"Delaying introduction of possible allergens isn't recommended anymore"

[CoteDAzur]

This is what DS' French paed said today, in answer to my question "So, which foods were to be avoided the first year"?

Apparently, it was recognized over the last couple of years since DD's birth that avoiding peanuts, fish, etc didn't help at all re allergies and may have even been harmful - i.e. increased rate of allergies. She named UK in particular as a place where this was observed.

Hmmmm....

I was given the same advice by my DS's gastro-paed and have read the research paper that supports this view. To be honest it makes sense...there are more allergies now in children that have been weaned late and where certain foods are avoided than there are in older generations.

But 99% of mums on this site will absolutely disagree and start shouting rude comments about it .

Interesting. Can you link to the research?

This is sensible, Cote...once a baby reaches six months there is really no good evidence for withholding any foods, and UK guidance is not to bother withholding any unless there is known to be an allergy or intolerance.

The advice on peanuts changed in the UK in August.

[Honey is still supposed to be withheld 'cos of botulism until age 12 mths, but as most commercial honey is pasteurised it's not an issue. ]

sambo - I think Cote's paed is not referring to the speculative discuss you are referring to.

Honestly, the main reason for weaning at 6 mths or later is not allergy - as I keep saying on mumsnet (to no effect) . The allergy thing is the least evidence-based of all the reasons. The main reason is nutrition: most babies do not need other foods and are better nourished on milk alone until 6 mths or so. So why give them something inferior which they don't need?

Well, I told her I was slowly weaning DS (5 months) and she said "That's fine. We advise not weaning before 6 months only for babies with certain allergy antecedents".

I don't know if babies benefit from the purees or not (and neither do you), but if there is no harm, why not wean before 6 months? It seems to me that the attitude on MN on this issue is a bit harsh.

Cote, you ask 'why not wean before 6 mths?' But I answered this, surely, with my own question, " most babies do not need other foods and are better nourished on milk alone until 6 mths or so. So why give them something inferior which they don't need?"

Tiktok - But I think that is the point - that the research I have read (ESPHGAN - sorry Cote, it isn't online), and from discussions with a gastro-paed and paed-dietician, ideas are changing...

Breast milk, formula milk and cows milk do not contain sufficient iron or full amino acids that are found in protein. ESPHGAN have said that complimentary weaning should begin before 6 months so that protein can be in a baby's diet by the time they are 6 months when the supplies they are born with significantly deplete.

What I think is most misunderstood on MN is that those mother's who 'wean early' are not dramatically reducing their child's milk intake. My DS certainly never had less than the daily recommended oz of milk per day when weaning. Weaning with purees is supplementing or complimenting (in the words of ESPHGAN!) their milk diet and, for me, enabled my son to feel satisfied.

Out of interest, what you do Tiktok? I notice you are very informed and I am genuinely interested as you are clearly a huge support to lots of MNetters.

Sambo2, I am not an expert but I am puzzled by your statement that breast milk does not contain complete protein. If this was the case how could a breastfed baby survive and grow for even a week, let alone 6 months? Where did you find this information?

sambo - ESOGHAN don't say weaning should begin 6 mths at all. Their position paper on this is crystal clear - they recommend 6 mths. Are you reading an out of date paper, maybe? It is online - Google espghan complementary feeding and it comes up as a PDF.

Western bf babies and toddlers don't go short of protein - I have never heard of this as a concern. The main reason for intro'ing solids at around 6 mths is to ensure the baby gets onto a diet that has sufficient iron. The protein in their diet increases, as it should, from about 6 mths but there is no real risk of a bf baby going short as long as he gradually increases the amount of other foods in his repertoire as he grows. Unless he has a very eccentric diet - say loads of spinach and broccoli and nothing else either - I can't see where he would have enough iron and not enough protein....am I missing something?

What are the 'protein stores' that babies are born with???

I will stop now - it occurs to me you're confusing iron and protein.

Apologies - my error - iron stores, not protein (although would a baby weaned at 6 months on pureed fruit and veg be deficient in iron due to the lack of animal protein?).

ESPHGAN don't say that weaning should start at 6 months - in fact it is very open to interpretation. They say that bf is desirable for about 6 months and go on to state, "Complimentary feeding should not be introduced before 17 weeks and not later than 26 weeks". I fully interpret that as stating complementary feeding can take place between 4-6 months?

But what am I missing/misinterpreting in this paper when it states, "The ability of breast milk to meet requirements of both macronutrients and micronutrients becomes limited with increasing age of the infant" and that there is limited scientific evidence on which the WHO have changed their recommendations to 6 months?

It is why I am genuinely interested in what you do? I was advised to wean early by professionals who supported the view that there was nothing wrong with 'complimentary' feeding (i.e. along side milk, not as a replacement to) from 17 weeks.

I am not trying to be difficult, it is just that there doesn't seem to be a balanced view on MN and I have been shocked by some of the abuse that some women have received.

Yes, the advice has changed. There is another thread about this (about 2 months old) in the allergies section with a good link on it.

sambo - I am an NCT breastfeeding counsellor.

Sorry - I'm a bit confused now about what you think about ESPGHAN. They say the same as the UK guidance on weaning - recommended age for complementary foods is 6 mths. If comp. foods are introduced earlier then 17 weeks is the min age. This is not the same as saying comp. foods 'can be introduced between 4 and 6 mths' as if it makes no difference....6 mths (yes, 'about' six months) is 'desirable'.

The evidence for this being a sound public health policy, generally applied, is pretty robust, and the Cochrane review backs this up. This does not mean that every individual baby has to be weaned at the same time.

A baby having fruit and veg at 6 mths would not be deficient in iron - why would he be? You seem to be assuming that iron stores deplete completely and suddenly. This is not the case.

I have not seen abuse on mumsnet on this issue. I have seen exasperation, when people talk rubbish about parental 'instinct' urging them to wean their baby early, or posts which talk about quite dangerous feeding practices as being benign. I think the 'balanced' view is to look at the published science, personally.

I don't think it is a massive big deal for most babies to wean before 6 mths, personally - but most babies who wean earlier than this really do not benefit from it in any way....so why do it?

I have certainly seen very harsh attitudes displayed on here to mothers weaning after 4 months but before 6 months.

Regarding allergies - we don't know what causes a child to have an allergy so how anybody ever concluded that witholding that food stuff from the diet until a pre-detrmined 'safe' point would I help, I have no idea. It's as much a stab in the dark as anything else and I will certainly not be surprised if the number of allergies increases even more over the next few years.

Northernlurker - I don't think there is good science to show risk of allergies increases when solids are introduced after four but before six months...but there is plenty of stuff that throws a lot of suspicion (at the very least) at the introduction of solids earlier than this.

Ask if you want to know more. There's quite a lot of good quality research on it.

In addition, we know how the infant gut works, and this indicates that giving it stuff it is not yet 'designed' to process may have unintended and harmful consequences.

This is why you need not have 'no idea' why withholding food would help - it is quite a sensible proposition that an infant may be better off having a diet consisting of his own species' milk and nothing else, until his gut matures enough to cope, and until his growth and development reach a stage where other foods are needed.

I say again - the harsh (I called it 'exasperation' but it could be perceived as harsh, I accept) attitudes are mainly reserved for people who claim their own instinct or family practice trumps anything else, including sensible, robust research.

tiktok - My point is that those of us with a reason to hurry up with weaning should go ahead and do so without being jumped on, for there is no harm from weaning at 4 months.

My reason is DS's extreme vomiting, others may have different reasons. A bit of thick puree thickens the mix with milk in his stomach and he brings up much less in quantity and much less frequently.

Incidentally, he has started to sleep through in the last couple of days. I'm not sure how this relates to him being sick only a few times since Tuesday (as opposed to 10+ times a day previously) but it does feel like it has helped.

Again, the point is that if there is no harm, why argue "Noo, don't wean before 6 months." etc? I'm not talking specifically about you - there is a lot of that judgemental attitude on MN whenever this subject comes up.

Cote, I agree there may well be justifiable individual health reasons for weaning before 6 mths.

As a public health policy - that is, a general recommendation, plus structures in place that enable mothers to wean at 6 mths instead of 4 - then 6 mths has a lot going for it. By 'structures', I mean good maternity leave, good education and training for HCPs, no commercial promotion of solids for babies under 6 mths.

I think from a nutrition point of view, most babies will be better off weaning at about 6 mths but some individuals may not be.

There's no justification for withholding any particular foods after 6 mths....speaking generally.