Baby Led Weaning

Growing healthy babies with healthy appetites

Posts Tagged ‘BMJ’

Further to Dr Ellen Townsend’s statement re BLW in the BMJ. Some more info on carbs and breast-feeding.

Sunday, February 12th, 2012

I asked for a wee bit further clarification on the breastfeeding rates – HUGE in both instances, if you look at the peer reviews it says ‘nearly all children in the matched sample were breast-fed (92% in the SpoonFed group, 97% in the Baby-Led group). Indeed, in the whole sample 94.8% of the children had been breast fed’. As you can see I asked if this was a bad thing, as it is unusual, or good because it meant that the study compared like with like.

Here is the reply from Dr Townsend.
“The breast feeding issue is interesting and crucial. On the one hand the fact that there was no difference in breastfeeding status in our matched sample (which we based our preference analyses on) is a good thing – because as you acknowledge that means we have homogeneity between the groups. With the BLW group the high rate is understandable as it is such a natural extension of breastfeeding. With the spoon-fed group – we had a sample who were willing to come to the lab to be tested etc – so again probably not entirely representative at a population level. We do now need to do research now that engages more parents who have used formula/bottle feeding. We do say this at the end of the paper …”In particular, a study is needed that includes a greater proportion of children who have been formula/bottle fed in order to compare the relative impacts of weaning method and milk feeding practices on food preferences and health outcomes in early childhood.””

Likewise the carbs thing, what were they using as their definition of carbohydrates?
And here is the answer.

“With regard to the carbohydrates issue. There are a number of ways we could have categorised/classified the foods in our study. We used typical food pyramid categorization where ‘starchy’ carbs are found at the bottom. Yes – sweets are carbs but of the ‘simple’ rather than ‘complex’ variety.”

Any thoughts?

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A quick statement from Dr Ellen Townsend re BLW in the BMJ

Tuesday, February 7th, 2012

I say statement, really I just buzzed her and said ‘givvusitinplainEnglish’… and she is a kind woman so she complied despite this probably being Quite A Busy Day for her. She says;

“We conducted a survey-based study with parents. Some of whom had used traditional spoon feeding and some who had used a baby-led approach. We asked them about their child’s food likes and how often they ate 151 different foods.

We then compared the groups on their liking for foods in the major food categories (carbs, proteins etc). What we found was that children weaned using a BLW approach like carbohydrates more than the spoon fed children. (In fact they liked carbohydrates the most as compared to the spoon fed children who like sweet foods the most.)

This is interesting because carbohydrates form the building blocks of healthy nutrition (being found at the bottom of the food pyramid). We also looked at health outcomes and found that BLW children generally had lower BMI compared to spoon-fed children. There was a small incidence of underweight in the BLW group but a larger incidence of obesity in the spoon fed group.

Carbohydrates are an ideal first finger food – so what we may be seeing here is an ‘age on introduction effect’ where BLW children are exposed to these foods in their whole food format earlier on. In relation to the BMI findings it could be that BLW learn to self regulate their intake because they are given control of the feeding process. We need longitudinal studies now that can tease apart our findings further.”

Tell you what I’m interested in… the breast-feeding rates seem high in both groups. I’m wondering whether that’s a good thing in terms of correlation of samples or whether it throws everything up in the air a bit. Anyway, I’ve asked her and hope that she’ll answer when she gets a minute.

I did ask if we BLWers should be worried by the fact that some of our kids were underweight and the answer came back “Not a big worry – most children in both groups were a healthy weight for their age and gender…”

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BLW in the BMJ – New study says Baby Led Weaning promotes healthy food choices

Tuesday, February 7th, 2012

I don’t have a lot of time to digest it all right now so I reckon the best thing to do is give you all the Actual Links to both the University of Nottingham press release and the article in the British Medical Journal.

The press pieces all seem okay so far but seem to be reporting the kids as still having been spoon-fed at 20 months which seems a bit… unlikely. I presume that this is a mis-interpretation of the fact that the parents were looking at what their kids eat after 20 months as by then weaning is well and truly over.

Anyway, as we say to our children faced with a bowl of lasagne, dive in…

Daily Mail from the paper that likes to terrify you with choking stories…

Guardian from the paper that likes to publish Zoe Whatsername saying we’re all loons. ;D

The Australian from the paper that likes to use eighteenth-century weaning terminology.

BBC slight erk at headline…

Press Association aaand here’s what went out on the newswires.

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The La Leche League responds to the BMJ hoo-hah

Tuesday, February 8th, 2011

Well, thank goodness for that, then.

“La Leche League GB’s response to the article reported in the British Medical Journal, January2011, questioning the recommendation to introduce solid food to babies at 6 months 19.01.2011

La Leche League has been providing breastfeeding information and support to parents for over fifty years. We support the view of The World Health Organisation (WHO), The Department of Health (DH), and other eminent organisations, that infants should be exclusively breastfed for around the first six months of life to achieve optimal growth, development and health. Thereafter, to meet their evolving nutritional requirements, infants should receive appropriate complementary foods alongside continued breastfeeding.

When WHO recommended this policy it was based on a systematic review of 3,000 studies on infant feeding. The article the British Medical Journal published, on 14 January 2011, suggesting that babies need solids earlier than six months of age, is not a new research study or a systematic review of all available evidence. Three of the four authors of this research have declared an association with the baby feeding industry.

There is clear scientific evidence that breastfeeding protects both the short and long term health of mothers and babies. It reduces the risk of infections such as gastroenteritis and respiratory, ear and urinary tract infections, particularly infections requiring hospitalisation, even in developed countries such as the UK. The risk of diabetes and obesity in children and cancer in mothers is lessened and it reduces the risk of postnatal depression and neglect. With the current risk of swine flu, exclusive breastfeeding reduces the risk of the baby catching secondary infections, which could be serious enough to need hospital admission.

• The BMJ article says that delaying introducing solid food may increase the risk of iron deficiency anaemia (IDA)

Breastmilk supplies all the essential nutrients a baby needs for around the first six months of life. There isn’t a lot of iron in breastmilk because there isn’t supposed to be. It is more completely absorbed by a baby than the kind in formula, baby cereal or supplements. Breastmilk contains a protein that binds to any extra iron that the baby doesn’t use because too much iron can end up feeding the wrong kind of bacteria in his intestines and this can result in diarrhoea/constipation or even microscopic bleeding. Formula fed babies can have too much iron in their intestines, which causes these problems and ends up reducing their overall iron.

If a baby is started on solids before he is ready iron stores can drop. Some fruits and vegetables can bind with iron before the baby has a chance to use it. These foods are often low in iron and so are simply replacing the perfect food for babies with ones with fewer nutrients.

To help ensure a breastfed baby has a good supply of iron, women can look at their diet during pregnancy and ask that the umbilical cord is not cut before it stops pulsating as this adds to his iron supply.

• The BMJ article says that delaying introducing solids may increase the risk of coeliac disease

Coeliac disease is associated with the early introduction of gluten, which is found in cereals. Currently available evidence on the timing of the introduction of gluten into the infant diet is insufficient to support any recommendations and a study suggesting this should be at four months is considered by many to be flawed. There is evidence suggesting that not being breastfed at the time gluten is introduced into the diet is associated with an increased risk of subsequently developing coeliac disease.

• The article says that delaying introducing solids may increase food allergies

A baby’s insides are designed to be ready for solid food once his outside has developed enough for him to eat it on his own. If offered too soon he will automatically thrust it back out to protect his digestive tract. La Leche League suggests mothers look for cues that their baby is ready, such as being able to sit up, pick up food, get it in his mouth and chew without choking, and that often happens around six months. A baby’s digestive tract needs to be mature before starting solids so the lining of his intestines is sealed against allergens (allergy producers). If given solids too early allergens can slip through the intestinal wall into the blood stream and the baby produces antibodies against them, which can result in allergies such as eczema.

At around six months a baby starts producing adult-type enzymes, which we need to break down food for digestion. If he has solids before he can digest them properly it can cause tummy problems and the nutrients will not be fully utilised.

Trials are being undertaken to test if babies with a family history of true allergy might be helped by earlier introduction of certain foods but, as a rule, the majority of babies are less likely to have an allergic reaction to foods by around six months.

• The article suggests that introducing new tastes at an earlier age may increase acceptance of leafy green vegetables and encourage healthy eating later in life

This is purely speculative. Breastmilk prepares a baby for family food as it changes in flavour depending on the mother’s diet and so exposes the baby to various tastes from birth on wards. In fact research shows that formula-fed babies often don’t accept new tastes as willingly as breastfed babies. What a baby prefers to eat will be dependent on many things and will change as he grows. Some mothers have found that if a baby was encouraged to eat a food he had shown a particular aversion to it caused a negative reaction, perhaps showing that babies instinctively know what to refuse. If offered a range of healthy foods babies tend to take what they need.

• The article says that delayed introduction to solid foods may be linked to increased obesity

This is in total conflict with the studies showing that early introduction, particularly of sugary foods, is an important factor behind the obesity epidemic and can lead to babies being overfed. Breastfeeding helps a baby to regulate his own appetite so that when he starts solids he may be better able to avoid over eating.

La Leche League GB knows that women already receive conflicting advice and information on many aspects of childcare and that this report has caused concern and confusion amongst parents wondering what to do for the best for their children. Babies’ individual development varies and parents are best placed to look for signs that their baby may be ready for solid food, around six months of age.

While we recognise that it is important to ensure that recommendations are based on the best available evidence, and are regularly reviewed, we continue to believe that breastmilk provides everything a baby needs up to around six months of age and that to introduce other foods before a baby is ready is not beneficial.

La Leche League GB offers breastfeeding information and support to all. Established as an Affiliate of LLL International in the 1980s, LLLGB has 68 groups and 245 Leaders. LLL Leaders are mothers who have breastfed a child for 12 months or longer and undergone an accreditation process. They know that breastfeeding is not always easy and how much difference having someone to talk to can make. Leaders provide telephone counselling, email support and local group meetings, as well as leaflets on a wide range of breastfeeding questions, information on more unusual situations, access to a panel of professional advisors, and can often lend out books covering various aspects of pregnancy and child care.

LLLGB’s national telephone helpline (0845 120 2918     0845 120 2918 ) connects mothers directly to an accredited Leader, while our website (www.laleche.org.uk) includes an online help form that enables a mother to receive email help from an LLL Leader. All our Leaders are volunteers and answer calls from home while looking after their families.

The new 8th edition of La Leche League International’s The Womanly Art of Breastfeeding was published on July 13th 2010 and can be purchased from the LLLGB SHOP www.lllgbbooks.co.uk.

Written by Anna Burbidge, Chair, Council of Directors, on behalf of La Leche League GB”

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Lisa Lactivist wants you all to email the BMJ

Wednesday, January 19th, 2011

She’s looking for the BMJ to put out another press release to the effect that the article from Mary Fewtrell et al was merely opinion, not fact.

here she is, do click, (despite the peculiar surname)

Now… let’s face it, it won’t get picked up in the same headline-busting way that the first piece did – if it even gets picked up at all – however it is a worthy effort I think insofar as when it comes up in the future we will all be able to link to it and say ‘look, here, worried breastfeeding lady, you are doing great, really, keep up the good work until the WHO tells us differently…’

Good luck.

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Look, it’s the Science Cavalry!

Tuesday, January 18th, 2011

Just to keep everything up-to-date… there was once this paper, which was a small review published in the BMJ and basically just said ‘mmmm-kay we should have a look at this 6 months thing as it may not be right for everyone’. (Preach it to the choir, ladies and gentlemen).

And as we all know by now, this nothing-y paper from UCL has been distorted in the most extraordinary manner by the press. So let us return to the BMJ once more, on whose site there are now a number of replies from credible-sounding (bearing in mind this is emphatically not my field) scientific, medical and public health bods that call for, amongst other things, looking at other methods of retaining or increasing iron levels in our babies.

I like this woman. She seems clever, just look at the alphabetti spaghetti of letters after her name. Go Miriam! For the rest of what she wrote, and comments from other irritated academics, please press here.

“Rather than calling for truncation of exclusive breastfeeding, limiting its myriad of positive immediate health, child spacing and long- term health effects, let us instead call for 1) delayed cord clamping for iron stores, with iron supplements as needed in later infancy, 2) research on the impact of exclusive breastfeeding vs. expressed milk feeding on the health of both mothers and their children, and, most of all, 3) unbiased, informed, and mother-centered support – clinical, social and economic – so that women may make an unbiased, informed infant feeding choice, and succeed in six months of exclusive breastfeeding.

Sincerely,

Miriam H. Labbok, MD, MPH, FACPM, IBCLC, FABM
The Carolina Breastfeeding Institute (CGBI) Professor, and Director, CGBI Department of Maternal and Child Health Gillings School of Global Public Health The University of North Carolina at Chapel Hill Chapel Hill, NC 27599-7445″

AMEN, sister.

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Aaaand we’re back in the room… did you all break breastfeeding while I was away?

Friday, January 14th, 2011

Well happy days, I’ve been out at a funeral eating curled-up gammon sandwiches and unusually firm chicken goujons with my now TWO-year-old daughter – the other one, a certain Babybear of these pages, is now FIVE <faints> – and meanwhile I see the world has gone to hell in a handcart. Breastfeeding, it seems, is rubbish. Honestly, I leave for one day… (might have been nearer two years actually, but that’s what having a couple of kids does to you).

So ya know, an international news story with weaning at the core… what better day than to launch the newer, purtier BLW blog? Let’s do it. Expect further communication on this matter. I bet you cannot WAIT.

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