Evidence basis for BLW?

[TruthSweet]

I had a v interesting conversation with a HCP today who is going to be running a parenting course for mums of babies 3m+.

Amongst other things, starting will be covered. I asked if BLW would be mentioned and she said no because as a HCP she can only talk about things with an evidence/research basis.

As the British Dietetic Society have produced a chart to show you what foods/texture and when that's all she is allowed to recommend. Plus the WHO only recommends purees.

Is there any research/studies/evidence base for BLW or has Gill Rapley just pulled BLW out of her arse Not that I think that you understand as stick blenders were very rare in the Iron age so what did early man do til the 90's?

Well, I'd be interested to see if the HV can provide research-based evidence for puree feeding, because I couldn't. That's accepted as a given, but there's no more research on that, as far as I can see. Try "infant self feeding" on PubMed - iirc, there were a few studies, but in general weaning research seems to focus on type of food/time, not texture.

From 6 mo the NHS recommends finger foods alongside puree, so I'm not at all convinced by your HV's stance, tbh. Some babies really like purees, some are utter spoon refusers - different weaning methods suit different babies and parents.

Well her stance was the BDS recommends it and the WHO does too, so she can't recommend anything else in case it comes back to bite her. Though she was really keen on the EAT study (the one with 3 month olds having solids).

I should have asked her what her bfing info was going to be like

not sure if this is published yet, but tell her to stick this in her pipe and smoke it.

Wright CM, Cameron K, Tsiaka M, et al. Is baby-led weaning feasible? When do babies first reach out for and eat finger foods? Matern Child Nutr 2010;10.1111/j.1740-8709.2010.00274.x [doi].

The study used data from the Gateshead Millenium Study, and the lead author is Charlotte Wright. seems like the authors found that, based on when babies began to reach out for food and feed themselves, BLW is "probably feasible for a majority of infants". concerns, obviously, that not appropriate for kids with developmental delays, to which one would reply duuuurrr.

here's what gill said to me "The GMS data show when the babies began reaching out for food and feeding themselves, and how many finger foods they were having (type and frequency) at six and eight months. The authors acknowledge that these babies were born (June 1999-May 2000) before either the six months recommendation or BLW had come into being, and that the parents' reports may therefore represent low parental expectations of their infants' self-feeding capacity, rather than genuine lack of ability. In other words, if they'd given them the opportunity earlier, who knows? So the fact that, on the basis of the data they do have, they are able to conclude that BLW is "probably feasible" for the majority is just great!"

We have a HCP who is running a similar course locally and she has begged me to come along and talk 1 session of the course about BLW as she says it is more beneficial for babies to start finger foods alongside puree or as pure BLW as it makes parents wait longer before introducing solids. They have noticed since talking about BLW at the end of the course (most babies are 16-22 weeks at this stage ) they have found the talk of early weaning amongst the group had dropped dramatically and they have very few of the group starting before 22 weeks. There was none of the 'evidence based only' argument.

...before blenders, people could chew their own food and feed baby mouth-to-mouth.

a blender is just easier, however may not add parental saliva which i suppose might aid digestion.

I've just looked up the WHO's Guiding Principles for Complementary feeding of the Breastfed Infant (6-23 months) 2005 and it does recommend purees to start with.

'Semi-solid or pureed foods are needed at first, until the ability for "munching" (up and down mandibular movements) or chewing (use of teeth) appears.'

Finger foods are not recommended until 8 months

Aitch - thanks for that study, I'll give it to her Be interesting to see what she says.

I've really never got the teeth argument. Ds is almost 14mo, and so far only has incisors - I'd guess this is pretty typical. I don't think anyone means to suggest children should be on purees until they have molars, but taken to its logical conclusion that's what it means. And surely if you feed them purees you don't see them munch at 6mo because they don't need to?

see the thing about babies wot do their own chewing is that they add their own salivary amylase...

Read the doh guidelines too.

While they recommend mashed up food, they also suggest finger foods from the beginning too and/or as soon as they show an interest.

DD3 didn't have any teeth until about 10 m/o and she'd been on solids (mainly finger food with high kcal stuff like double cream added to anything possible) since 26 weeks. If you look at babies gums they are quite ridged and shaped- they aren't flat and smooth so lots of surface area to 'smush' food themselves. You should have seen what DD3 did to whole grapes at 28w.

DD1 had more teeth earlier but was fed more purees (PFB and a Bamix obsession to blame) she did still go onto self feeding with out problems but at 4.9 would still have you spoon feed her if she could!

Aitch - there would be no use me chewing food up for my babies as I don't make salivary amylase and no, I don't smoke nor have I ever. I'm a freak of nature me. I hope the DDs haven't inherited this as I really hated doing starch experiments at school (chew white bread until it goes sweet, etc).

Well, exactly, Truth. So what is it with the waiting for teeth thing?

blueberryboybait - me too! I'm going along to a weaning talk next week to talk about BLW, at the request of my HV.

She was supportive of my decision to BLW DS2 and said that she gets asked about BLW a fair bit.

In her view, anything that stops parents obsessing over every mouthful that the baby does or doesn't eat, and removes the stress from the situation, has to be a good thing.

Wish me luck!

And DS2 had no teeth at all until 13 months and was maanging all sorts of things well before then

I think it might possibly something to do with elderly people losing their teeth/false teeth traditionally having to have soft/pappy foods. Also it might be a hangover from when panada/pap was fed to babies in the absence of bfing. Just a thought.

It is published Aitch and there will hopefully be some more evidence coming soon

I'm surprised to read this - my health clinic ran courses to specifically highlight blw - this was 6 years ago and 3 yrs ago!

Maybe we are very enlightened here in the North?!

Sparkly DoH and BDA do not officially support it as there is no academic evidence for it (eg in journals). They cannot advise based on what is essentially anecdotes (although we know there are thousands of babies being successfully and happily weaned this way). Until there are studies showing its efficacy and safety they will not advise.

However those studies are starting to emerge

oh i wish it ruled out people stressing, it does seem like there are some people who were just born to stress. but i do think it offers less opportunity for stressing iywkim, if only because there is less aiding and abetting?

good to know, peppa.

peppa, but where are the studies showing the safety and efficacy of puree feeding? Isn't that essentially anecdotal too (if on a huge scale)?

Well the one paper did show that following BLW was linked to stressing less about what they eat (although direction of that unclear)

here

And the other one showed it was linked to a more laid back feeding style in general which has been shown to have a positive impact later on

here

Is that a reply to me, peppa? Think we've crossed wires - I was noting that you (and many HVs) said they can't "promote" BLW w/out safety and efficacy studies, but I've never found safety and efficacy studies for what they do promote (i.e. puree).

Habbibu I know! I totally agree with you its crazy. But puree feeding is such the norm now that they will not 'change' the guidelines without any evidence behind it. Their reasoning would be that if they recommeded or gave guidance on BLW without evidence and then a child choked...(which I know it wouldnt if done correctly).

I know it is a complete contradiction but hopefully things will change. They are realising how popular it is

No I was replying to Aitch and no I know. I think it has just become very ingrained in our society that puree feeding from jars courtesy of some multibillion company is normal

Well, yy to choking, but in that case no people should ever eat non-pureed food! But ok, I get that reasoning.