Archive for the ‘Feeding’ Category

I have just read this article in the Guardian and sighed when I read it. It refers to an article published a couple of weeks ago in the British Medical Journal (here is the article, but it requires a subscription/payment to read it all) where a research group (Fewtrell et al) questioned the policy in the UK to recommend exclusive breastfeeding of infants for six months. Just to be clear, exclusive breastfeeding means that for the first six months, an infant is given breast milk only: no solids, no formula, just breastmilk.

This follows the WHO guidelines, and the Australian government recommends the same. I should emphasise that the researchers are not recommending formula over breastmilk, and they are talking about the introduction of solid food, not formula.

What are they worried about? Well, the researchers are worried about links between late introduction of solids and iron deficiency, a potential increase in food allergies, and of coeliac disease.

I’m sure that this is going to confuse mothers even more. Any new mum knows that they are bombarded with a huge amount of advice from friends, families, and experts. I know that when I had my first child, I spent a lot of time consulting baby books and the internet for every little thing. But with my second child, I didn’t have the time, or inclination, and used a much more intuitive style of parenting.

I didn’t manage to exclusively breastfeed for six months, despite knowing that it was recommended, and despite having every intention to do so. My first child started solids at about five months, but my second was grabbing food from my plate at four months and I knew she needed more than breastmilk. I didn’t believe that something magical happened at six months of age that was missing at five and a half months, and so I did what I thought was best for my children – which is what mothers have been doing forever.

I’m curious about how many mums do actually manage to breastfeed exclusively for six months. I am very pro-breastfeeding, and had every intention of doing so, but for us, it didn’t work out and I did start solid food earlier (even though I continued breastfeeding for about a year with them both).

Did you manage?

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Kangaroo care refers to early skin to skin contact between a mother and her newborn infant. It involves the newborn infant being placed straight onto the mother’s chest immediately after birth. The infant is covered with a blanket on top, but has bare skin to skin contact with mum for as long as the mother and infant are happy.

There seems to be a culture in our society of taking the baby away to be weighed and examined, cleaned up and wrapped before being given to the parents to hold. Obviously if there is any concern about the infant’s health, then they need to be given the appropriate treatment, but in healthy babies, there is now evidence of the positive benefits of early skin to skin contact.

The Cochrane Library publishes systematic reviews of existing studies on particualr topics. By collating all the data and assessing the methodological merit of the studies, they aim to provide evidence based papers. They have a review, last updated in 2007, on early skin to skin contact (Moore ER, Anderson GC, Bergman N. Early skin-to-skin contact for mothers and their healthy newborn infants. Cochrane Database of Systematic Reviews 2007, Issue 3. Art. No.: CD003519. DOI: 10.1002/14651858.CD003519.pub2).

This review found statistically significant evidence that early skin to skin contact had positive effects on the success and duration of breastfeeding, and trends towards positive effects on maternal affection behaviour during feeding and attachment. The infants also cried less and one group (late preterm infants) showed more stable cardiorespiratory function.The authors  also commented that there were no negative associations found.

It is completely natural and instinctive for mothers and their young to be in close contact after birth, and it makes sense that this creates the optimal physiological state for the pair. I am not against hospital births at all; both my children have been born under obstetric care in modern hospitals and personally, I wouldn’t have had it any other way. However, within that medical system, there are ways to make sure that you and your infant start your relationship in the best way possible, and one way is to make sure you have early skin to skin contact.


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Baby led weaning

I went to a seminar today by the Australian Breastfeeding Association which was about ‘baby led weaning’. I hadn’t heard of this until a friend told me about it, so I had a look online first and was intrigued.

The basic principle seems to be that rather than feeding the baby pureed food by spoon, that you allow the baby to experiment themselves with tastes and textures and eat when they are ready. So, they suggest that when the baby is ready for solids at around 6 months, you offer the baby a modified version of what you are eating and you all sit down together. The baby uses her hands to pick up pieces (cut into wedges/chips) and suck/bite them when she is ready. They say that developmentally, a baby who can pick up a certain size of food can eat it, and that there is less risk of choking than when we ‘force’ food into their mouths by tricking  them. They showed videos of babies eating florets of brocolli  – shoving it into their mouths!

As a child psychiatrist, I have worked on a team for children with feeding difficulties, usually children who have had aversive experiences with food due to medical issues. One of the main things I would recommend to these families is giving the child control, and allowing them to have small successes to build on rather than pushing food on them and ending up in a battle.

I believe strongly in baby led play (again, something I would teach at work) and baby led routines rather than routines being forced on babies to suit parents’ lifestyles (as suggested by at least one popular parenting book). So this intutively makes sense to me. When in doubt, I always think of the bigger view around the world, or through the ages. Have babies always had rice cereal fortified with iron? No. And do children around the world have their food pureed? No. Babies are pretty well designed to tell us what they need and like and we should allow our child to experiment and experience success and failure until she finds what suits her.


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When to start baby on solids

I am amazed at the huge amount of – often conflicting – advice about starting food, as well as most other baby issues. Most advice (including from the Australian Breastfeeding Association and most paediatricians) is that babies don’t need anything other than breastmilk until about six months. The reason for this is that around this time, the baby’s iron stores are becoming depleted and they need the extra nutrients that food can give them.

There is also a lot of talk about the early introduction of solids being associated with food allergies and atopic conditions (asthma, hayfever, eczema). I had a look on the net for the evidence of this (being a good evidence based practitioner!) and struggled to find much. There was, however, an article published in Pediatrics in 2008 (PEDIATRICS Vol. 121 No. 1 January 2008, pp. e44-e52) which looked at over 2000 kids from a birth cohort study, and found that there was no evidence that introduction of solids before 4-6 months was associated with food allergies, asthma or allergic rhinitis. They found that food allergies were actually more common in children who had been started on solids after six months. The results for eczema were conflicting and the authors say that there is a possibilty that eczema is more common in those given foods under 4 months.

I think that parents are often tempted to start solids due to excitement and impatience. Of course, this is completely the wrong reason to start them and we need to follow our baby’s cues as to when she is ready.


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