Friday, January 14, 2011

When to wean babies

Interesting news published today, in the British Medical Journal.

We were slightly surprised when new parents that we knew of said they intended to exclusively breastfeed their children until they were six months old. Evidently, this was because we were out of touch with the current recommendations. In accordance with the prevailing advice when our babies were small, we had started weaning our children at around three to four months. None had seemed any the worse for it, and to be honest, by the time they were that age, they seemed ready to move onto something other than milk.

The report is interesting, as it explains the history of the six month recommendation. Ten years ago, the World Health Organisation advised that children universally be breastfed for six months. Breastfeeding is the best option for small babies, and clearly where access to clean water and safe and affordable alternative food supply is limited, continuing to do this while possible is a good idea.

Initially, Western countries seem to have largely ignored the advice, and it was only in 2003 that a health minister said that the UK would comply.

In actual fact, the case for and against starting weaning before six months is quite balanced, from a scientific point of view. Whilst breastfeeding reduces the risk of infections, there's some evidence of undernutrition in children who are exclusively breastfed to six months in Western countries (the BMJ references studies in the US and Sweden). In any case, a lot of children are weaned early and successfully regardless of the advice - the effect of such guidelines can quite often be to lay a burden of guilt and anxiety (or smug self-righteousness) on particular sections of the population (largely middle-class) when the guidance is simply ignored by the rest.

The Royal College of Paediatrics and Child Health, the Royal College of Midwives and the National Childbirth Trust have lined up in support of current guidance. The comments from the RCM are interesting. Their spokesperson said:
I believe that this ... plays into the hands of the baby-food industry which has failed to support the six-month exclusive breastfeeding policy in the UK.

There is evidence that some babies do die in developed countries from inappropriate young child feeding, such as the introduction of solid foods earlier before their swallowing mechanism is mature enough or they have fully developed the capability to cope with solid foods.
The fact that the baby-food industry stands to gain or lose has little to do with the medical evidence - it's more strongly suggestive of an anti-corporate bias in the commenter. Similarly, the fact that the baby-food industry hasn't supported a policy signifies little, particularly if the alternative, which they were able to make money from, seemed to work just as well. For what it's worth, the total income of the baby-food industry from us before our children were a year old was probably around £10 (with the exception of expenditure on formula milk - but that's another story). And there's always a risk of babies dying as a result of inappropriate young child feeding. There's a risk of babies dying as a result of all sorts of things. It's one of the depressing things about babies being born is that they are often born to people like us who are barely competent to do anything with them, and have to learn quickly on the job, generally under massive sleep deprivation.

However, this report has the effect of drawing attention to the fact that the six months advice was advice given with a world readership in mind, and is more to do with hygiene than scientific evaluation of nutritional requirements - and where it's down to that, the conclusion seems to be that the evidence is neutral. That, of course, should hardly surprise us - the world hadn't fallen apart before the WHO recommendations came along.

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