Toxic Breastmilk?

"'Cocktail of chemicals' found in UK mothers' breast milk due to home furnishings" 

The Telegraph

Household chemicals blamed as UK mothers have highest levels of toxins in breast milk

Daily Express

And yet again I wondered who really funds these clickbait headlines.

The paper that provoked such a media response is an environmental audit called "Toxic Chemicals in Everyday Life".  It explores the toxic contamination of our environment, the impact to wildlife, the food chain and society as a whole - with a particular focus on the aftermath of the Grenfell Tower fire. It discusses the levels of toxin exposure we face and how these can affect our health.

They note that toxins from fire-retardant sprays for home furnishing are at significant and worrying levels in everything they tested - from newborn cord blood to the urine of adults.

What's truly bizarre is that the media ran with the breastmilk angle - which is only noted briefly in one of the subsections, and frankly is a drop in the ocean in terms of the level of the problem.

The relevant section reads:

"44. Flame retardants have been detected in air, soil, water, food, wildlife and humans. They are present in homes and offices via dust and on surfaces including windows, floors and carpets.151 Exposure occurs when additive flame retardants leach from goods into the air, dust and surfaces.

So in short, flame retardants (PBDEs) have contaminated everything from the air in your home, to the soil your food is grown in. Oh and the formula you have to use if you don't breastfeed.

"152 Breast Cancer UK suggests the US and UK have the highest levels of flame retardants in human body fluids."

I dug out the Breast Cancer UK briefing which states:

"In general, the USA and the UK have the highest recorded levels of flame retardants in human body fluids (36). The highest concentrations of legacy PBDEs in mothers’ milk have been detected in American women, and the second highest levels in those from the UK (37). Elevated levels of PBDEs have also been found in human blood serum in Californian children at 5 times the US average, and 10-100 times the European and Mexican average"

Oh, so hang on Daily Express - UK mothers don't have the highest levels, Americans do. 

Reference 36 is a 2008 study exploring the US population - it highlights that there are significant differences recorded depending on area and age.

Reference 37 is a 2009 review with particular focus on external exposure routes (e.g. dust, diet, and air) and the resulting internal exposure to PBDEs (e.g. breast milk and blood).

So let's pause a moment to consider that yesterday's headlines were in fact based on a TEN YEAR OLD study...

They note that fats contain higher levels of contaminants presenting an important exposure pathway for humans. This includes foods like fish, dairy products and breastmilk,

They state blood serum levels are 10 times higher in the US in their study than in Europe.  Yet they  couldn't find ten times the difference in the food chain.

But do you know where they did?

Dust

"The ingestion of dust conveys the highest intake of BDE-209 of all sources, possibly also of other PBDE congeners. The PBDE exposure through dust is significant for toddlers who ingest more dust than adults.
Indoor air and dust concentrations have been found to be approximately one order of magnitude higher in North America than in Europe, possibly a result of different fire safety standards."

To compare breastmilk, researchers searched for recorded data from different countries. We're not really comparing like for like, since not all data compared is from the same time period, nor using the same techniques or sample sizes. In the context of contaminants this is a significant flaw, because even within the same area, research highlights massive variations from sample to sample based on their immediate surroundings; some data pooled was samples from 10 people, some from 100, we have no idea what the ages of the sampled were (as the previous study highlights, the older we are - the higher our toxin level).

Everything tested recorded higher in the UK than other parts of Europe, in the one data sample we provided - blood serum, dust etc.

Peeing your pants about breastmilk, is like realising the entire second floor house is on fire, about to burn to the ground - and you make a public announcement your ashtray downstairs in the basement has just caught alight, distracting everyone from the actual imminent disaster.

What the media also fail to recognise - is that by scaremongering against breastmilk, not only will infants continue to be exposed (via the placenta, maternal blood flow, infant formula, the air they breathe and so on), but parents may wrongly believe it to be beneficial to their infant to not receive breastmilk.

In fact - this is like swapping the water you were pouring on the fire to cooking oil.

Exposure to environmental chemicals has been linked to dysregulation of the immune and reproductive system, diseases like cancer - and are known to alter the gut bacteria (microbiome).

Numerous studies have demonstrated that breastmilk is significant in terms of the developing microbiome, contains factors that assist regulation of the immune system and in short, assist the body in dealing with the effects of exposure (1-8).

It's time some media sources started sorting fact from fiction, before they write their headlines.

1. Pannaraj PS, Li F, Cerini C, et al. Association Between Breast Milk Bacterial Communities and Establishment and Development of the Infant Gut Microbiome. JAMA Pediatr. 2017;171(7):647–654. doi:10.1001/jamapediatrics.2017.0378
2. Van den Elsen LWJ, Garssen J, Burcelin R, Verhasselt V. Shaping the Gut Microbiota by Breastfeeding: The Gateway to Allergy Prevention?. Front Pediatr. 2019;7:47. Published 2019 Feb 27. doi:10.3389/fped.2019.00047
3. Alba Boix-Amorós, Fernando Puente-Sánchez, Elloise du Toit, Kaisa M. Linderborg, Yumei Zhang, Baoru Yang, Seppo Salminen, Erika Isolauri, Javier Tamames, Alex Mira, Maria Carmen Collado. Mycobiome profiles in breast milk from healthy women depend on mode of delivery, geographic location and interaction with bacteria. Applied and Environmental Microbiology, 2019; DOI: 10.1128/AE
4. Cacho NT, Lawrence RM. Innate Immunity and Breast Milk. Front Immunol. 2017;8:584. Published 2017 May 29. doi:10.3389/fimmu.2017.00584
5. Hsu PS, Nanan R. Does Breast Milk Nurture T Lymphocytes in Their Cradle?. Front Pediatr. 2018;6:268. Published 2018 Sep 27. doi:10.3389/fped.2018.00268
6. Laura M'Rabet, Arjen Paul Vos, Günther Boehm, Johan Garssen, Breast-Feeding and Its Role in Early Development of the Immune System in Infants: Consequences for Health Later in Life, The Journal of Nutrition, Volume 138, Issue 9, September 2008, Pages 1782S–1790S, https://doi.org/10.1093/jn/138.9.1782S
7. Molès, J‐P, Tuaillon, E, Kankasa, C, et al. Breastmilk cell trafficking induces microchimerism‐mediated immune system maturation in the infant. Pediatr Allergy Immunol. 2018; 29: 133– 143. https://doi.org/10.1111/pai.12841
8. Babak Baban, Aneeq Malik, Jatinder Bhatia, Jack C. Yu. Presence and Profile of Innate Lymphoid Cells in Human Breast Milk. JAMA Pediatrics, 2018; DOI: 10.1001/jamapediatrics.2018.0148

Breast may not be best to prevent allergies

Or so the headlines have told us this week.

The Daily Mail went with:

"Breastfeeding may not help cut allergies in children after all: Study shows bottle-fed babies are equally resistant to host of common conditions"

The Telegraph went for a slightly more emotive slant:

"Is this proof the witches of breast milk are wrong after all?
A new study shows breast may not be best in terms of preventing allergies. Anna White, mum of twins, rejoices.".

Anna appears to be developing a theme (or lacking imagination), as her 2013 piece carried the title: "The witches of breast milk need to back off".

Personally I think Anna might be "rejoicing" a tad too early.


The tiny study of 200, was presented at a conference and so as of yet I haven't managed to obtain a copy. Thanks to the Daily Mail however, I don't need to.

If you read their entire article via "don't link"  it states:

‘This study did not take into consideration whether babies were exclusively breast fed or supplemented with formula."

OK.

So as a comparison, let's pretend we want to explore whether salad or pizza are healthiest.  One group eats

Peppers count as salad, right?

pizza only, the other can choose either salad or pizza at each meal, or they can  have one mouthful of salad per day and the rest of the time eat pizza, or any other combination they choose.  They might even only eat salad every few days, but as long as they're eating some - they qualify for the salad group.

If I then gave you that study and said see, whether you eat salad or pizza makes no difference - would you rejoice? More likely you would simply laugh.

Even if we pretend it's true - there is no suggestion formula proffers protection; at best  it's stating formula might not cause harm.  I think Anna understands this, as the only other logical conclusion otherwise is she's "rejoicing" because she's glad babies who were breastfed aren't "protected" either?

The truth is this conference bulletin, that we have no context for (either in terms of the rest of the presentation or indeed funding,) tells us absolutely nothing.  It certainly isn't "proof" of anything other than bad science.

The "auto-bots at La Leche league", as Anna calls them - or the "fabulous mothers who have often struggled themselves, so now volunteer to give their time they could spend with their own family in order to help others to the the tune of thousands of calls per year", as I prefer to refer to them as, won't need to update their training manual just yet.

Sorry Anna.

The NHS lacks compassion when it comes to breastfeeding...

Is the headline in the Daily Telegraph today.

Sally Peck talks us through her experience trying to breastfeed her tongue tied baby.  It seems that despite early diagnosis of the problem, Sally ended up waiting four weeks for treatment.  Furthermore even though her baby was struggling to breastfeed, she was told not to supplement formula as this would lead to further problems.

Sally explains:

"NHS guidelines require a new baby to be under observation for at least a week before the tongue tie is dealt with - though no one told me this until my son was nearly a week old, despite the fact that many midwives in hospital and three excellent community midwives saw him and confirmed the initial tongue tie diagnosis."

This is all despite the fact there were very clear signs both mum and baby were struggling:

"We therefore spent two weeks with a very hungry baby, who lost 13 percent of his already modest (for his size) birth weight, and a mother with very sore nipples."

Sally comments her husband asked whether the baby should be supplemented formula but:

"The universal response from the NHS workers was NO! Substituting formula would confuse him, it wasn't necessary, it would deter him from latching on once the tongue was separated, and it would confuse my breasts in terms of how much milk they ought to produce."

Her beef (quite rightly) is what should we do, let babies starve?  The NHS shouldn't be so down on formula if the baby is hungry and can't feed well; and look here's some evidence showing early formula helps extend breastfeeding duration!

Well quite, in a system as FUBAR as Sally describes, I'm totally with the theory that some supplementation may actually improve breastfeeding rates overall!  If the alternative is having a distressed, clearly hungry baby  who is losing or unable to gain adequate weight (for a month!) of course many mothers will opt to stop breastfeeding if supplementation is shunned.

That's without taking into consideration that a baby intaking significantly less calories than they need, becomes even less effective at feeding which may further deplete mum's morale, raise her anxiety levels and pose significant health risks.

Throw some pain into the mix and it can quickly turn what is already an emotionally intense time into a severe cause of stress (which coincidentally further hinders breastfeeding by reducing the amount of milk released with mum's milk ejection or "letdown").

But surely, ultimately the problem is the FUBAR system, not the sticking plaster that is formula?

If nobody will treat the cause of baby's feeding issues, nor help the mum in what could be any number of ways to increase the amount of breastmilk her baby is receiving, how on earth can we then tell them they shouldn't use formula either?

Since when do we have to wait a week to treat a tongue tie?  Which NHS trust decided this?  It's not on the NHS page here, nor is in the NICE guidelines which state:

"If the condition is causing problems with feeding, conservative treatment includes breastfeeding advice and counselling, massaging the frenulum, and exercising the tongue*. Some practitioners, however, believe that if a baby with tongue-tie has difficulty breastfeeding, surgical division of the lingual frenulum should be carried out as early as possible. This may enable the mother to continue breastfeeding rather than having to switch to artificial feeding."

* I have never been able to find any evidence that massaging or exercising the tongue carries any benefit.  I contacted NICE who said it had been information a consultant provided at the time of drafting guidelines, but they couldn't provide me with any evidence base.

Frenulotomy, the term for treatment of tongue tie is a minor procedure (so much so our local ENT doesn't even take the baby out of their baby carrier!).    The risks are small, infection rate is minimal (estimated around 1 in 10,000) yet the risks of formula include potentially sensitising baby to a cow's milk allergy and changing the gut flora, the effects of which may be far wider reaching.

If for some reason this isn't possible, helping mum optimise attachment, showing her how to massage her breasts to help her baby receive as much colostrum/milk as possible should come next.

If baby is still shows signs of insufficient intake, showing mum how to hand express is the next option.  We run into a problem here however as some midwives don't know how to effectively hand express, so they give a mum expressing drops of a colostrum a huge hospital grade pump; epic fail (as my youngest would say!).

If baby still needs more, where is the NHS supply of donor milk?  If they're not prepared to rectify the cause of the feeding problems, surely an alternative from the same species should be on offer?

If not, it appears to me the only option is formula?  It was once said to me years ago that the first rule always has to be "feed the baby".  Yep there are risks to formula, but then again losing 13% of your body weight is hardly risk free.

Mums reaching breaking point and throwing in the towel totally because it's painful and their baby is constantly unsettled and wanting to be at the breast 24/7 - dreading each feed, putting off holding her baby incase he wants to feed, struggling to bond, isn't risk free.

How do we quantify all these risks?

I'm not sure how formula would "confuse the baby", very hungry babies don't organise and latch on too well either!  As for the claims it would impact on mum's supply, perhaps if someone was helping her drain them sufficiently and use that for the supplement, we wouldn't be having the debate!  Before mum's milk comes in, the process is hormone driven.  Once it has, showing her how to drain her breasts well will protect her supply.

Here is a bit of a news flash, but a baby who is effectively starving, isn't transferring milk well - whether mum gives the baby another milk or not is a moot point, her breasts are not getting the milk removed and thus supply may suffer! (I say may as constant removal of small amounts of milk seems to trigger an over supply in some mothers.)

The NHS do need to up their game, but on a much bigger scale than simply advocating formula use.

For UK independent in person breastfeeding support please visit my site: www.milkmatters.org.uk

Anna White @ The Telegraph Spectacularly Misses The Point

Yesterday I thought the Editors at The Telegraph must have been sniffing Tippex when this piece appeared from Anna Burbridge, a breastfeeding volunteer.  It discusses how terms such as "Nazi" and "Breastapo" don't belong in a conversation about breastfeeders.  How nice I thought,  to see a piece offering an alternative view after that appalling article by Anna White.

Yet today they've let Anna White loose again, in a reply to Anna Burbidge.  Sigh #headdesk!

Of course there is no mention made of the crux of the argument, the fact a group of people are being stereotyped with insulting derogatory labels.

Just imagine mainstream papers referring to those who support male gay rights as "Bum Nazis", or those who support healthy eating and anti obesity as the "Fatapo".  It would never happen, there would be outrage.

Do we see the media referring to those not breastfeeding as "Formula Feeding Fascists"?  Noooo that would offend too many of their readers!

Remember the drama when Jade Goody in Big Brother (many years ago now) referred to Shilpa Shetty as "Shilpa Poppadom"? Tony Blair and Gordon Brown ended up involved in debate with the Indian Minister for External Affairs, who pointed out any kind of racism was unacceptable in any civilised society.

Quite right!

So will someone please explain why "civilised society" doesn't find discrimination based on sexual preference, gender, skin colour or culture acceptable, yet considers mothers who choose to feed their baby milk of the same species, and who ultimately ARE a minority as fair game?  We've even had a widely reputed TV doctor publicly referring to the "breastapo".

Anna didn't apologise for her terminology, instead attempting to justify it with further passive aggressive insults; anyone else wish she's drop her suitcase off before she sits at the keyboard?

I think aiming for impact at the expense of accuracy, is an interesting opening:

"The experienced lactation counsellor is leading a backlash against the breastfeeding backlash"

Is she?  did we read the same article?  I thought Anna Burbidge was leading a blacklash against the offensive names Anna called breastfeeding supporters, and tried to emphasise that she doesn't act in the way implied.

Anna says:

"Here’s about the size of it: a growing number of academics are questioning the presumed-to-be empirical evidence promoting the health benefits of giving babies the boob."

Well yes I guess technically it's a "growing number", from zero to one with Ms Joan Wolf.  I guess technically she's an academic, although whether a "women’s studies assistant professor" is qualified to examine medical research and make any earth shattering claims is another question altogether.  Even the formula manufacturers gave up trying to convince folks of that one and altered their marketing techniques.

"Concurrently mums are reacting to the pressure placed upon them by a faction of the post-natal community to breastfeed regardless of the impact on their wellbeing and therefore the wellbeing of their new born babies."

Who and where are these people that Anna claims are "pressuring mothers to breastfeed regardless of the impact on mum's wellbeing" exactly?  Many hospitals still don't even employ a qualified Lactation Consultant and only 4% of mothers in the UK are left exclusively breastfeeding by six months.

Anna Burbidge also clearly stated in her article that pressurising wasn't her bag anyway, so what relevance does it even have to her piece?

The trouble is, tell a mother X is best for her baby and the vast majority want it.  Tell them the alternative is not as good, and the pressure mothers place on themselves is greater than that anyone else could apply.  So it seems to me, we either stop paying lip service to breastfeeding and start providing the mums who want to do so with decent help, or we (as I suspect Anna would prefer) pretend the alternatives are nearly as good so nobody feels bad.

Because that's the reality.  Mention that not breastfeeding increases the risks of gastroenteritis (something even Wolf acknowledges), and I guarantee at least one of the replies will be along the lines of "way to go, making us that couldn't do it feel bad".

After a few more personal digs Anna continues:

"This isn't a personal attack against breastfeeding volunteers - they play an invaluable role within society, but widespread denial that there are health professionals who lurk within our natal system bullying vulnerable new mums, is dangerous."

Oh right, it walks like a duck and quacks like a duck, but it isn't one!  I see.  I think Anna is also in denial that there aren't health professionals lurking within our system, bullying vulnerable new mums to bottle feed. And from 9 years experience, I can tell you there are far more doctors and paediatricians doing this than pushing the breast.  Where are the articles complaining about this and did Wolf examine this side too?

Many mums I see have been told by their midwife or health visitor they must supplement with formula because their baby isn't gaining weight "as expected".  Nobody has assessed a full feed, or established why;  who needs to do that when we can tell mums that they're clearly just breastfeeding for themselves, it's time to move on - and with our wonder substitute we can see exactly how much baby is drinking!  Sometimes the parents are helpfully told if the baby hasn't gained at the next weigh in, then she will insist formula must be given; whilst giving them absolutely no support of how to try and maximise baby's gain in the meantime.

More still are told to perhaps "try a bottle" with their fussy baby, maybe the colic or wind would be less with a "comfort milk"?  Give a bottle so you can get a break from the realities of being a new mum.  Hell there is a whole book dedicated to the ways mums are pushed to bottle feed, perhaps someone could pop Anna White a copy in the post?

Anna clearly has got herself rather riled at this point as she spits:

"Recently one mother commented to me that she had breastfed her twins for 28 months. Firstly, get a life. And secondly that's the kind of smug, self-righteous attitude that fuels self-loathing and a sense of failure in other mums. What's wrong with this woman? Was she always picked last in PE? Becoming an Olympic breastfeeder does not compensate for other flaws and fundamentally it doesn't make you a better parent."

Get a life?   A mum breastfed her children for four months longer than the minimum recommended by WHO and she should "get a life".  How insulting to suggest mothers cannot "have a life" and breastfeed.  Sounds like something my friend's teenage son can be heard chuntering, rather than a supposedly mature mother of twins!

Secondly, I'm still trying to work out how telling someone the length of time you breastfed, can possibly fuel "self loathing and a sense of failure" in someone else.  I mean if this mother had told Anna that formula was crap, that her children had only received breastmilk and she wouldn't consider giving them something so processed; I could see Anna's point.  But if someone simply stating the number of months they fed evokes such powerful feelings of guilt and self loathing, perhaps the pertinent question is why?

Where is the cut off in terms of how long one can feed before making others feel self loathing failures?  Twelve months?  Six?  Six weeks?  Six days?  Where is the tipping point one must not state they have breastfed beyond?

I can't decide if Anna is asking "what's wrong with the woman?" because she breastfed for 28 months, or because she dared to tell Anna!  Who (apart from Anna) suggested breastfeeding compensates for other flaws, or that it made someone a better person?  That bag of Anna's must really be making her shoulders ache now!

Anna then moves on to a SCBU comment she overheard, a nurse telling a mother:

"I realise you are determined to breastfeed but you have a very small baby who needs to learn how to eat quickly. You may need to think about him not you and introduce a bottle soon." The mother refused.

Whoop Whoop!  Hurrah for the mother in question for recognising bullshit on a plate!  Bottle feeding is more stressful for preemies, with studies showing they experience more dips in oxygen saturation.  Best practice is not to introduce artificial teats if you are trying to establish breastfeeding, full information here.  The mother was thinking about her son, how utterly ignorant of the SCBU nurse to say she was being selfish!  Of course this horrendous lack of support is perceived by someone with no training as "tailoring advice to suit each case", the reasonable middle ground.

Then again SCBU units in the UK are hardly setting the world alight with their use of evidence based medicine, hence why we're still separating mothers and babies and making establishing feeding a hundred times harder.

I think the only point Anna and I do agree on is:

"We need more information and earlier, about formula feeding, what may prevent breast feeding, and how emotionally to cope if unable to breastfeed."

Not least because that might save our brains from the constant supply of emotionally fuelled articles such as this in our newspapers...

Daily Telegraph - Stop You're Killing Us!

And not so much softly as with a brutal thwack.  My eyes are bleeding this week after seeing not one, but two lots of dire material hitting the Daily Telegraph. It's beyond painful reading, so much so I briefly pondered whether perhaps flu had rendered any of their journalists who are able to string a half decent story together incapable; or if perhaps some morale boosting team bonding jaunt had left the offices empty?  I hear you can get good deals on a twin room at this time of year...

But Anna White's offerings are cringe worthy, even for the Telegraph.  Think car crash.

Her first offering entitled "The witches of breast milk need to back off" (seriously, hello Mr Editor!)

Let's forget content for a moment and pretend the piece isn't an excuse for someone to unload their personal baggage in print, the article is messier than leaving your 2 year old unsupervised with a tub of Sudocrem!  Perhaps Anna needs to debrief her own experiences before she can rationally and coherently attempt eloquence when covering infant feeding?

To be honest, I'd rather forget the content for more than a moment; permanent deletion "Men in Black" style would be better.  I found it uncomfortable reading, as Anna's emotionally charged attack picked out midwives, health visitors and nurses as "witches".  One Facebook reader suggested the piece needed an Armadillo style re-write, but to be honest I just didn't have the heart.

When I read the piece, I see a mother who tried to breastfeed and like so many was failed.  Who writes about a Health Visitor waving a magic wand and lifting the guilt fog, whilst not recognising the guilt dripping from her own words.  Who clings to the "potential fairy tale" that Joan Wolf might just be right, and that formula is absolutely nearly as good as breastmilk.  Surely anyone who loves their baby and didn't succeed would feel the same?

Only someone emotive about infant feeding writes an article as provocative as this, resorting to playground name calling and not so thinly veiled insults.  Those who work with mothers who haven't breastfed for as long as they planned,or who have been that mother, know that feelings often remain long after the relief of being told it's fine to formula feed has passed.

Her next article however "Is baby-led-weaning a load of mush?", takes terrible journalism to a whole new level.  One can't actually use this piece to weigh up the pros and cons of introducing solids this way, because Anna clearly has done absolutely no research into either the concept or how it's done.

Anna says:

"Picture this family scene...mid-afternoon Mum tweets tonight's set menu, offering her kids a choice of main course and pudding. A reply pops up on Facebook "Cottage pie please Mum but make that with lamb not beef, drop the carrots, and I'll have the gravy on the side." As ridiculous as that sounds is it but 10 years down the line from a six-month-old selecting tea from a platter of finely chopped foods. From the child's earliest culinary memory he is dictating the dish du jour."

"Baby-led-weaning means letting your little one choose food themselves - a term coined by former health visitor and mid-wife Gill Rapley." 

That's right Anna, every meal time mothers everywhere gather their child up, take them to the fridge and let the babies self select.  The youngest know to point and grunt at desired items, whilst the older ones competently sign the exact ingredients required for a three course meal.  Honest.

"From his throne-like high chair oh bibbed-one chooses his food, reaches for it and feeds himself."

His throne like high chair?  (has Anna been snooping on the Beckhams I wonder?).  The irony in implying there is something "precious" about a child reaching for, and feeding himself (as apposed to his mother mushing it to save him chewing, then popping it in his mouth to save him feeding himself too) clearly lost on this writer.

Apparently mums are divided on the issue, which is interesting as whilst I read lots from people who have done one thing or another; it's hardly the stuff of explosive discussions.  As Gill Rapley herself points out, long before she coined the phrase "Baby Led Weaning", mothers had for centuries been introducing solids this way.

A rather flaky "against" argument develops:

"On one side of the table: what if your child, who has no concept of solids or how they taste, doesn't like any of the components of your evening meal? Forget the hassle of purée, you now have the faff of preparing dinner for two and a finger food buffet for one - a toddler tasting menu."

I think I actually snorted my coffee at this paragraph.  If the child has no concept or solids or how they taste, how can they at that point dislike anything?  They can't until it's offered.  Then they may (believe it or not)  dislike whatever puree is offered, just as they may dislike your meal.  Does Anna keep a selection of "absolutely zero effort" purees on hand?

Because here's the thing Anna, pureed baby food doesn't magically appear when you turn the blender on.  Nope, you have to spend time lovingly creating a meal, squishing it up and then dividing into weeny portions to freeze.  If he doesn't like it?  You have the hassle of making more.  If he throws it across the kitchen several nights in a row, let's see how quick you're claiming self feeding infants are "dictating the dish du jour".

Again the irony seems to woosh right over Anna's head.

When babies are starting solids at their own pace, the answer to what if they don't like dinner is: "So what?". Nutritionally babies don't need to eat every time food is on offer, milk is their main form of nutrition in the first year.  Solid foods are initially for taste and texture.  If they don't like dinner, perhaps they will like breakfast, or lunch; or perhaps they will (if not truly ready) wipe it about the table, gnaw the edge before abandoning it down the side of their seat.  If it's something you were making anyway it's no big deal.

Anna ploughs on regardless.

"There is something rather medieval (and messy) about a feeding style where the little critic lobs rejected courses over his shoulder. This early selection process gives children the freedom to turn their noses up at food making it difficult to later on enforce such rules as no greens, no pudding. Staple values end up in the bin once you hand over control on a plate."

Firstly, are we seriously suggesting puree weaned babies don't turn their noses up at foods?  Don't clamp their mouth shut and twist their little heads fiercely side to side?  Don't manage to grab the dish and tip it on their heads?  I have photo evidence proving otherwise!

Food is a fantastic sensory experience for babies, think of all the smells, tastes, textures.  How much pressure before something squishes or slides out of your hand?  As Gill herself says, parents spend a fortune on sensory toys - whilst the best toy of all is right their under their noses.

To have a parent controlling the food, the spoon and what's on it deprives them of this experience.  It also makes it easy to overeat which can lead to constipation.

"But for mums who are more budget eatery than fine dining there is limited time and money to provide a tapas style supper, much of which may end up on the wall."

A tapas style supper?  Did Anna actually even Google Baby Led Weaning before attempting this article?  I don't understand how serving up an extra portion of your meal is "tapas style", well unless of course you're having tapas anyway!  How does a meal cost any more served whole rather than blending?

"Diet-related anxiety on the part of the parent, albeit their own intake or that of the child, can allow the toddler to use food as emotional blackmail."

I absolutely agree anxiety around eating should be avoided.  Mothers who used baby-led weaning were found to be less anxious about feeding and less controlling than “spoon-feeding” mothers.(1)

As for emotional blackmail, I think the thing is that a healthy appetite isn't the only thing that can be shaped by a parent's attitude.  Perhaps reconsidering strategies like "no greens, no puddings", might help.

Anna concludes:

"My four-month-old twin girl is already a particular feeder - the type of teat, temperature and position can determine how much milk she deems to drink, and as a premature baby it's a volume game. Allowing her breaks, remaining calm and playing while feeding, works for us."

Which despite all Anna's comments above sounds like responsive parenting.  To the trained ear I suspect whatever makes her daughter fussy with the bottle, is likely the root cause of their breastfeeding problems too.

"So when it comes to serving up the solids to twins with potentially differing tastes I intend to practice the technique, you'll get what you're given, in the hope it limits mealtime chaos."

Excellent, Baby Led Weaning all the way then Anna?

1.  Brown A, Lee M. An exploration of experiences of mothers following a baby-led weaning style: developmental readiness for complementary foods. Matern Child Nutr. Nov 28 2011.