Introduction of Complementary Foods

The introduction of solids (also called weaning or complementary feeding) has become quite a complex topic for both healthcare professionals and parents. This is most probably related to the fact that although we have the World Health Organization (WHO) guidelines on complementary feeding many other health organizations have published their own guidelines on weaning, which do not reflect the same information as the WHO. Add on to this the worry about the increase in food allergy and confusion when to start solids to prevent the development of these and you have a perfect recipe for confusion.

So lets start with the basics: the WHO recommends that weaning is commenced at 6 months of age, with this recommendation being  backed up by a very good systematic review of many studies indicating that breastfeeding exclusively until this age provides a baby with all the nutrition that they need and has the added benefit of reducing infections (see blog post on the benefits of breast milk). So the ideal from the WHO perspective is to breast feed exclusively until 6 months and then introduce solids. This is the advice currently also supported by the Department of Health in the UK. However, the European Society of Paediatric Gastroenterology Hepatology and Nutrition and the American Academy of Pediatrics both recommend introduction of solids occur between 4-6 months of age, when the child is ready. The latter recommendations are also based on really good research indicating that too early (< 17 weeks) or too late (> 26 week) weaning can also introduce a multitude of problems, which I will discuss under feeding difficulties, food allergies and micro-nutrient deficiencies in future blog entries.

So what are parents supposed to do? For me as a healthcare professional the most important aspect to commencing solids in any infant is not to do any harm, so DEFINITELY no solids < 17 weeks and it is important NOT to delay solid introduction beyond 26 weeks. In between this age, each baby will indicate whether they are ready to be weaned. Generally this would include being able to sit upright and hold their head in a steady position, having eye-hand-mouth coordination with food (looking at food and wanting to grab it) and lastly that they are able to manage food in their mouth (babies who are not ready will push their food back out with their tongue). It is important not to miss these cues with your baby and rather follow your baby’s development for readiness for food introduction.

Babies start mouthing usually from 3 months of age, this means they are putting their fists/fingers in their mouth and can often be associated with a lot of salivation. This often gets misinterpreted as either early teething or that they are hungry. In fact, this is a wonderful developmental stage that all children go through, desensitizing their mouth for future solids and also learning to explore. In future you will not only see them explore their fingers in this way, but foods and toys as well. Similarly often parents interpret night time waking, when they have slept through as a sign to wean, when there are none of the other signs (i.e. eye-hand-mouth coordination ect)  present. Babies will go through these periods naturally, so it is not necessarily a sign that they need food.

So look and listen to your baby’s cues and start when your baby is ready, but remember never before 17 weeks! I will guide you through weaning with future posts.

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The wonders of breast milk

Okay, so your baby is born and the obviously choice of feed is breast milk. I cannot say how amazing breast milk is! It has the right balance of energy, protein and vitamins and minerals, the baby’s stomach digests it much easier and also flavours of what you consume (i.e. garlic) are transferred through your breast milk, starting the journey of oral taste perception. You will often find that a breast fed baby is much more open for stronger flavours, including onion/garlic and herbs and spices, especially if mum likes those types of foods and consumed it during breast feeding. As your baby grows older, breast milk also does not remain the same; non-nutritive factors (antibodies, enzymes, good bacteria) adjust to your child’s needs, making it perfect.

I often get the question to how mum’s diet influences the breast milk and the answer is HUGELY. As already mentioned, flavours get transferred but the nutritional content can also be influenced by the mother’s diet. For example the nutritional status of the mother appears to influence fat concentration and thus the energy content of breast milk as well as its fatty acid composition (i.e. omega-3-fatty acids from oily fish) and immunological properties. So it is really important that a breast feeding mum also has a healthy diet. Here is a great article to read when you have time on breast milk properties and dietary influences.

How long should you continue to breast? Instead of me saying 2 years, which is recommend by the World Health Organization I usually say, that every day of breast feeding is a bonus, because breast milk is the “liquid gold” of nutrition. So it is important not to feel guilty if you do not manage to breast feed as long as recommended, because any breast milk your child gets is great! That also means, if you are not able to exclusively breast feed, to not just stop, because you think breast feeding is “all or nothing”.  Any amount you can provide your baby with is amazing!

If you are one the mums where breast feeding comes easy and you manage to breast feed until 6 month you have done an amazing job, if until 1 year of age, my goodness this even better and if you last longer, good on you! Remember, though, too much breast milk, meaning too frequent breast feeding in the older child can also become a problem. A child is supposed to have solids from 6 months of age, as they do not only need to develop oral motor skills but also contribute to essential nutrient, in particular vitamin D, Vitamin C, iron and vitamin A that are not sufficient in breast milk alone after 6 months. Too much breast milk, can displace solids and children can develop an iron deficiency or vitamin D deficiency. It is therefore important to ensure that your child receives a balanced diet and breast milk after 6 months of age. All breast fed babies from six month of age should take a daily supplement containing vitamin D, in the form of vitamin drops. This helps them to meet the requirement set for this age group of 7-8.5 micrograms of vitamin D per day. If you did not take a vitamin D supplement during pregnancy it is better that your baby is supplemented from 1 month of age.

So the message throughout my blog will always be that breast milk remains the best source of nutrition, BUT we have to acknowledge that not everybody can breast feed and I also want to ensure that mums get advice on formula feeding in subsequent blog entries.

My first blog…..

Its been some time that I have been meaning to blog about common themes in regard to paediatric nutrition, but I was waiting for the elusive 36 hour day to fit blogging into my schedule….never mind that I  am not blessed, when it comes to the technical aspect of setting up a site. I have now realised that the 36 hour day is not going to happen and unless I make time for this, it is never going to become a reality. Surprisingly, with a little bit of help from my husband, I have also been able to master the basics of the blogging site.

As you will see from  “about the author”, I am a paediatric dietitian and hope to demystify paediatric nutrition for you. I will try as far as I can to keep my blog as evidence based as possible, but make this information practical for daily use.

So what should I write my first blog about? Of course it should be mind-blowing and make you want to follow my blog. I therefore thought a good start would be to discuss good resources, because I may not always blog exactly on the topic that you are struggling with at that stage, but knowing where you can find the information is important. “Dr. Google” is a wonderful tool to use for all questions, but sadly has no medical degree, so you need to be smart in choosing the right information. The amount of tears I have had in my clinic about parents thinking their child will suffer long term problems, because of misinformation from the internet! Don’t get me wrong, the internet is a wonderful tool, its just important to know what information is trust worthy. I will therefore try to provide you with some international  and UK specific sites (I work in the UK) that you can use.

As a healthcare professional, I will always go to pubmed to provide me with the latest peer reviewed (meaning no article is published here unless reviewed by peers specialising in the field that check the information) information. This may be useful to you, but remember for the majority of publication you can only access the abstract and the medical terms used may be a bit overwhelming. Otherwise, I suggest using the NHS or the Food Standard Agency for general information on infant feeding. For specific infant and toddler feeding information, the Infant and Toddler Forum, which I am part of is really good and the British Dietetic Association has Diet sheets on healthy eating, calcium intake and food allergy in their list of public fact sheets.  As we go through topics related to childhood nutrition, I will be providing more specific sites that you can access for further reading, but for the time being I think this is enough to digest for a first blog.