Friday, September 13, 2013

Around six months

At five months of age, my granddaughter Charlie is now the only one of ten babies in her Mums Group not to have started solids.

This despite none of those babies yet reaching the "around six months" age recommendation for doing so.

Sometimes, it feels like we are banging our heads on a brick wall trying to achieve the guidelines of babies being exclusively breastfed in the first year of life - between the push for supplements of infant formula from as early as the first week to solids being actively encouraged at four months of age, it seems that many health professionals are either ignorant of, or disagree with, both the World Health Organisation AND the National Health & Medical Research Council, both of whom clearly state the age at which foods other than breastmilk/infant formula should be introduced to a baby:

Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants; it is also an integral part of the reproductive process with important implications for the health of mothers. As a global public health recommendation, infants should be exclusively breastfed1 for the first six months of life to achieve optimal growth, development and health2. Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues for up to two years of age or beyond. Exclusive breastfeeding from birth is possible except for a few medical conditions, and unrestricted exclusive breastfeeding results in ample milk production.World Health Organisation Infant Feeding Guidelines
In Australia, it is recommended that infants be exclusively breastfed until around 6 months of age when solid foods are introduced. It is further recommended that breastfeeding be continued until 12 months of age and beyond, for as long as the mother and child desire. NHMRC Infant Feeding Guidelines 2012
Now, these are not some wacko group with an agenda to push, they are the formal bodies who provide guidelines on all aspects of health care globally and in Australia. I wonder if those health professionals are also defying the recommendations in other areas?

Call me cynical, but you have to wonder who else has an interest in starting babies earlier than these clear guidelines - oh, that's right - the very large, multinational baby food industry! You only need to browse the aisle of your supermarket to see row after row of jars and packets stating "suitable from 4 months".

When babies are given "solids" (actually a misnomer) before they are developmentally ready, the foods need to be so liquified that they are nothing like the foods we eat. So all these "4-6 months" jars are pureed and contain nothing lumpy. They slip into the open mouths of babies, don't challenge the tongue thrust reflex very effectively and slide down the throat without much difference to the milk feeds the baby is used to.

Which is why the media reports of a recent study in the UK make such interesting reading:

Commercial baby food too sweet, lacks nutrition

The nutritional content of commercial foods was compared to typical homemade foods in the study.
The comparison showed commercial foods generally had half the nutrients of typical home made foods with the exception of iron content.
A 50g service of homemade food would supply the same amount of energy and protein as 100g of a similar commercial product, say the authors.
The reason for introducing solid foods is to increase the energy content of a baby's diet and provide more nutrients.
"Yet the most commonly used commercial foods considered in this study supply no more energy than breast or formula milk," the study says.
"While it is understandable that parents may choose to use these products early in the weaning process, health professionals should be aware that such food will not add to the nutrient density of a milk diet," the authors say.

But what about that other "first food", almost universely used with fondness, despite agreeance that it tastes on par with something like wall-paper paste: Farex and other brands of rice-cereal?
As long as iron-rich foods are included in first foods, foods can be introduced in any order and at a rate that suits the infant, NHMRC experts say.
But a national obesity conference in 2012 was told a baby's first solid food should be mashed vegetables - not the traditional baby rice cereal.
Endocrinologist and Obesity Australia chief Professor John Funder says the first four years of a child's life is crucial in determining whether they will develop eating habits that lead to obesity.
Starting a child off on a diet of rice cereal was like giving them "an oral glucose tolerance test''.
Children fed high carbohydrate, high salt and high fat diets as toddlers will have their brains wired to desire these foods for the rest of their lives, Professor Funder said.

So why are these products so blatantly marketed as being  the first foods for infants, if they are clearly not the healthiest options for parents to choose? This is a question that has been put to the FSANZ - (Food Standards Australia & new Zealand) who sets food labelling standards in the Food Standards Code. These standards are enforced by the Australian states and territories and, in New Zealand, by the Ministry for Primary Industries (MPI).

Their final report makes interesting reading and contains this telling statement:

Most parents relied on two main signals from their baby in determining if he or she was ready for solids – these were regarded more as signs of hunger rather than developmental readiness: 
• an indication of strong interest in food by following with their eyes when others eat around them, or reaching for food from an adult’s plate; and 
• disturbed sleep patterns at night, indicating that the breast or bottle feed was no longer enough
You will note their is no reference to being physically ready - the tongue-thrust reflux gone, able to sit in an upright position to eat safely.

You can read the full report here. You will note this document is dated 2004 and clearly labelling has not changed as suggested.

So we are left with the following confusing picture for parents:

  • The WHO and NHMRC guidelines say around six months is the age to introduce foods other than breastmilk.
  • The commerical baby food industry continue to label their products as suitable from four months.
  • Health professionals and others continue to suggest starting solids will improve infant sleep and infant growth - despite the normalcy of increased night waking and weight gain plateau in the 4-6 month age group.
Its time we asked the question of our Local, State and Federal Governments WHY so many mothers are starting solids at 4 months and not around 6 months. In Victoria, solids are discussed at the four month Maternal & Child Health visit. One has to question if the emphasis of that talk is on waiting until 6 months or if mothers are being encouraged to start earlier. Statistics on breastfeeding rates may tell the story:
Statistics from the 2010 Australian National Infant Feeding Surveyresults indicate that 96% of mothers initiate breastfeeding. Thereafter, exclusive breastfeeding rates drop off. Less than half (39%) of babies are still being exclusively breastfed to 3 months (less than 4 months) and less than one quarter (15%) to 5 months (less than 6 months).
Is it really a move to infant formula replacing breastmilk that gives these figures or are our exclusively breastfed babies during this significant age range decreasing because of the early introduction of other foods?

Questions you might like to ask your State and Federal Health Ministers.


Anonymous said...

Interesting that it says "Comment moderation has been enabled. All comments must be approved by the blog author." I was gonna comment but I dont think youd let it be posted anyway as I think you are sitting on a very high horse and disagree entirely but it must be nice and lonely up there judging everyone .. xxx Pamela

Yvette ODowd said...

Thank you for your opinion, Pamela. I wonder who you think I am judging? For the record, I started my first child on rice cereal just prior to four months, my second child on the same at 5.5 months and my third child on home-prepared vegies at six months, although he wasn't interested in eating until about 7 months. I judge marketing and advertising departments. I judge those who give lip service to the guidelines they are supposed to follow with the mothers who consult them. I don't judge mothers who follow the guidance given without knowing it is against health recommendations.

Willisa said...

I can see someone judging here, but it isn't Yvette. :)

Willisa said...

I can see someone judging here, but it isn't Yvette. :)

Cat said...

Fantastic article. It is sad that society and some health professionals want babies to grow up so quickly, rather than let them and their parents follow nature and their instincts.

Raven said...

Yep. I'm in the US & our baby just had her 4 month visit last week. The doctor told me about rice cereal & how I could start any time from now. (I told him we'd continue EBF to 6 months.) I also received mailings from 3 baby food companies encouraging me to start their foods now & explaining to me all about how to start. Even coupons & offers for samples. (I've received 3 sets of formula samples in the mail, too.) If I was waivering in my decision even a tiny bit, the system is definitely set up to push me to baby food now.

Anonymous said...

Interestingly the Australian Society of Clinical Immunology and Allergy (ASCIA) recommends starting solids at 4-6 months. These are guidelines from 2010 and are based on some more recent research. NHMRC and WHO are generally slow to change guidelines and are conservative when considering new evidence, not that this is a bad thing. It is thought that introducing solids whilst being breastfed may be protective against developing food allergies. As more babies are breast fed between 4-6 months than six months and beyond, this may be an argument for earlier (4 month) introduction to solids. Of course in an ideal world everyone would be breastfeeding for 12 months and beyond but an ideal world this is not.
I think the scientific evidence is far from conclusive for either argument. You can hardly conduct a double blind randomised controlled trial on infant feeding. I think Mums may need to rely on instinct and individual babies development to a certain extent but it would certainly be easier to do this without the marketing pressure.

Yvette ODowd said...

That is correct Amy, however the NMHRC guidelines were reviewed in 2012 and the recommended age was unchanged.

Not everyone agrees with ASCIA's recommendation and it needs to be kept in mind that allergy risk is only one aspect of the ideal age to introduce solids and may not even be relevant for the vast majority of children.

Regardless, health professionals cannot really take it upon themselves to disagree with the guidelines and implement their own in conflict with those of the NMHRC. It would be like doctors suggesting that smoking is really not so bad or a nurse telling parents that SIDs guidelines don't really matter.

ASCIA, along with everyone else, has the opportunity to make a submission to NMHRC during the period of review and if their suggestions are not implemented, then are probably very good reasons.

Further reading:

Anonymous said...

The recent research on allergies has been misinterpreted by some. What the research into allergies showed is that the optimum time to introduce solids (from the perspective of allergies alone) was between 4 to 7 months. This means there was a demonstrable disadvantage to introducing before 4 months, and after 7 month. Between 4-7 months it was THE SAME ie the outcome was neutral, keeping in mind this is for allergies only, not all the other reasons as considered in teh NHMRC feeding guidelines. Since the outcome for allergies is neutral between 4-7 months, and there are lots of other reasons to wait until around 6 months (eg digestive readiness, kidney load, displacing room for breastmilk/formula), the decision was made to keep the recommendation in the 2012 NHMRC infant feeding guidelines to "around 6 months". The article on the ABA website Yvette has linked explains this in more detail. However in short, the infant feeding guidelines take into account the latest allergy research, which gave a range of 4 to 7 months as the optimum time to introduce, and the NHMRC infant feeding guidelines recommend introducing solids at around 6 months. Allergies were considered in this decision.

Anonymous said...

In my mothers' group only two of us waited until 6m to introduce family food, and we have noticed that the babies who were started on purees are not necessarily eating any better than our girls, who just munch away on whatever we make for them. Our babies' food is much chunkier and they also eat corn cobs, fruit pieces and chew on meat strips, without gagging or choking. At 9m they are eating at most meals but we never push food on them, it's still just 'taste testing' at this stage, so if they refuse a meal, we just offer again later. They always have their breastfeeds first, so we know they are well nourished :) There is lots of pressure on mums to make their babies 'grow up' faster and achieve milestones earlier. It can be really annoying and distressing when you are letting your baby set their own pace for eating, to be questioned time and again about your choices, even when you know they are backed up by eons of evolution and research study after research study. I feel like asking people if they would enjoy me commenting on everything their children ate! This is a good article Yvette, backed up by information that some won't like to see - but as mothers, we are not into making a guilt trip for other mums! Learn and change - if you learn that commercial baby food has more fillers than food, blend up some of your own fruit or chicken and veg and move on. or don't - your choice ... but your baby doesn't have a choice, you make it for them, just remember that.