Evidence against early weaning

[floozles]

Just wondering if anyone can point me to the evidence for not weaning until 6 months (am looking into it as planning to start solids for DD at 22 weeks). I've read through the Optimal Duration for Exclusive Breastfeeding:A Systematic Review published by the WHO and am left scratching my head. As far as I can ascertain, the review was carried out predominantly to see if there was any evidence of harm in recommending exclusive breastfeeding until 6 months in developing countries, in terms of reduced weight gain & poor iron status.

There is evidence of reduced GI infections in babies exclusively breastfed for 3 months vs 6 months in a study from Belarusse, and reduced eczema in the Belarusse study and a study from Finland which looked at children of atopic parents only.

The summary states that 'Besides their reduced morbidity due to gastrointestinal infection, infants breastfed exclusively for 6 or more months had no observable deficits in growth, and their mothers were more likely to remain amenorrheic for 6 months postpartum. No benefits of introducing complementary foods between 4 and 6 months have been demonstrated, with the exception
of improved iron status in one developing country setting (Honduras).'

I can see how exclusive breastfeeding till 6 months is ideal in developing countries where you don't really want your baby getting d&v, and prolonged amenorrhoea is useful in terms of birth control. I can't see from this any real evidence that giving my daughter a daily spoonful of apple puree from 22 weeks will harm her.

Just wondering if there's more up-to-date evidence that I've yet to come across.

[Ducks head below parapet...]

It irritates me that some people on MN think NO baby is ever ready for solids before 6m.

But I do agree it is good that whenever a debate about weaning takes place, it is pointed out that the longer you wait the better. That is better than Bounty where everyone seems to be racing to be first to get baby rice down their LOs.

I don't think people do say that no baby is ready before six months. This debate is going on on another thread now on BLW.

x-posted mersmam - the benefits of weaning before 6m were clear to me. My twins increased their demand for my BM at 5mo, feeding evey hour during the evenings. After I introduced food that cluster feeding stopped. Food meant that they needed less BM which was good bcause I am not sure my body could have made much more.

So it would have been trouble and sacrifice for me to wait until 6m.

WME, when a thread started a few months ago 'for people weaning early' it got slated and lots of people were on the thread saying 'you should only wean before six months on the advice of a HP' and then VS started a new thread 'for people weaning early on the advice of a HP'

I will try to find links.

www.mumsnet.com/Talk?topicid=weaning&threadid=639481-THREAD-FOR-ANYONE-WHO-DID-WEAN-IS-WEANING-EARLY -BECAUSE#13031475

VS is saying no one should wean before 6m except in the case of a medical condition.

www.mumsnet.com/Talk?topicid=weaning&threadid=637839-Anyone-who-weaned-is-weaning-early-and-wants-to -talk#12992307 this is the original thread

So I think that yes there are some people on MN who do think that NO baby is ready for solids before 6m when that is just ridiculous, like saying no baby is ready to crawl before 6m, but some do.

neenztwinz, I'm sure somebody like hm or tiktok will correct me if I'm wrong but I believe your body doesn't need to make 'more' milk for a hungry baby. The amount of milk you produce and the baby takes is fairly constant, what actually happens is that the increased feeding tells your body to change the composition of the milk to satisfy your changing baby. Introducing solids early interferes with this process.

What about hungry twins ShowofHands?

Did my body make the wrong sort of milk for ages cos it was being doubly pumped and it was confused about how old my 'baby' was?

No I think you've missed my point. That was a generic 'baby' I referred to.

Your body makes the amount of milk it needs to make for the baby/ies you are feeding. It levels out and after a while and when the baby/ies changes its feeding patterns, your body changes the composition of the milk. This is the same process regardless of the number of babies you have.

I was saying that your body knew how to make milk for both your babies.

There is a theory to suggest that every Mum starts by making enough milk for more than one baby because your body doesn't know how many you've had. It then adjusts to the reality.

The advice is around 26 weeks, which to me implies a week or so either way give or take.
If a baby was showing real signs of readiness earlier than that, as in sitting up and putting food in it's mouth, then I don't think most folk round here would complain too loudly.
But as there's no evidence of any benefit in weaning earlier than that, apart from those very few with reflux issues, then why rush?

mersmam, the point is, I'm struggling to find any evidence to say that introducing solids before 6 months is harmful. There is evidence in the WHO paper (which is the same as the Cochrane review btw) that exclusive breastfeeding for 6 months increases the risk of iron deficiency in babies, however this is felt to be outweighed by the protective benefits of breastfeeding in developing countries (where iron deficiency is more of an issue unlike this country, unless you're preterm).

The government guidelines are based on the WHO recommendations (based on the findings of their systematic review). I prefer to look at the actual evidence myself, rather than follow DoH guidelines because they're from the DoH (even if they're endorsed by MN ).

Hi Mersman, Having started to wean my son I can see that it is messy and more work etc but I felt it was important to wean him when I perceived that HE was ready and strongly showing biological indicators (strong interest in food etc etc, in his case at around 22 weeks).

The results of a large randomised trial in Belarus (Kramer et al, 2002) confirmed thatexclusive breastfeeding for six months considerably reduces the risk of gastrointestinalinfection. No effect on the incidence of eczema was observed in this study, though others havenoted a reduction in the risk of atopic conditions.

Longitudinal studies have indicated risks of eczema, wheeze and latent heart disease inchildhood if solids are started early. One Scandinavian study found that not giving solid foods before six months to children from atopic families greatly reduced the risk of eczema at 12months (Kajosaari and Saarinen, 1983).

Reviews of the literature on three aspects of the developmental readiness of babies forsolid foods with respect to physiological maturing were published in April 2001 (Wellstart,2001). These aspects were development of the baby's immune system, maturation of thegastrointestinal tract and oral development in relation to coping with the transition from apurely liquid diet to semi-solid and solid foods. Suppression of fertility in the mother as a resultof breastfeeding was also considered. The expert review team concluded that the majority of full term babies are probably ready to start solids near sixmonths or perhaps a little beyond.

Stevenson and Allaire (1991) suggest the conventional practice of progressing fromliquids to semi-solid or pureed foods to solids must be recognised as a belief that is notsupported by empirical data. Other cultures do not dwell on transitional feeding but continuebreastfeeding or infant formula milk and wean straight onto solid foods.

Spoon-feeding begins for most infants at around 5 months of age. Active spoonfeeding with the upper lip moving down to clean the spoon emerges at 6 months. Refinement of tongue activity during the swallow of these strained foods is noted at 9 months with up and down tongue movement. Lip closure during swallowing appears at 12 months and resembles mature feeding behaviour (Stevenson and Allaire 1991)

Anderson et al (2001) held focus group discussions with mothers to try to identify therange of maternal attitudes and beliefs that influence the timing of introducing solid foods.Mothers who had started their babies on solids believed their babies had shown behaviourindicating readiness. They were also aware of the recommendation to wait until four months but did not know the reasoning behind this. There was little appreciation of the risk of long-termill health.

It is common for mothers to believe that giving solid foods will help their baby tosleep longer at night. Heinig et al (1993) reported virtually identical sleeping times (729 versus728 min/day).

Hi,
have not read the whole thread as do not have time but I wanted to share my personal experience. I weaned all of mine early - a lot earlier than 22 weeks and they are fine. However if I was doing it all again I would follow official advice and wait as I know now that if any of them do develop any health problems that could be attributed to early weaning I will never forgive myself. I dread finding out that I have harmed them in some way.

Original Article
Early weaning is related to weight and rate of weight gain in infancy
S. Sloan, A. Gildea, M. Stewart,? H. Sneddon and D. Iwaniec
*Institute of Child Care Research, and
?Department of Child Health, Queen's University, Belfast, UK
Correspondence to Seaneen Sloan, Institute of Child Care Research, School of Sociology, Social Policy and Social Work, 6 College Park, Queen's University, Belfast, BT9 1LP, UK
E-mail: [email protected]
Copyright © 2007 The Authors; Journal compilation © 2007 Blackwell Publishing Ltd
KEYWORDS
early weaning ? infant feeding ? weight gain ? weight
ABSTRACT
Abstract Introduction Methods Results Discussion References

Background Evidence relating to the effect of early weaning on infant weight and weight gain is conflicting. The aim of this paper is to compare weight and weight gain in two groups of infants; one group weaned before 4 months (early weaned), the other weaned at 4 months or after.

Methods Feeding practices were assessed through semistructured interviews with mothers of 1-year-old infants. Weight at birth, 8 weeks and 7 months were taken from an administrative database (Child Health System), and an additional measure of weight was taken at 14 months.

Results Infants weaned early were heavier at 7 and 14 months, and gained more weight between 8 weeks and 14 months, even after breastfeeding was controlled for.

Conclusion Early weaning is related to rapid weight gain in infancy. This may have implications for childhood obesity.

and of course we musnt' forget good old kellymom which is always well researched and referenced

so, there is, in fact, plenty of evidence out there that wening early can be harmful to your child's health.

there is nothing that suggests that waiting would be harmful.

so why not do it? all your child usually needs is more milk if they seem "hungry" before 6 months.

it's all well and good saying "well, mine were weaned early and they're fine"

that's like me saying "well, i know someone who smoked 60 a day and she's fine"

it doews not mean that smoking doesn;t cause cancer. it just means you've been lucky

Neenz, I think most bf-ing mothers go through several phases of thinking "oh my god I am running out of milk", esp around 4-5 months. DD cluster fed like your twins for 5hrs every evening - she was 10lb 11oz at birth, and stayed on the 99.6th centile until about 7 months, when she started to drop slightly. I remember really worrying that I was just running out of milk, but (a) I'm a born procrastinator, so didn't really think about what else I might do (b) she was still putting on weight and being generally well and (c) I wanted to do BLW, and she wasn't ready for that.

I can understand that these feelings must be magnified a lot with twins, and think that hourly cluster feeds with twins must be quite a physical and psychological effort - what I'm trying to say is that it may not have been biologically necessary for you, but it may have seemed like the most pragmatic decision for you, having weighed up the pros and cons. It doesn't, however, mean that in general babies need anything more than milk until around 26 weeks-ish.

I guess it's similar to the SIDS and dummies research (though I know some question the validity of that research) - I don't like dummies, for some reason, so if I had another baby, I'd probably not use a dummy (unless circumstances drove me to it) given that our other risks for SIDS were relatively low. On the other hand, I know that I can't risk not taking folic acid in pregnancy, as I know I'm high risk for NTDs. Would like to have not found that out the hard way...

Hi thisisyesterday, thanks for your posts - do you have the full references used in Wellstart, 2001 or a link to the paper? Not esp fussed re: purees vs BLW. re:Stevenson & Allaire, as we all know babies don't all achieve motor milestones at a set time, there is a 'normal' range; also, my DD was born at 40 weeks, so at 23 weeks will be the same post-conceptional age as a baby born at 37 weeks who is now 26 weeks old. You mention wrt Anderson et al (2001) 'There was little appreciation of the risk of long-term ill health.' - My question is where is the evidence for these risks?

The abstract from Sloan et al compares those weaned before 4 months with those weaned at 4-6 months; as the debate is whether to wean at 4-6 months, rather than at 6 months this paper isn't really relevant. Not many people would want to begin weaning at under 4 months, and that's certainly not what I'm advocating.

'so, there is, in fact, plenty of evidence out there that wening early can be harmful to your child's health.' - I'm still looking for that evidence.

hang on, will see if I can find. the source i got them from had a huge list of references eep.

I am also finding that a lot of the data I can come up with is from BMJ, which you need to pay to view. so not that helpful to the majority.

and you seem to be ignoring the studies done that have shown a link between gastrointestinal infections and eczema.
evidence no???????

The results of a large randomised trial in Belarus (Kramer et al, 2002) confirmed thatexclusive breastfeeding for six months considerably reduces the risk of gastrointestinalinfection. No effect on the incidence of eczema was observed in this study, though others havenoted a reduction in the risk of atopic conditions.

Longitudinal studies have indicated risks of eczema, wheeze and latent heart disease inchildhood if solids are started early. One Scandinavian study found that not giving solid foods before six months to children from atopic families greatly reduced the risk of eczema at 12months (Kajosaari and Saarinen, 1983).

this is my list of references to work your way through!

ReferencesAnderson, A.S, Guthrie, C, Alder, EM. et al. Rattling the plate ââ?¬â?? reasons and rationales for earlyweaning. Health Education Research. August 2001; 16(4):471-9.

Cohen RJ, Rivera LL, Canahuati J, et al. Delaying the introduction of complementary food until6 months does not affect appetite or mother's report of food acceptance of breast-fed infantsfrom 6 to 12 months in a low income, Honduran population. J Nutr 1995 Nov; 125(11):2787-92.

Department of Health. Weaning and the Weaning Diet. Report of the Working Group on theWeaning Diet of the Committee on Medical Aspects of Food Policy. Report on Health andSocial Subjects No 45. 1994 HMSO. London.Dewey KG, Cohen RJ, Rivera LL, Brown KH. et al Effects of age of introduction ofcomplementary foods on iron status of breastfed infants in Honduras. Am.J.Clin.Nut.1998, 67:878-84.

Hamlyn B, Brooker S, Oleinikova K, Wands S. Infant Feeding Survey 2000. BMRBInternational. 2002. London. The Stationery Office ââ?¬â?? see www.doh.gov.uk/public/infantfeedingreport.htmHeinig MJ, Nommsen LA, Peerson JM, et al. Intake and growth of breast-fed and formula-fedinfants in relation to the timing of introduction of complementary foods: the DARLING study.Acta Paediatr 1993, Dec; 82(12): 999-1006.

Illingworth RS, Lister J. The critical or sensitive periods, with reference to certain feedingproblems in infants and children. J Pediatr. 1964, 65, 839-848.Kayosaari,M. & Saarinen, V. ââ?¬Å?Prophylaxis of atopic disease by six monthsââ?¬â?¢ total foodeliminationââ?¬Â?. Acta Paed. Scand. 1983, 72:411-414.

Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding (Cochrane Review). In:The Cochrane Library, Issue 1, 2002. Oxford: Update Software.Mehta KC, Specker BL, Bartholmey S, Giddens J, Ho ML. Trial on Timing of Introduction toSolids and Food Type on Infant Growth. Pediatrics 1998 Sep;102(3 Pt 1):569-73.Mercer JC. Current best evidence: a review of the literature on umbilical cord clamping.MIDIRS Midwifery Digest 2002; 12(2): 249-57.

Northstone K, Emmett P, Nethersole F & the ALSPAC Study Team. The effect of age ofintroduction to lumpy foods eaten and reported feeding difficulties at 6 and 15 months. J HumNutr Dietet. 2001, 14; 43-54.

Scientific Advisory Committee on Nutrition (SACN) Minutes, September 2001.www.sacn.gov.uk/meetingsept01mins.htm(accessed 09.08.02)Stevenson RD, Allaire JH. The development of normal feeding and swallowing. [Review] [22refs]. Pediatric Clinics of North America 1991; 38(6):1439-1453.

Reviews of the Relevant Literature Concerning Infant Gastrointestinal, Immunologic,Oral Motor and Maternal Reproductive and Lactational Development. April 2001. Eds. AJ.Naylor, AL Morrow.Wilson AC, Forsyth JS, Greene SA, et al. Relation of infant diet to childhood health: seven yearfollow up of cohort of children in Dundee infant feeding study. BMJ 1998, 316; 21-25.

World Health Organisation. 54thWorld Health Assembly Resolution. May 2001.