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...]

as you say, solid food does not, in itself, cause infections.
but it may damage the lining of the gut so that a baby cannot fight off infection, or has an increased risk of infection.

I've just done searches for the phrase 'virgin gut' in the title, abstract or text of any and all articles in the British Medical Journal, Archives of Disease in Childhood (the journal of the Royal College of Paediatrics & Child Health), Pediatrics (the journal of the American Academy of Pediatrics) and the Lancet, and none of them have any articles at all mentioning the phrase. If it's mentioned in a peer-reviewed scientific journal, then I'll look into it more. Otherwise

The Millennium Cohort Study (amongst others, but this is a very big, authoritative one) found that as soon as babies stopped being exclusively breastfed, their risk of being hospitalised with chest infection increased significantly.

It does look like much more than simply a bottle washing/clean water issue.

the virgin gut not a medical term, hence why you din't find anything.

but that explains how breastmilk protects the gut.

Sorry, rereading - what I wrote was ambiguous. Here's a quote from the abstract which should be clearer:

"Population-attributable fractions suggest that an estimated 53% of diarrhea hospitalizations could have been prevented each month by exclusive breastfeeding and 31% by partial breastfeeding. Similarly, 27% of lower respiratory tract infection hospitalizations could have been prevented each month by exclusive breastfeeding and 25% by partial breastfeeding."

So in this study any breastfeeding at all had a strong protective effect against both gastro and chest infections. When comparing exclusive vs mix-feeding, the effect was more strongly seen for gastro infections than chest infections. Whether that's a true effect or just an artefact of the study is hard to say.

Just thought I'd say that I'm finding this discussion v interesting, thanks everyone

thisisyesterday the link you posted talks about the protective benefits of breast milk in the preterm gut in preventing necrotising enterocolitis. This is now fairly well-established, and mothers of preterm babies in intensive care are encouraged to provide breast milk in order to reduce the risk of NEC. I'm not sure that you can extrapolate from this to say that exclusive breastfeeding until 6 months vs exclusive breastfeeding for 5 months, then predominant breastfeeding until at least 6 months affects gut flora, or your risk of getting gastroenteritis. It was the extrapolation of neonatal intensive care practice that led to the advice to put babies on their front to sleep (babies with breathing difficulties breathe better when nursed on their tummies), however the increased SIDS rate as a result led to the back-to-sleep campaign and subsequent reduction in SIDS cases.

Go floozles! I think everyone agrees that, for most babies, solids at 4/5mths will not do any harm, but we cannot tell which babies are ok and which are not ok, so it is safer to wait. But only 1% of mums wait till 6mths so what does that say? That they are all reading their babies wrong? That everyone on MN knows better than them? I don't think so.

Thanks tiktok for that info about BM. Can you reference the stuff about frequent feedings changing your milk rather than increasing the quantity of it?
If the 6mth guideline is not about allergies, what is it about? I thought giving food to a baby with an immature gut can cause it to get allergies and that was why the guidelines changed. They did change the guidelines on peanuts as an experiment so I don't see how my comment is so outrageous.

So in developed countries there is no evidence of harm if you wean at 4-6mths so why the hysteria about waiting till 6mths?

I don't get it.

I just read that article on peanuts you linked to Neenz and don't see anything about an experiment. I would have thought that would be rather unethical.

I don;t think it is unethical to be on he cautious side.

I will try to find a better article (was in a rush before - Daily Mail ffs!!!)

Could only find this.

It doesn't mention an experiment but it is a review of all the evidence since the advice first changed in 1988. It says the evidence is not good enough to support telling pregnant women not to eat peanuts.

But when this was in the news last year I definitely heard someone say the advice to stop eating peanuts was done as an experiment to see what would happen to the prevalance of allergies.

neenztwinz, from this and a couple of other threads it's clear that you desperately want it to be OK to wean at 4-5 months.

Not just you - there are many here who have a similar agenda.

I understand that feeling and sympathise, but you (all, I'm not picking on neenztwinz) don't seem to be able to see that you're turning these discussions into a competition, encouraging people to take sides and score points, crowing when people can't produce evidence good enough for you.

I think this is extremely damaging. We're not here to attack other people's choices or prove points, we're here to discuss the issue so we can make good decisions for our own children. It's not about winning or losing.

The evidence is overwhelming that the longer you can exclusively breastfeed, the better. It's also pretty clear that at a population level, babies don't need anything except breastmilk until 6 months.

The issue of how weaning age affects children, on the other hand, is very confused. There is no clear answer on what happens to weaning risk between 4 and 6 months. Lack of evidence of risk is not evidence of lack of risk. We simply do not know at the moment what the answer is.

Objectively, just going on what we know, the "least risk" option from the health point of view is to wean later than most people currently do. Nobody is saying that it's irresponsible to wean your baby before 6 months, or that a baby fed solids before 6 months will suddenly grow an extra kidney or something. Weaning at around 6 months is just a reasonable, plausible interpetation of research to date, and something new parents might want to be aware of.

We really need to bend over backwards here to make sure that our own wishes and biases aren't colouring how we discuss weaning. Bias is very interesting - the massively strong cultural bias in the UK about weaning between 4-6 months is a good example - but it's a terrible way of getting at the truth, and ultimately, the truth is what I'm after.

Not point-scoring.

Sensible post, well-argued, welliemum.

Neenz - the guidance is not driven by the 'allergies' agenda at all, as you would know if you read some of the links given here.

'Experiments' with guidance - eg the idea that peanut advice was given with an experiment in mind - is not how research is conducted.

I think you should stop saying things like you 'definitely heard something' about an experiement and 'they did change the guidelines as an experiment ' - this sort of dogmatism is worse than any 'mantra' about 6 mths. You do not have evidence for this because it isn't true!

I will find a link for the bit about breastmilk changing tomorrow

Not sure I am 'desperate' for it to be OK to wean aft 4/5mths welliemum - I don't need anyone on MN to tell me whether I did the right or wrong thing. I did what was best for me and my babies.

I agree we should be telling all parents that the advice is 6mths and the reasons why. If you read my post from 21.56 you won't find any desperation in there. Someone said there is no evidence of harm if you wean between 4 and 6 mths and I was asking why do we get so flustered about it here if there is no evidence?

Floozle has hit on an interesting point, that the actual evidence is patchy.

Some people on MN do judge if you wean before 6mths. It does not bother me, but I know lots of people don't post on these threads cos they are too scared of the reaction. I just like to voice the other side of the argument.

If everyone agreed, how boring would it be. Not sure you are going to find the truth on MN tho.

Tiktok, you can argue against what I say and point out that it is a load of old crap if you want to, but I will say whatever I like in my posts.

neenztwinz You do seem to keep sumarising the conculsions of this thread so far as 'so it is alright to wean at 4/5 months', which as far as I can see ISN'T a summary of this thread.

As Wellimim mentioned, lack of evidence of risk is not evidence of lack of risk. And actually it is a very important point.

Now in some circumstances you can argue reasons to dismiss this when the alternative shows proven benefits. However, so far, in this case there are no benefits from weaning early (except in certain diagnosed medical conditions perhaps).

As far as voicing the otherside of the argument, - well, there really is no other side of the argument. The argument is very one-sided. What you choose to do with the information is up to you as a parent, but weaning before 6 months is at best unnecessary, and at worse risky.

Just come across this thread and see that the things I would say have been said but in relation to the changing back to four months thing, Hunker has actually researched this.
The Doh have confirmed to her this is NOT true. See here

I weaned mine when they seemed ready - which was about 5 and half months with each of the three. They were watching eating with almost manic interest and a lot less interested in milk. Surely 6 months is a guide - not a rule. Nothing magically happens at midnight when a baby enters its 6th month. It is interesting to read the evidence and comforting to feel you have informed yourself to the best of your ability but as your confidence as a parent evolves you make up your own mind. It is much easier to feel sure of yourself and your own judgement with a few facts in your head - even if you choose to disagree with them or find contradictory evidence more compelling. Guidelines about weaning etc are useful and help most of us think about how to apply them in a way that works for us. If you stuck rigidly to all the guidelines about how to care for children you'd be a nervous wreck. Access to rational information and then trusting your instincts seems a good approach to me.

Neenz, of course you can say whatever you like - but equally I am entitled to advise you that saying something is 'definitely' true, when it clearly isn't, is something you shouldn't do. Why shouldn't you do it? Because debate and discussion flourish best when we make a distinction between opinion and fact. But you then go ahead and turn my advice into a 'free speech' argument.

I could come on here and say it is 'definitely' true that solids a five months makes babies' hair fall out and crosses their eyes. Or that I had heard 'rumours' that the department of health was going to make it illegal for parents to buy baby rice without special permission from Gordon Brown. Or in one post I could say that 'thousands' of mothers knew that avocados curled their babies' hair, and in the next post admit I did not know what I was talking about.

I won't do any of that, because it doesnt help debate or discussion.

So, I am asking you to stick to facts when it's facts and opinion when it's opinion..and everyone will get along just fine

Norma - no one sensible thinks that the exact date of six months is the only time for weaning onto solids.

I am sick of this 'straw man' argument - setting up a ridiculous proposition (in this case, the 'straw man' is that every baby should have solids on exactly the same date) to argue against it.

Of course people should be guided by their babies and not the calendar. In the vast majority of cases, real signs their babies are 'ready' for solids happens some time around 6 mths.

There is no evidence that the majority of healthy babies benefit from solids earlier than this, and some evidence that they may run some health risks - these risks are more difficult to quantify in a developed country, and impossible to quantify if we are trying to 'prove' a difference between, say, 5 mths and 6 mths.

This is not the same as saying 'it is fine to wean at 5 mths', or 'all babies should have solids at exactly six mths'.

Neenz - I'm worried that if I post in opposition to you it's going to feel like you're being persecuted, and I hope you don't feel that that's the case. But I did want to pick up on:

"But only 1% of mums wait till 6mths so what does that say? That they are all reading their babies wrong? That everyone on MN knows better than them? I don't think so."

But everybody (apart from maybe Franny!!!) does things that they are pretty certain aren't good for them - look at smokers, for a start. And the benefits of breastfeeding are well established, but some people choose not to (and this IS NOT a criticism of that, nor a criticism of people who are unable to breastfeed), and many women stop by about 6 weeks (tiktok will have better stats, no doubt). People just don't stick to guidelines, and it's not, I think, often because they think the guidelines are wrong, it's that they want (for a huge variety of reasons, some compelling, some less so) to do something else.

Tiktok, if you're around - can you enlighten me on any variation between "term" babies at 37 and 41 weeks? I've not heard of any, tbh, but it's just sparked an interest in me.

Habbibu - haven't heard anything, sorry.

I promised neenz a ref. for the way breastmilk changes over time:

PEDIATRICS Vol. 116 No. 3 September 2005
"Fat and Energy Contents of Expressed Human Breast Milk in Prolonged Lactation " shows the results of tested samples of milk in mothers who were bf babies of a year or more, and fat and calories are greater.

I have not found anything that tests milk at nine months, but one can safely assume these changes happen on a continuum, rather than with a boom on a certain day. So it's likely that breastmilk at nine months is higher in fat and calories than the milk of a mother of a much younger baby. This increase in fat and calories prob compensates for the fact that babies do not increase the volumes of milk that they take, after the first months.

It's also why the milk from the mother of an older baby would not be ideal for a pre-term.

Hope that clears things up for you, Neenz.

whoops - neens, you asked me for a ref for freq feedings changing the milk, not for milk changing as babies get older.

I don't understand what you are asking, sorry.

The way I see it, we all want to do the best as parents and no-one wants to put their child in harms way; when I asked the original question I was, and still am genuinely wanting to learn more about the risks of introduction of solid food at under 6 months (call it evidence-based parenting...). I'm not suggesting we go back to a 4-6 month recommendation. My assumption had been that the evidence was fairly concrete, given the strength of feeling from some, and I was surprised at the lack of research to show ill-effects of solids at less than 6 months. I'm not trying to prove any points, and am not looking to justify one position over another, just trying to be open-minded and looking at what the arguments are for and against, with a slightly critical eye. I guess the overall conclusion (as always )is that we need more robust research, larger studies etc to show more clearly which way the land lies. In the meantime, as several people have mentioned I suppose it's down to how you interpret risk, and adapting all this to your individual situation.

Jerry Springer moment over

And like I say, if anyone comes across more info, I'm wanting to learn, so please share.