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Starting Solids - The Facts Behind Today's Media Hype

Part 1

So - most people by now will have heard today's news, if not here's a brief summary:

"Relying purely on breastfeeding for the first six months might not be best for babies, experts in the UK have warned.  The team said breastfed babies may benefit from being given solid food earlier."
"They suggest later weaning may increase food allergies and iron deficiency levels, but other experts backed the existing guidance."
Current advice suggests weaning (insert - from WHO and the Department Of Health) should occur at six months, but the UCL team say it could happen as early as four.
The feedback I'm getting from mums already is that many people with a young infant coming up to solids age will now be absolutely bewildered about when they should be thinking about solids!

Before I get on to the paper that fuelled today's news - let's start with a few facts we should bear in mind:
  • The paper states three of the four authors "have performed consultancy work and/or received research funding from companies manufacturing infant formulas and baby foods within the past three years".
  • The recommendation not to wean until six months has substantially cut the numbers of women who introduced solids before four months – from 85% in 2000 to 51% in 2005.  This is massively significant in terms of health implications as the evidence against introducing solids before 17 weeks is extremely strong.
  • The recommendation not to wean until six months is also going to have impacted significantly on the profits of baby food companies.  As more parents follow the guideline for six months, less are buying baby food from four to six months...
  • Why are non breastfed infants not discussed?  When are they supposed to introduce solids?  I guess this is far less likely to be of interest because most formula fed infants receive solids pre 6 months.  Whilst the DOH guidelines state 6 months for both breast and formula fed, there is no big focus on "6 months exclusive formula feeding" and so profits from this group are likely to remain far more stable.  Ironically as the non breastfed infant's gut matures more slowly than that of a breastfed infant due to lack of human growth factors, and as non breastfed infants are not exposed to new flavours via breastmilk, starting solids is likely to be just as significant (if not more) to non breasted infants and an area that really should receive more focus in terms of health impact.
What does the paper actually say?

The paper is entitled "Six months of exclusive breast feeding: how good is the evidence? and despite the media coverage of this, says far less than you may think.  It notes that the DOH guidelines are based on the WHO paper, which found:
No deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for 6 months. 
But says the science was not fully evaluated by the DOH and calls for a reappraisal of the evidence.

They raise several concerns they feel warrant further investigation (as other studies contradict the ones quoted - it's not cut and dry and needs further evaluation)

Window for introducing new tastes

The discussion is all quite vague, from the paper:
There are also relatively unexplored concerns about the potential for prolonged exclusive breast feeding to reduce the window for introducing new tastes. Bitter tastes, in particular, may be important in the later acceptance of green leafy vegetables, which may potentially affect later food preferences with influence on health outcomes such as obesity
Perhaps this is relatively unexplored because we know babies are exposed to different flavours via breastmilk and so experience a wide range of tastes?

I asked Gill Rapley - Ex-health visitor, Ex midwife, Ex NCT breastfeeding counsellor, Ex lactation consultant and Baby Led Weaning proponent what she thought of this comment:

This is pure speculation and scare-mongering. Two counter-arguments spring to mind:
- Breastfed babies get a variety of flavours in their mother's milk and are known to be more receptive to a range of tastes once solids are introduced. They do not need experience of the food itself beforehand to be able to enjoy it at 6 months. (However, this may not be so for formula-fed babies.)
-The evidence for a 'window of opportunity' for the introduction of tastes is largely based on the observation that babies of 6 months and older tend to refuse new flavours. What these studies actually show is that they refuse new flavours offered on a spoon. No one has questioned the fact that the method of feeding used (in all the available research) happens to be spoon-feeding, simply because no one realised that there was an alternative way of offering solid foods to babies. In fact, in research terms, the feeding method is an important variable, whose significance has not been formally tested. As we know, the mass of anecdotal evidence from BLW parents suggests that babies who are allowed to feed themselves rapidly acquire a liking for a wide range of foods, including those with a bitter taste, such as broccoli.
Insufficient Iron

From the paper:
More recent data from 2007 raise further concerns on whether six months’ exclusive breast feeding would reliably meet iron requirements. US infants exclusively breastfed for six months, versus four to five months, were more likely to develop anaemia and low serum ferritin, which is of concern given irreversible long term adverse effects on motor, mental, and social development after iron deficiency.(20) (21) (22) Such risks might be reduced by improving iron status in pregnancy, delaying umbilical cord clamping, and supplementing infants at risk (for example, those with low birth weight).
So I dug out the studies they quoted (20-22)

Only one examines iron levels and infant feeding (20) The others are about the effects of severe anaemia.  The study examines 2268 infants, which sounds pretty impressing - until you discover only 136 were breastfed exclusively for six months.  Furthermore it's 6 months or more, so some may have been exclusively fed longer than 6 months which is often advised at the moment for high risk infants.  They found solids at 4-6 months instead of 6 months + reduced the risk of anaemia, low serum ferritin but not low hemoglobin and concluded:

Young children in the United States fully breastfed for 6 months may be at increased risk of iron deficiency. Adequate iron may not be provided by typical complementary infant foods.
It adjusted for birth weight and demographic, but no mention of other factors ie prematurity

This small study also contradicts the finding of numerous other studies.  For example a 2008 study found:

Full-term babies who are exclusively breastfed are not at heightened risk of low iron stores by the age of 6 months, even if their mothers were iron-deficient during pregnancy
Breast milk is low in iron, but infants can absorb it much more easily than they absorb the iron in fortified formula. Healthy full-term infants are also born with enough iron stores to make deficiency unlikely in the first 6 months.
Read more here

The evidence does seem to be particularly conflicting regarding iron, probably due to all the factors that can influence baby's store; such as type of birth, time of cord clamping and potentially mother's levels.  I fail to see however the connection with the starting solids debate, if an infant is low in iron they can have a supplement?  Cultural beliefs in the UK mean the first foods many infants receive are low in iron eg carrots, apples and we know introducing solids reduces the bioavailability of iron from breastmilk - therefore encouraging early weaning may increase risks of iron deficiency.

Coeliac disease

From the paper:
A more recent study in infants at risk (with a first degree relative with type 1 diabetes or carriage of certain HLA types), showed that introduction of gluten before three months and after six months was associated with increased risk of biopsy proven coeliac disease(26) and islet cell autoantibodies(27) . This finding suggests that gluten may best be introduced during a critical window of three to six months. In the same cohort, introduction of wheat after six months predicted increased risk of wheat allergy at age four years.(28)
Hmmm well it's an interesting interpretation of the studies.  The first they quote (26) has no mention of exclusive breastfeeding and purely examines the introduction of solids.  It also (significantly) is studying a group of "at risk" infants.  Those introduced to solids in the first 3 months had a five fold risk, and children not exposed to gluten until seven months or later were at a slightly increased risk compared to those who received it at 4-6 months. This difference was only marginally significant, however. 

When examining just the 25 children with biopsy-proven celiac disease, initial exposure to gluten in the first 3 months or at 7 months and later, significantly increased the risk compared with exposure at 4 to 6 months.  But it doesn't say how many of the 25 children with CDA were exclusively breastfed.  They also note that CDA rates are much lower in Finland (that consumes small amounts of Gluten) compared to Sweden which consumes far more.

They conclude:
The results of the present study provide for the first time convincing evidence that the time-honored, widespread recommendation to introduce gluten at the normal time into the diet of infants born to at-risk parents is indeed correct.
The second study they quote (27) is also examining high risk infants and has very similar findings to (26) again no mention or separation of feeding method.

The third study (28) is of 1612 children, four of whom developed detectable wheat-specific immunoglobulin. All four were first exposed to cereal grains after 6 months AND a first-degree relative with asthma, eczema, or hives was also independently associated with an increased risk of wheat-allergy development.   Four children doesn't seem very compelling evidence, and at least some of the four must have had another risk factor mentioned in order for them to associate it! Again no mention of feeding method. Feeding method is extremely significant as a study by Lvarsson found:
The risk of celiac disease was reduced in children aged <2 y if they were still being breast-fed when dietary gluten was introduced. This effect was even more pronounced in infants who continued to be breast-fed after dietary gluten was introduced.  The risk was greater when gluten was introduced in the diet in large amounts  than when introduced in small or medium amounts.  American Journal of linical Nutrition, Vol. 75, No. 5, 914-921, May 2002.
Allergy

The authors note that allergy and intolerance is still on the increase despite later weaning and conversely peanut allergy is low in cultures that wean with peanuts.  They go on to say:
The development of immune tolerance to an antigen may require repeated exposure, perhaps during a critical early window, and perhaps modulated by other dietary factors including breast feeding. A 2008 review(24) found an increased risk of allergy if solids were introduced before three to four months. After four months, the evidence was weak, but suggested an increased risk with delayed introduction of certain allergens
I can't access the review (24) but I have read before that links with allergy prevention were less compelling after 17 weeks - I don't think the WHO dispute this either.

In response to today's media coverage - a couple of leading organisations have released a statement:

UNICEF
Baby Milk Action
NHS

What actually is the Department of Health Guideline?
From the DOH:
At about six months babies are ready to be moved onto a mixed diet.
Try giving solid foods when your baby:

  • can sit up
  • wants to chew and is putting toys and other objects in their mouth
  • reaches and grabs accurately.
It is normal for babies aged three to five months to begin waking in the night when they have previously and starting solids will not make your baby more likely to sleep through the night again.

Health experts agree that around six months is the best age for introducing solids. Before this, your baby’s digestive system is still developing and weaning too soon may increase the risk of infections and allergies. Weaning is also easier at six months. If your baby seems hungrier at any time before six months, they may be having a growth spurt, and extra breast or formula milk will be enough to meet their needs.

If you decide to wean at any time before six months, there are some foods that should be avoided as they may cause allergies or make your baby ill. These include wheat-based foods and other foods containing gluten (e.g. bread, rusks, some breakfast cereals), eggs, fish, shell fish, nuts, seeds and soft and unpasteurised cheeses. Ask your health visitor for advice, especially if your baby was premature.

Solid foods should never be introduced before four months.
Here
and:

The World Health Organization(WHO) recommends that infants are fed exclusively on breastmilk until the age of 6 months and then breastfed alongside food for as long as the mother and baby are happy. Evidence suggests that as well as providing all the energy and nutrients that the child needs in its first few months of life, breastmilk promotes sensory and cognitive development. It leads to slower, healthier weight gain, reducing the chance of later obesity. It provides greater protection from infectious and chronic disease.
Babies breastfed for a minimum of 6months are less likely to experience colic, constipation, sickness/vomiting, diarrhoea, chest infections and thrush. Breastfeeding has also been shown to reduce the risk of ovarian and breast cancer in mothers. 
How do guidelines influence parents?
 
Parents who feel baby is happy and content are likely to follow the guidelines; those who feel concerned their baby is ready earlier, can speak to their Health Professional about earlier weaning; the HP can then judge each case on the individual child and signs of readiness.  The truth is that many parents are often unsure why the guidelines exist and also what risks studies suggest are involved at different ages (which I will discuss more in part two) therefore people often wean a couple of weeks prior to the guideline feeling it is close enough.  As mentioned above the recommendation not to wean until six months has substantially cut the numbers of women who introduced solids before four months – from 85% in 2000 to 51% in 2005.

Part 2 - Can babies be ready before six months and how will I know?

66 comments:

  1. Thank you for posting this. I will direct as many people as possible to read this.

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  2. Great post as ever! With regards to the introduction of stronger foods (such as broccoli), I wonder whether English children don´t have a tendency to like those kinds of foods because of their mums´ diets (well, the breastfed ones anyway). In Spain children eat all sort of foods with quite strong flavour and I´m sure in places like India where children may be not be fed solids until they are older (I don´t know about this for sure but guess the poorer families delay solids) children are still happy to have curries when they are older. My youngest child didn´t have solids until she was 8 months old and she likes all sorts of fruits and veg including broccoli, lemon, green and black olives, hummus and many other strong flavoured things. But, I like them too.

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  3. I weaned my daughter at 18 weeks (patly to get HV's off my back) and fed her all sorts of stuff including green leafy veg and biter tastes like brocoli and cabbage, she is the fussiest eater ever and HATES HATES HATES green veg!!!!! What does that tell you? She was breastfed for 12 months and 2 days. My son is 8 months and has been BLW for 8 weeks or so. I tried him at 6 months and he showed signs of not coping with solid food so I stopped and treid again 2 weeks later. He eats what he can get his hands on now and I'm really glad I held off this time.

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  4. Really wonderful post - I've linked it in my blog post here: http://www.howbreastfeedingworks.com/?p=325

    I love the way you break things down so beautifully - analytically, I guess!

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  5. All three of my children were not introduced to solids before 6 months. The oldest was supplemented with formula and weened completely at 11 months and is my picky eater. The other two refused solids until they were almost 10 months old. My second child nursed until he was 30 months and my little one is 23 months old and still nursing and they will eat just about. anything. They all like their fruits and veggies and have no allergies.

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  6. Thanks for the perspective and thorough review!

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  7. Thank you, Thank you, Thank you! I find it hard to intelligently interpret these articles...especially ones that just make the hair on my arms stand on end, because they are so obviously WRONG! You took it apart in an easy to follow fashion, and did not let the anger-factor take over...more than I could do. I actually had to turn the news on mute yesterday after hearing the news a few times...to prevent blood-boiling incidents!
    I am just in the process of starting weaning with my 8 month twins, and feel it would have been ridiculous/impractical/unneccessary/unhealthy for them and me to start any earlier...but was starting to feel shaky on my decision. They have only just started, and will eat almost anything within reason....if they make a face the first time they taste something, so what? The second time they wolf it down! Thank you again!

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  8. Thanks all! Quite stunned as the article has had over 1000 views since I posted it LAST NIGHT LOL
    Very big TY for sharing :D
    Anon I too had to mute the news lol

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  9. I echo all the above. You are the best voice of reason in this sometimes crazy subject. My boy is nearly 8 months and still breastfed, he was weaned at 5 months but very very slowly with the introduction of breakfast rice in the mornings only - not sure if it was the right thing to do, but it was the right thing for us. Now he is eating pretty much anything we put including leafy greens. The only thing he doesn't seem to like...banana! which last time I checked was sweet, so figure that one out. All this media hype just adds to the pressure on breastfeeding mums when really we should just focus on enjoying giving our children the best. Thank you again AA.

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  10. Thank you for this excellent analysis and for putting it also within the conflict of interest perspective, i.e. the links of the authors with the baby food companies. If weaning is urgently needed anywhere, then it would between scientists and the industry...and one can go certainly beyond this group (politicians, media, some patient groups...). Reading this part of your analysis I thought it may be interesting to mention that the article,-- just by coincidence?! --appears on front pages only a few days before the Executive Board of the World Health Organisation starts its session in Geneva (17-25 Jan). And guess what is on the agenda among the technical health issues: infant and young child feeding. So are we really talking a coincidence here? The same phenomenon invariably occures before just about every World Breastfeeding Week celebration...
    Thanks again for the great posting.

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  11. Thanks Charlie - have shared widely. Thanks particularly for being so quick off the mark when so many of us were floundering to answer questions yesterday!

    Maddie xx

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  12. My oldest son (now nearly 15) was formula fed and weaned at 4 months (as were the recommendations back then) I steamed vegetables for him and he never ate any canned or jarred baby food. His favourite food to this day is broccoli. My daughters were breastfed for 6 months but were weaned on jars and packets of baby food, they are both incredibly fussy eater with a very sweet tooth. My 4th child (now 2) is still breastfed and was first given solids at just over 5 months (he could sit up unaided and was reaching for food) following BLW principles, he eats a wide variety of foods including veg, curry and chilli. I think one of the main factors which influence children's tastes is the first foods they are given, and those children who are fed commercial baby food are likely to have a sweeter tooth and a much more limited palate than those fed wholesome family foods.

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  13. excellent blog piece AA - the ABM is proud of you :))

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  14. **The paper states three of the four authors "have performed consultancy work and/or received research funding from companies manufacturing infant formulas and baby foods within the past three years".**
    You missed the bit about the nutrition experts also doing research in favour of breast feeding and you dont shoot them down when they have produced a boob police positive report? I am glad that the formula and infant food producers use experts who know the benifits of breast milk and all the goodness it has in it to help them develop formula that best matches that of the mother so we are able to have a choice with our babies!

    **The recommendation not to wean until six months is also going to have impacted significantly on the profits of baby food companies. As more parents follow the guideline for six months, less are buying baby food from four to six months...**
    Who mentioned buying baby food? they talk about making it not buying it?


    **Why are non breastfed infants not discussed?** Where they discussed in the WHO "article" or did they yarp on and on about breast feeding only? this report was about the WHO guidlines on BREAST FEEDING and not Formula feeding.

    I was Formula fed, I have no allergys, I am rarely ill. How shocking!

    A mother knows best and will make up her own mind. All of this boob police pushing turns me off doing it more and more, the un-needed preasure from pro breast feeding fractions is too much and people need to keep there violent opinions to themselves! I will do with my child what I want, when I want and do not appreciate being told by a boob police chief that I will murder my baby giving it formula!

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  15. Wow, Anonymous, you seem to be very cross.
    You write " the un-needed preasure from pro breast feeding fractions is too much and people need to keep there violent opinions to themselves!"
    The only 'violent opinions' I can see seem to be coming directly from you...

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  16. Wow Anon as Mumof4 said you do seem pretty worked up that I've explained the paper - I have no idea why as it's not about breast v formula but introducing solid :S
    I'm not sure either where the "violent opinions" or suggestion you wil "murder your baby" are apart from in your own mind - perhaps some relaxation techniques might be in order, OR consider breastfeeding next time, the oxytocin hormone is known for chilling you out ;)

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  17. Thank you so much for this. Really. The most upsetting part of yesterday was the statement in the study that hardly anyone exclusively breastfeeds for six months, so we don't need to worry too much. Well, I did. And I did worry. Now - much less.

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  18. Yes I am cross that views can be so blinkered, you explained it in a breast only view not a choice view!
    I got told that if I fed my baby formula I would be murdering it, by someone who has violent breast feeding views. I thought it was about choice. sorry if choice is violent to you mumOf4.
    I am so laid back I am nearly lying down, generally things dont bother me however when I get "breast feed your baby or else" shoved in my face every day it does make me get a little annoyed.

    A mother has a right to choose and not to be cast out for her choice. I would never say someone should feed a baby breast milk nor would I say you should feed a baby formula nor would I say wait 6 months for weaning and do you know why ITS A MOTHERS CHOICE TO MAKE NOT YOURS

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  19. " I am glad that the formula and infant food producers use experts who know the benifits of breast milk and all the goodness it has in it to help them develop formula that best matches that of the mother so we are able to have a choice with our babies!"

    Best match is still nowhere near sweetheart.

    "I was Formula fed, I have no allergys, I am rarely ill. How shocking!"

    OK but you are obviously mentally challenged and more than a little unhinged. Great advert for formula aren't ya?

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  20. Anon1 (gawd it gets confusing with a few Anons!) I explained it in a "breast view" because the paper is solely about breastfed babies? I asked at the top why non breastfed weren't included as surely knowing when is best is relevant to everyone - regardless of how you feed? So am utterly confused as to what your issue is to be honest.

    Where on my blog do I say if you give your baby formula you are murdering it? or is this someone totally unrelated to my blog you are talking about? how is it linked to this post is what I don't understand?

    I have lots of non breastfeeders read my blog (I know as I've been emailed by them!) BECAUSE my blog is NOT judgemental and I've never "cast anyone out" because of how they feed their baby!

    Your last quote implies I am setting the guidelines LOL Nowhere in this post do I tell mothers when to wean :S I purely respond to the points made in the paper and point out the flakiness of the research quoted. The DOH are the ones who set the guideline in the UK as the article states :)

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  21. Anon, I don't think that anyone here is telling *you* how to feed *your* baby. You are right, that is most definitely your choice. What is being discussed here is the validity of this re-evaluation of research, the impact that may have on official guidelines (that being those folks in the government & baby clinics that *do* tell you how to feed your baby) and how we might limit the confusion that mothers might feel.

    I'm saddened to think that you feel attacked by this article and these comments, because they are not trying to stop you from making your own choices at all.

    We all need to be able to make confident choices about raising our children. Some of us will rely on gut instinct, some of us will do research, some of us will listen to recommendations from health professionals, some of us will ask other mothers for advice - or any combination of those!

    Don't we have a right to demand that the recommendations of health professionals are based on sound and up to date research?

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  22. Anonymous said...
    " I am glad that the formula and infant food producers use experts who know the benifits of breast milk and all the goodness it has in it to help them develop formula that best matches that of the mother so we are able to have a choice with our babies!"

    Best match is still nowhere near sweetheart.

    "I was Formula fed, I have no allergys, I am rarely ill. How shocking!"

    OK but you are obviously mentally challenged and more than a little unhinged. Great advert for formula aren't ya?

    Dont call me sweatheart. I am a very well educated, happy and stable person who has a wealth of friends and family, I have never suffered depression nor have I had to be seen by any mental health experts so please do explain your mentally challenged comment. Pot-Kettle? have I attacked you? No, have you lowered yourself....I think so. Perfect advert for......nah not going to bother.

    I never said this blog called me a murderer, nore did I emply it did. I got told by a pro breast extremist "friend" that giving my baby formula would make me a murder. sorry my last quote was about the WHO guidlines, I think I did mention them and not you.?

    My point is mothers are getting battered into thinking they are bad or not breast feeding which is wrong, it is hard enough without being told if you dont breast feed you are a bad mother (I would point out this site has not said that it is opinion from others)

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  23. I think most reaserch is flawed, peope can manipulat it for there own cause.
    My point on your points at the top of this page was it appears rather bias towards breast feeding. So many pro breast groups jumped on this and turned it into another onesided amd usless debate.

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  24. Choice choice choice....

    We have become such a selfish world. Where women scream at the idea of having to do anything inconvenient to them.

    I can understand being "unable" to Breastfeed. I became violently ill and had to use meds that were unsafe to nurse with when my firstborn was 3 months old. Before that it was about 6-8 weeks of HELL trying to figure out nursing. I wanted to give up. But I'm glad that some women around me "pressured" (more like encouraged) me to keep at it. I ended up giving my boy 12 weeks of liquid gold at least.

    What I don't get is when women CHOOSE to not breastfeed because of inconvenience or... ignorance.
    They think formula is the same thing, why sacrifice time for yourself being tethered to a demanding infant when they can just receive a bottle by a willing relative or friend?
    Or they believe it will ruin the breasts, yet the elasticity of the breasts break down during pregnancy and not from nursing.
    The main one that gets me is "ot was to hard."
    Well some things in life are hard.
    Not everything will be handed to you on a silver platter.
    You do not go to college and sit on a lush cushion being fed grapes all day and then receive a diploma.
    You do not go to a gym and watch Lost on the TV eating bon bons and never break a sweat and end up toned and healthy.

    But guess what, with hard work comes reward. *gasp*
    When did our society lose this precious concept?

    Your CHILD receives a reward that can never be replicated. It is a once in a lifetime chance to give them what they NEED, not want.
    Breastmilk isn't BETTER, its the NORMAL thing to give a human child.
    Anything else is indeed less.

    What also grinds my gears is when I hear someone freak out on a forum like this and start ranting about breastfeeding nazis breathing down their necks and then shout "choice!" I get a mental image to someone pointing at their swollen bellies and the life inside and shout "choice!". Like that beautiful person who is completely trusting of their mother's womb can be a choice. Because our woman freedom should enable us to "choose" to allow this baby to live.


    Now I'm ranting...
    I cannot stand the pro choice argument in most circumstance.
    Do what is good for your little one.
    Its not always easy, but its worth it to that human who will live to reap what you've sown in their infancy.

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  25. Loved this article! Wasn't too impressed with the trolls though. It seems to me that some women are harboring guilt for their choices and instead of embracing responsibility for those choices, prefer to aggressively attack those who choose differently, or in this case, advocate for a healthier alternative. If they were really comfortable with their choice to formula feed they wouldn't need to come onto this site and vomit their spiteful remarks. Just saying.

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  26. Thankyou so much for your time in posting this!
    Reading thro the comments, there will always be those who challenge breastfeeding mothers. I suspect somewhere at a deep level and they are possibly not aware of it, but there is a fraction of guilt; that they were not in posession of the facts of the miraculous properties of breastmilk etc.
    To say ' I was formula fed & I'm ok ' is a personal remark, indeed there are many who were formula fed & not alright! Why are we seeing a massive increase of cases of Crohns Disease in those born in the 70's???
    Thanks AA for your great articles xxx

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  27. QUOTE My point on your points at the top of this page was it appears rather bias towards breast feeding. So many pro breast groups jumped on this and turned it into another onesided amd usless debate.

    But I didn't start any debate, I just examined the research? Breast v bottle didn't (to me) even come into this as that was never the focus of the original paper? It's PURELY about solids for the breastfed baby (and as I said why aren't non breastfed included when we know they are at increased risk?)

    At the end of the day the researchers have declared a conflict of interest - which is of course relevant to ANY research. I'm not sure what you mean about biased towards breastfeeding, in which points?

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  28. just saying.....
    Please tell me how many children I have and how I have feed them? You are rather hasty with your comments "If they were really comfortable with their choice to formula feed they wouldn't need to come onto this site and vomit their spiteful remarks. Just saying." never given a child formula in my life and to be honest my personal choice is not to as I have everything i need to feed a child provided by nature. However I am not going to make someone feel guilty that they choose not to do the same as me, they are not a bad mother just because they choose to feed the child the product that suites them. the next best thing to mother natures finest.


    If you are refering to me please explain your "agressivly attack those who choose differently" comment. My point was exactly what you have said, women are being "agressivly attack those who choose differently" why should a view that ITS A CHOICE what to feed your child and no one should be attacked for that choice breast feeding or otherwise. I am sure if I was anti formula no one would be calling me mentally unstable nor a troll. I am not pro either way, if a mother chooses one over the other then they will have there reasons for doing so.

    I have not vomited any spitefull remarks, wuite the opposite, all the spite hurt and anger has been directed at me.

    Hardworker- How can you be so anti choice? pressuring a mother into doing something she is not comfortable, willing or maybe able to do is going to have an adverse affect on a mother. think of her mental well being. stressed, depressed and being forced to do something which in this day and age she does not have to do. Yes you many not like it and she may not like your choice but what gives you the right to judge her.

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  29. AA your 1st comment was about the researchers being involved with baby food companys, there is also a bit about them completeting reaserch into the wonders of breastfeeding. you didnt include it. so many pro BF people grasped this and automatically went for the bias "profit of baby food and formula companys".

    The breast v bottle comment was this- This report was in response to the WHO report into exclusive breast feeding. Yes attack the report for not including it but to be unbias the WHO report should also be granted a mention for failing to include formula feeding as an alternative. If the WHO report had mentioned Formula as an alternative for those unable to BF then this study would also have made comment on it. It was, for the side by side study unmentioned (like I said a flaw for both reports)
    Yes there is a conflict in interest but the nutrition experts are just that experts and can only be so by intensive reasearch into the product that they are trying to replicate. This report should have been kept under wraps as should the 6 months breast feeding report. Our grandmothers fed our mothers without the need for expert inturuption and we have been able to do it for many thousands of years so why is it now that governments and organisations seem to feel the need to stick there noses in.

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  30. Thank you for doing the hard work and frankly appraising this piece of "research". I was surprised at how much press this report received given that it is so obviously flawed. Mothers produce the best nutrition for their babies which changes from feed to feed and we have been successfully weaning our babies onto a wide variety of solid foods for an awful lot of years. If it wasn't efficient, we would probably have died out as a species by now.

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  31. Anon - formula/food companies always talk about the "wonders of breastfeeding", just like they talk about "breast is best" - that's marketing for you.

    ""This report should have been kept under wraps as should the 6 months breast feeding report. Our grandmothers fed our mothers without the need for expert inturuption and we have been able to do it for many thousands of years so why is it now that governments and organisations seem to feel the need to stick there noses in.""

    Because ill health as a result of suboptimal feeding practices costs the government (ala us)dearly?

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  32. lots of things do, lots of peoples personal choices for there life cost us money.

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  33. Absolutely and generally I think the govt (at least lip service wise) tries to give guidelines to encourage safe(r) choices - ie eat 5 a day, recommended amount of alcohol units, smoking cessation support, etc etc

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  34. "They found solids at 4-6 months instead of 6 months + reduced the risk of anaemia, low serum ferritin but not low hemoglobin"

    I am not sure how a baby can be at risk of or have anaemia but not have low haemoglobin. I thought having low haemoglobin *is* anaemia? I understand this to mean that exclusively bf babies that don't start have solids until 6+ months must have 'normal' serum ferritin and therefore all the other babies have elevated serum ferritin, something that is highly undesirable.

    What do you think?

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  35. Thanks for this article - it's great. I love to read more details about how research was funded, and specifics like numbers and actual quotes. This is great work!

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  36. Brilliant blog. Sickening how the media here are falling right into the hands of baby food/formula companies.

    Do you know in New Zealand the plunket service (the equivilent of HVs) are SPONSORED by a baby food company? And family there I have spoken to about BLW asked their plunket nurse about it and were told that it sounded dangerous and not to do it, to stick to purees? What is the world coming too? How long before we serve up babies prepackaged airplane baby meals because only a company (and the media) know what is best for babies?

    Arrrrrhhhh!

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  37. Really appreciated reading this post and getting some background on those involved in the study.

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  38. Just a little nugget of info. I have heard from a VERY reliable source that the ' baby food' companies often shift thro the social networking sights & the forums. They often pose as a parent whose baby ' is fine on formula' & give the ole spiel how BF didn't work for them etc and will create great waves! xx

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  39. Thank you very much for this post! I hope many people get to read this.

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  40. Brilliant break down of the article!! Puts my mind at ease as I was a little upset as currently breastfeeding my 24 week old son exclusively and the headlines made me feel I was damaging him by following the DOH guidelines.
    I feel much better now. Thank you!!

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  41. Roxy - this REALLY confused me too! But am not a doctor and don't know enough about anaemia to explain their comment. Anyone?

    Thanks everyone :)

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  42. Thank you for this. Am just starting to introduce solids to my breastfed baby girl who's 7 months. Am not rushing it, taking things very slowly. Your article is great, thank you.

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  43. I find any study like this highly dubious. Humanity has survived for nearly its entire existence upon breastfeeding not to mention the flaws pointed out by this article. None of us would be here if our ancestors hadn't breastfed.
    However, I wish people wouldn't take this as another excuse to bash the formula feeding Mummies. Making people feel like bad parents is not the way forward. Nor is it good for your soul.

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  44. Fantastic article once again. Thanks for converting a sensationalist and hyped media story into the actual, and unbiased facts. This story has received so much media coverage purely due to its contraversial nature. The media aren't interested in printing the true facts, rather they want to make money spurting out such controversial stories because they know what sells.
    I am a firm believer that it is what you feed your babies, and your whole approach to mealtimes that dictates how fussy they will be. my 2yr old was introduced to solids later than his older brother, just short of 6 months, but of the two he is the less fussy one. He has always shown preference for fruit and vegetables above other foods, and as a baby preferred the more colourful and appealing foods, broccoli, peas, carrots etc, rather than bland, white foods. Now he eats nearly everything, including curry and sometimes lettuce, and still fruit and veg are his favourite. Both my children eat well and I put this largely down to my persistance in eating together always, and leading by example.

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  45. Just a quick note, because this always irritates me: It is an unbiased fact that breastmilk is better for babies than formula. Stating this fact is not "violently forcing" formula-feeding moms to breastfeed any more than stating the fact that feeding your child fast-food every day is unhealthy is "violently forcing" moms to feed their children healthy foods. It is still a choice, but it is clearly not the best choice for your child and he/she has a chance of being worse-off for that choice. These are simple facts, not opinions. There are many good reasons out there for formula feeding rather than breastfeeding, and I am in no way trying to make those mothers feel guilty for doing what the had to do. But the fact still stands that breastfeeding, if you have the choice to do so, is the better option. Not making that choice is no reason to make someone feel guilty, and I definitely agree that rabid "breastfeeding nazis" are incredibly irritating, but choosing not to breastfeed JUST because someone yelled at you that you are "murdering your child" is rather like choosing to smoke cigarettes JUST because someone yelled at you that you are "killing yourself".

    Also, suggesting that scientific research should be kept under wraps because it is somehow insulting to you is ridiculous. I (and I'm sure many many others) would like to know what the consequences of their actions are, rather than go blindly into something with no idea what the potential effects could be. Mercury (and lead, and asbestos, and DDT, and... well you get the point) for many years were used in high amounts in a great number of things, until scientific research showed that they were highly poisonous. Should this research have been kept under wraps because "that's the way their grandmothers did things"? Obviously not. Our world would be much worse off if valid research were hidden from public view simply on the basis of tradition. Obviously formula-feeding a child is much less severe than mercury poisoning, but the point still stands.

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  46. Emu, I think formula feeding mummies know that and that is why they feel so defensive. Imagine if you couldn't breastfeed your baby no matter what you did and you wanted to? Wouldn't it break your heart? If you couldn't give the most precious thing in your world what she needed and to top it off you thought people might make judgements about you because of it? Not all formula feeding mummies are doing so because they are worried about their breasts becoming saggy, there are women out there for whom it wasn't possible or didn't happen for them because of lack of support or for medical reasons.
    The judgements made by Hardworker when she got into that argument above are typical of forums and just build up barriers between formula feeding mummies and breast feeding mummies. There is an awful lot of guilt involved with not being able to breastfeed, I think it's often the women who tried, sat there in the early days crying whilst they tried to feed their babies and then never got the satisfaction of doing it successfully that strike out at anything berating formula. It is surely an understandable response if the only other option is deep guilt that you can never get away from. All I'm trying to do here is make people understand why some are so defensive. Imagine if you COULDN"T breastfeed, not that it was just hard, but that actually, due to medical reasons, you couldn't breastfeed? It's not the fact that everyone knows breast is best that hurt it's peoples judgements that you are a selfish mother that really cut deep. And as for those who didn't have support or know where to turn when they were desperate, how will making them feel bad help anyone going forward, might it even put them off trying again with future babies? As women we should learn to be more understanding of each other instead of cutting each other down because situations in our lives took us in separate directions.
    I know this works the other way too and some Mums who formula feed argue a losing battle, taking things to a personal level. And that sometimes breastfeeding mums feel that they are backed into a corner and up against the world. People need to be more understanding of where each other are coming from, only then can will we break down these barriers and encourage more people to breastfeed and also that if it didn't work the first time it doesn't mean it won't in the future.

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  47. Good analysis. Looking at the various evidence it could seem wise advice, exclusive breastfeeding for 6 months, especially to really reduce, as it has done, introduction of solid foods before 4 months.

    A couple of issues, not with you but with some of the sources:
    UNICEF say "Health experts agree that around six months is the best age for introducing solids..." and "some foods that should be avoided as they may cause allergies...including gluten"

    1. which experts? do they all agree? ESPGHAN (European Society for Pediatric Gastroenterology, Hepatology, and Nutrition) would be a collection of experts I assume. They advise:

    "It is prudent to avoid both early (<4 months) and late (>or=7 months) introduction of gluten, and to introduce gluten gradually while the infant is still breast-fed, inasmuch as this may reduce the risk of celiac disease, type 1 diabetes mellitus, and wheat allergy"

    The evidence for this may not be bullet proof, but there is evidence. I don't know where UNICEF get the evidence to say that gluten should NOT be introduced until after 6 months because it can cause allergy

    I think the evidence points towards the ESPGHAN being valid for a subset of babies - those genetically at risk (not necessarily high risk as mistakenly mentioned in the quoted sources) - this is expanded upon more at http://bit.ly/gDDCs0

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  48. Fab,Fab,Fab read, I could bearly listen to the news the other day, new mothers have a hard enough time as it is with hearing conflicting information and "advice" from various sources, it goes to show the influence these big baby food companies have. I'm sure on Wednesday at the support group I help run this will be topic of conversation and new mummies will want some clarification on thisnews report, so thank you for this blog I will direct them all to it.

    Big thanks

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  49. QUOTE I think it's often the women who tried, sat there in the early days crying whilst they tried to feed their babies and then never got the satisfaction of doing it successfully that strike out at anything berating formula.

    I absolutely agree with you - mums who are ambivalent generally respond in an each to their own way.

    I also think mums judge themselves far more harshly than anyone else could (I know I beat myself up about perceived failiures far more than anyone else would!) and it's a huge shame the barrier between breast and bottle exists. Often mums that are most passionate about breastfeeding are the ones who did the crying/struggling and are now fighting for better support for others. Anyone who understands even the very basics of breastfeeding and society understands there are many influences that impact in all different ways.

    Pregnancy, birth and breastfeeding are all intricately linked and so many practices routinely undertaken by hospitals hinder and ultimately remove the infant's natural instincts and reflexes. Mums are starting off on the back foot, followed up by often poor support - then left feeling bad because they have been told for 9 months to breastfeed!

    This article might be of interest:
    http://www.analyticalarmadillo.co.uk/2010/07/formula-feeding-mums-start-shouting.html

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  50. Please fight to get this article into the national press!!!! Some of the headlines associated with this article have been sp irresponsible and, unfortunately, the headline is as far as many readers will have got. ALthough there are many interesting and valid points in the original article, the healdines and news stories do not reflect the true content. In addition, this article shows that many of the valid-seeming points are, in fact, scientifically unsupportable. I'm amazed that an article of this standard have been published and given the respect that it has generated.

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  51. Can i just say in my little to no time on the computer i had to send you a big virtual hug for posting this. You are awesome!!! This was the 1st time i visited your blog after i got sent this link from a friend. You have gained a new follower for sure!

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  52. I cannot thank you enough for posting this wonderful article. Am sharing as much as I can!!

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  53. @anon who posted on 15th of jan at 16.54 (there are so many anon people it´s hard to know who is who!), you said:
    "So many pro breast groups jumped on this and turned it into another onesided amd usless debate."
    It was not the paper published on the BMJ (which doesn´t actually tell us much of interest as far as I´m aware) that people got worked up about. It was about how the media reported it (why did they bother with it in the first place? who told them about it, I wonder?) but saying that exclusive breastfeeding a baby for 6 months could cause them harm amongst other things. That is what caused all pro breastfeeding groups to jump on this as you put it.

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  54. "It's not the fact that everyone knows breast is best that hurt it's peoples judgements that you are a selfish mother that really cut deep. And as for those who didn't have support or know where to turn when they were desperate, how will making them feel bad help anyone going forward, might it even put them off trying again with future babies? As women we should learn to be more understanding of each other instead of cutting each other down because situations in our lives took us in separate directions."

    I completely agree. That's why I said specifically that "there are many good reasons out there for formula feeding rather than breastfeeding, and I am in no way trying to make those mothers feel guilty for doing what they had to do" and that "not making [the choice to breastfeed] is no reason to make someone feel guilty." I hate when pro-breastfeeding mommies try to make formula-feeding moms feel guilty over something they actually HAD to do to keep their baby alive. The ones who actually have a choice and choose to formula feed because of unfounded fears over breast changes or something, I don't feel AS bad for, but I still think nobody should be judging anybody, especially not directly to their face. It's like somebody choosing not to exercise: it's their choice. It may not be the absolute best choice but nobody has the right to berate them for it. I hate that it's become such a black-and-white issue for so many. Either you're a rabid breastfeeding nazi or you're a lazy formula feeding baby-killer. There really needs to be a lot more middle ground where things can be discussed rationally by both sides (or simply dropped completely, since there really is no way to come up with an agreement considering it really is a personal choice).

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  55. Yes Keith - I think it's interesting that the research quoted in this paper re solids was for high risk infants, yet the implication was for all.
    I also personally think we need to see studies that clearly split exclusively feeding infants and formula fed, and furthermore that also establish mums allergy status and or examine breastmilk content. Mums who aren't aware of the signs of food intolerances may consume the trigger. This as I'm sure you know is linked with leaky gut and the passage of proteins into breastmilk (which is why some infants can show intolerances to foods through breastmilk, most often dairy and wheat) therefore potentially some infants could be exposed to the allergen well before the introduction of food? which presumably would impact on the reserach?

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  56. BIG thank you to everyone for all the lovely comments too - much appreciated :)
    AA

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  57. Thank you for posting this.

    I do have a question--what does "wean" mean in the context of the articles and comments? Reading it in context, I'm intepreting it as "starting solids", is that right?

    One big problem I have with the article and news headlines is that here in America, I have only ever heard the term "wean" used as a reference to being *off the breast completely*. If you wean, you stop breastfeeding. If you wean from the bottle, you get rid of the bottle. IOW, all this stuff advocating "weaning" might mean to some just starting solids, but to others it's going to come across as *stop breastfeeding completely*. Of course, what are you going to "wean" a 4 month old to? They can't be exclusively on solids, so women who misunderstand this simple issue with British vs. American English may think that continuing to breastfeed is in and of itself a "danger" to their baby. :(

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  58. In the UK people use the term weaning with the of meaning starting solids. The journalists that wrote the articles in the press are English so that is why they used that term.
    Technically, weaning means stop the breast/bottle gradually and we should really say start solids if you mean that. Sorry this sounds like a riddle but I hope you know what I mean.

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  59. It's a shame that this forum about an important topic- to do with when best to introduce your child to solids- has turned into a battleground on both sides about formula v breastfeeding. It's important for all us mums to be clearly given the facts and the appropriate guidlines, on when to feed our children no matter which form of milk they are receiving. This should be based on strong evidence based research.

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  60. Thank you so much for doing this. xxxPeacexxx

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  61. I emailed the BMJ to ask them to try and clarify the facts with the press given how this has been taken as 'advice' by the public and even some health professionals. This is their reply to me today:

    Many thanks for your email. We too have been surprised by the misrepresentation of the article in the press. I have looked back at the press release and can confirm that it was very measured and accurate in the way it summarised the paper. I will discuss with colleagues what we might do to address this, though I fear that the press's record on correcting misapprehensions they have created is not good. I wonder if a message on Mumsnet wouldn't be the best way to go. I will talk to friends and colleagues who are active on mumsnet. In the meantime, please do send a response to the article on bmj.com, and do consider writing to the press yourself. On a lighter note, it is unusual for a BMJ article to be so instantly picked up by practitioners in the field! All best wishes, Fiona

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  62. I recently came across your blog and have been reading along. I thought I would leave my first comment. I don't know what to say except that I have enjoyed reading your post and read the comments. Really a nice post here!





    knowledge closet

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  63. I read in this blog archive so nice or interesting many thanks for your email. We too have been surprised by the misrepresentation of the article in the press. I completely agree. That's why I said specifically that "there are many good reasons out there for formula feeding rather than breastfeeding,I like this lovely or informative blog.

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  64. I was particularly interested in this article being Celiac myself, and having an EBF 25 week old son. I am a nervous wreck trying to figure out when is best, if ever, to introduce gluten into his diet. I became rather excited to see what the article recommended but have to say, I am more confused than ever! I guess I just have to trust that breast milk, and delayed introduction of any solids will be enough! Thanks for sharing.

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  65. my 4 started to have 'tastes' around 4mths. I didn't go off health advice or standard practice, I went off the babies queues. Happy to report that none have allergies, speech difficulties or are in any way developmentally disadvantaged. Also never use rice cereal either.

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