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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