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...]

the kellymom article also contains links to all the articles she has used as references.

not sure why this is being ignored as well.
all seems plenty of evidence to me

Oh look - crying can reduce latex allergy... apparently. I like the choice of Kramer vs Kramer!

I really think if you wait for baby to reach out for your food, you wont go wrong.

Lovedogs, I think lots more research on motor skills, etc in relation to readiness to wean would be really useful. As everyone says, 26 weeks is obv something of an arbitrary date, esp as "term" babies can vary in age by 4 weeks. The ability to sit up, hold head steady, pick up food, put it to mouth and chew all seem like quite logical indicators. Obv. you'd need longitudinal studies to see if weaning in accordance with these indicators had a measurable benefit, but I do think it would make things clearer.

No-one is saying NO baby is ready before six months, simply that ALL babies are after 6 months and that those who are ready earlier miss nothing by waiting.

I think if you have a good reason for weaning before six months (as you obviously did neenztwinz then it's fine, it's not going to make much of a difference and no-one can say a baby is not ready at five months and 29 days and then ready at 6 months and one day

The general advice is to wait though - mine all went to six months and longer with no problems so I had no reason to wean them. At the time I read the research and decided that was best for them, but I was also under a lot of pressure from other people (particularly those who had weaned their babies earlier!) that it wasn't good for them and they 'needed' some solids (at about 12 weeks according to my MIL!!) - the stuff about iron deficiency at 6 months is rubbish, that was something that was quoted to me when I didn't wean them early and got me really worried - but as I say they were all weaned at 6 months or later and I've never had the slightest indication that any of them in anaemic! (obviously that might happen if you left it too long though!)

Habbibu - really good point re studies needed in behavioural indicators, that would be fascinating.

Also wanted to add - my DS was reaching out for biscuits etc at about 2 months... just because babies are interested in putting things in their mouths does NOT mean they are ready to be weaned!

mers, I think that's why you'd need to put the whole range of indicators together.

the whole term thing is interesting too - a 37 week baby and a 41 week baby with the same birthday are both full term, but one is 4 weeks "older" than the other. Does anyone know if this makes any difference - to anything, I mean, not (just) weaning?

My baby watched me eat my post-childbirth toast!

best food in the world, starlight...

But what exactly are the whole range of indicators Habbibu?

A baby waking through the night probably just needs more milk (?) Babies can reach out for food at a very young age...
So doing both of those together doesn't necessarily mean they're ready for solids.
Babies obviously can't tell us what they need so I think sometimes we need to trust the guidelines and what the experts tell us (Only sometimes though!)

Just because you think a baby might want solids doesn't mean it's what's best.
My three year old indicates that she only wants to eat chocolate biscuits but somehow I don't think it would be too good for her

She would get bored eventually.

at post childbirth toast.

I had an ancient curly sandwich which they acted as though I was lucky to have given I'd had the audacity to give birth in the late evening.

Couldn't eat the fricking thing for half an hour anyway as my hands were covered in...I don't know what

I just think we get a bit worked up on MN about weaning at 5mth v weaning at 6mth. I think we all agree that the danger zone is pre-17wks.

I would like to see that BF research ShowofHands, because as I understand it if your baby (or babies) increase the frequency of feeds, you produce more milk, not necesarily different milk.

The donated milk they feed preemies/newborns in hospital - is that milk pumped only from mothers who have just given birth themselves or could I, who is now 9mths into BFing, donate my milk for use for a preemie? I think I could, and that says to me that milk is milk is milk and it is pretty consistent throughout.

'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). '

This misses the point. It is not TOTAL minutes asleep that matters, but total minutes WITHOUT WAKING FOR A FEED . When my DD doesn't eat well she wakes up for a BF At 6am the next day. If she eats well she wakes at 7.30am.

mers, I listed a few that babies typically show around 6 mo above - ability to sit unaided, loss of tongue-thrust reflex, ability to manoeuvre food pretty accurately to the mouth, and to chew. I don't include night waking, as I don't think that's partic. relevant. I'm quite pro 6 mo, btw, mers! I just thought that the developmental indicators might be a useful addition to the research.

Sorry Habbibu - should have read the whole thread more thoroughly

Gill Rapley has said before that you could sit a child up at the table with you from birth onwards with food available to it, but it is unlikely to eat anything until it is mature enough to (ie, around 6 months)

there is reason to believe that the gut matures at the same time as a child is physically able to eat and digest food.
SOME indicators of this are:
losing the tongue thrust
ability to sit up
using pincer grip
ability to chew

this is why BLW works well for so many people, because if your child is not physically able to sit at a table, get food in their mouth and actually chew and swallow it, then it's unlikely they're ready to eat.

I can see the logic behind those things, as I've said, but think more research might be really helpful.

Hey thisisyesterday, thanks again for the many references! Not that I?m trying to pick holes, I?m just not sure that any of these papers show good evidence of harm in introducing solids from 4-6 months.

The results of Kramer et al show that breastfeeding reduced the incidence of GI infection ? that?s fine, other studies show this too, I can go with that.

The paper by Kajosaari & Saarinen from 1983 only looked at the children of atopic parents. Therefore their findings, if produced from sound research, can only be applied to the children of atopic parents, and not across the board. I?ve not been able to locate the original paper myself, but Kramer et al in the WHO publication state that confounding factors in their research were not controlled for, the researchers were not blind to the measurements they were taking and loss to follow-up was either more that 25% or not even reported in the paper. Again, their methodology was to compare babies started on solids at around 6 months with those started at 3 months, which is earlier than anyone?s advocating. All in all, not a great quality paper, findings as you say yourself not replicated in the study from Belarusse, not applicable to the general population and not really addressing the issue in question.

Wilson et al (1998) in the BMJ looked at introduction of solids at 15 weeks vs after 15 weeks, and did not find a significant association with respiratory illness or asthma, but did find a significant association with wheezing. However this study used data collected from a parent completed questionnaire, and does not define what is meant by ?wheezing?- different parents will have differing views on what wheezing is, so this could well have counfounded their results, aside from the recall bias inherent in using questionnaires. Again, as this study looked at solids at 15 weeks vs solids after 15 weeks, it does not tell me about harmful risks of introducing solids at 22 weeks.

The abstract of the DARLING study (Heinig et al 1993) says that morbidity did not differ between the two groups (early solids vs late solids), and that they found no difference in energy intake (which goes against the ?continue with breastfeeding as breast milk has more calories? argument) or weight gain between the groups either, so no benefits or risks were identified in that paper.

The abstract for Naylor et al states that ?there is no reason to conclude that exclusive breastfeeding should not continue to 6 months.? It says nothing about there being risks of the introduction of solids at 4-6 months rather than 6 months plus.

So I?m still unconvinced that there is credible research out there that says introducing solids at under 6 months poses significant long-term risks.

Blimey, now I?ve got brainache

neenz - it is hard for me to take your posts seriously when you say in one post that 'thousands of mothers' can testify to 'good night' milk helping their babies sleep, and in another post you say you 'could not say' if it helps a baby sleep!

In addition, 'rumours' (from where?) that guidance is going to change back to 4-6 mths? I have not heard these rumours and while it is true that some HCPs are not in favour of '6 ths' there is not a whisper anywhere that policy is made about it.

Your milk would not be suitable for donation to a pre-term baby, though some milk banks might accept it as part of the 'mix' they give in SCBU. Your milk changes over time, to meet the needs of the older baby - there is some good research on this, which partly explains why older babies do not appear to take greater volumes of breastmilk as they grow (unlike ff babies).

More generally - the guidance of 6 mths is not really to do with allergies and it is preposterous to suggest the guidance is part of an experiment to see if allergies reduce ...who do you talk to to get these ideas??

In developed countries, there is no real evidence of harm to babies who go onto solids at 4-6 mths, compared to 6 mths, if they continue bf alongside. But there is no evidence that babies in general need solids at 4 mths. Mothers are best advised to watch the baby, not the calendar, and to look for real signs their baby is ready....the vast majority of babies will show these signs at around 6 mths or so. Its sensible to offer more milk first if a baby shows persistent signs of hunger before 6 mths.

Floozle, i think you are slightly misinterpreting things:

The results of Kramer et al show that breastfeeding reduced the incidence of GI infection ? that?s fine, other studies show this too, I can go with that.

the results show that EXCLUSIVE breastfeeding, for 6 MONTHS reduced the incidence of GI infection.

that menas. NO solids.

thisisyesterday,it's the protective effect of breastfeeding (maternal antibodies) that reduce the incidence of GI infection; if you're bottle fed, esp in developing countries where clean water & ability to sterilise equipment is not readily available, then you will be more at risk of diarrhoeal illnesses. Solid food, providing it is appropriately cooked, stored & served, in and of itself, does not cause infectious gastroenteritis. If my DD continues to receive my breastmilk alongside a small amount of solid food, then she will still receive protective antibodies in the milk. If I don't rub her feeding spoon on the doormat, give her raw meat and leave her food out in the sun all day, then I don't see that she is at an increased risk of gastroenteritis . Besides the Kramer et al paper was carried out in Belarusse, not sure the standard of living equates that well with life in the UK, but I've not been there (the radiation fallout is somewhat off-putting), so maybe I'm being unfair...

although some would argue that the protective effect of breastmilk is what keeps the "open" gut in small babies sealed.

anything else, inc formula, destroys that protective layer and leaves the gut "open" rather than closed.

thus allowing things to pass through which wouldn't were the baby exclusively breastfed.

dunno if you've googled virgin gut yet, but it's worth a read