takes time and varies enormously child to child. we cannot force them to learn a new skill (one reason I love BLW so much - DS is in charge).

I HATE that some HV's don't think BF after 6 months is beneficial to a child so try and encourage weaning from the breast. I'm not a BF nazi, and DS now has formula at bedtime, but how can the milk that your body produces specifically for your child be a bad thing???? Until 1 year solid food is supplementary to milk, be that BM or formula, which remains the most important part of their nutrition. Food is important too, and I think I'd be wary of a mother who didn't really try to wean (occasionally you find them) till much later. But the child needs milk, and if the mum and child are happy for that milk to be BM, then fantastic. Formula isn't bad, but it will always be a substitute for BM. Also, if your child is a milk monster till 10-11 months despite being offered solid food, then so be it.

I've just revisited this thread after a few days off MN - thanks so much for your replies everyone. The links in particular are very much appreciated.

I will continue to bf but will probably take up the offer of the vitamin drops at 26 weeks to be on the safe side. we gte out and about a bit but I try to keep DD in the shade and indoors if its very hot so sun sxposure may not quite be enough. My pregnancy began in April 2009 so obviously spanned Autumn and the coldest winter in about 40 years so sunlight def in short supply for about 2/3 of pregnancy.

As for weaning I will poss start to offer some fruit in the next week or so and see what happens! The paper that Lovely74 posted is v interesting with the emphasis being that weaning should start by 6 months. I had been conditioned into thinking that starting before 26 was detrimental but am now revising that view. I started at about 22 weeks with my DS not knowing about the 26 week guideline and whilst we started slowly he was fine and remains a good eater at getting on for 3 years of age.

Thanks for your advice everyone.

i'm in the same position but i would ignore your HV,they are just an irritation put there to make you feel useless which in fact is what they are. you can't find out anything from a HV that you can't find on the NHS website (which isn't alot) because they do everything by the book. Don't worry as long as you wean your baby with the right foods they will get everything they need and you don't need to use follow on milk. and well done!