A Unique Child: Early Weaning - Starting on solids

Is it really best for babies to be fed only breast milk for the first six months of their life?

An evidence review of breastfeeding studies, which sparked much press coverage this month, has questioned the UK's current public health policy of babies not being weaned on to solid food until they are around six months old (News, 20 January). Researchers at University College London's Institute of Child Health said that breastfed babies may benefit from being given solid food from as early as four months.

At issue is the balance between the benefits for the baby of being exclusively breastfed, including a reduced risk of various infections, with the negatives such as potentially not meeting infants' energy needs and iron deficiency.

It is also suggested that later weaning may increase the risk of children developing food allergies and having difficulties accepting new tastes, particularly bitter ones, which could lead them to rejecting healthy foods such as leafy green vegetables. This, in turn, may increase the risk of obesity.

In 2001 the World Health Organization (WHO) advised that countries should adopt the recommendation of exclusive breastfeeding for six months. This policy was introduced by the UK in 2003, but the United States, and 65 per cent of European Union countries, as well as other countries, chose not to follow the WHO recommendations. The research team suggests that this recommendation should only be followed in developing countries where there is limited access to clean water and baby food.

IN RESPONSE

Parents and early years practitioners have been left confused by the polarised evidence and sensational headlines, but the Department of Health has issued a statement which firmly stands by its policy. A spokesperson said, 'The Department of Health has a clear public health policy to encourage exclusive breastfeeding for around the first six months of an infant's life, as it is the best form of nutrition and uniquely provides substances that protect the infant from infections.'

The Department maintains that the totality of evidence supports a protective role from exclusively breastfeeding for the first six months and states that there is 'clear scientific evidence that breastfed infants are less likely to have gastro-intestinal, respiratory, ear and urinary tract infection in the short-term, and particularly infection requiring hospitalisation, even in developed countries such as the UK.'

Midwives have also strongly challenged the research and regard the calls for earlier weaning a 'retrograde step'. Janet Fyle, professional policy advisor at the Royal College of Midwives, believes that introducing solid foods to babies before their swallowing mechanism is fully developed can lead to choking. 'There is evidence that some babies do die in developed countries from inappropriate young child feeding,' she states.

Contrary to the report findings, she is also concerned that weaning children earlier could adversely impact on children's eating habits. She says that in reality, many parents would wean their children early on to sugarbased solids, which could develop the child's taste for sweet foods.

Ms Fyle calls on practitioners to be consistent in the advice that they give to new parents. 'The confusion arises for mothers because often various articles appear which tend to contradict the current advice on breastfeeding. This tends to leave some parents wondering what is best to do for their infants,' she says.

'We must remember that the advice is based on very good evidence of the benefits of exclusive breastfeeding for the first six months of life.'

It must be emphasised that the evidence review is clarifying whether breast milk alone provides sufficient nutrition for the first six months of a child's life, rather than arguing about the benefits of breastfeeding.

It is known that breastfeeding does not just benefit the health of the baby but also the mother, including a reduced risk of breast and ovarian cancer. It can help to build a strong physical and emotional bond between the mother and child and, of course, it's also convenient and free.

Current advice is that solid food should be introduced at around six months. It is acknowledged that babies' individual development varies widely. Some will be ready to be weaned before or after this time. UNICEF UK states, 'Since the introduction of this recommendation, the number of babies experiencing the potentially harmful introduction to solid food before four months has reduced.

'Health professionals should continue to support mothers with accurate information based on Department of Health and WHO guidance, helping them to recognise the signs of when their baby may be ready to try new foods, while continuing to breastfeed.'

FURTHER INFORMATION

• 'Six months of exclusive breast feeding: how good is the evidence?' is available at www.bmj.com
• The Scientific Advisory Committee on Nutrition is to review infant feeding and is due to report later this year
• 'A parent's guide to weaning' by Penny Tassoni, Nursery World, 14 October 2010
• 'Baby-led weaning - All by myself' by Annette Rawstrone, Nursery World, 18 November 2010.