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Breast Milk and Alcohol: Busting Myths and Demystifying the Science

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Why wait until 6 months before introducing solids

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Why wait until 6 months before introducing solids

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The WHO and the NHS recommend exclusive breastfeeding for the first 6 months, with solids introduced from then on, alongside continued breastfeeding. In this article I explore the evidence behind the recommendation to wait until your baby is 6 months old before introducing solids.

Parents are often told, sometimes by family members, and sometimes by health professionals, to introduce solids to their exclusively breastfed baby before 6 months, in the belief that the baby needs more calories. This makes no sense since breastmilk and formula have 22kcal per fluid oz, whereas typical weaning foods are very low in calories. For example, an ounce of puréed carrots only has 7kcal per fluid oz, puréed apples has 13kcal per fluid oz, and pear has 16 kcal per fluid oz.

Gill Rapley, the Health Visitor who coined the term Baby-Led Weaning, says:" There is no rationale for pushing solid foods at the expense of breastmilk (or, indeed, formula). No solid food comes close to the concentration of nutrients in breastmilk, so, spoonful for spoonful, breastmilk will always provide better nutrition (and more calories) than any other food. Seeking to replace breastmilk in a child's diet risks them being less well nourished, not more. All that human babies need, once they're over six months, is access to small amounts of other foods - in addition to breastmilk - to make sure they're getting enough of the smallest nutrients."

Another common reason for suggesting solids is to help a baby sleep longer stretches at night. In fact, introducing solids usually has the opposite effect: babies wake up more often because their body needs to get used to digesting foods they aren't accustomed to. Sleeping longer stretches is developmental and has nothing to do with how much a child has eaten.

In 2003, following a systematic review for the World Health Organisation on the optimal duration of exclusive breastfeeding, infant feeding guidelines in the UK were changed to recommend exclusive breastfeeding for the first 6 months, with solid foods introduced from then on, alongside continued breastfeeding:

"Infants who are breastfed exclusively for 6 months experience less morbidity from gastrointestinal tract infection than infants who were mixed breastfed as of 3 or 4 months of age. No deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for 6 months or longer".

In 2018, the Scientific Advisory Committee on Nutrition(SACN) considered evidence relating to feeding in the first year of life, and reached the following conclusions:
'The totality of the evidence reviewed for this report supports current guidance to breastfeed exclusively for around the first 6 months of an infant's life and to continue breastfeeding for at least the first year of life. Each makes an important contribution to infant and maternal health.' 'By around 6 months of age, infants are usually developmentally ready to actively accept foods other than breast milk (or infant formula). The available evidence indicates that the introduction of solid foods or infant formula before 6 months of age reduces the amount of breast milk consumed and is associated with greater risk of infectious illness in infants.'
In addition, according to the independent public health nutrition charity First Steps Nutrition: 'there is increasing evidence that breastfeeding is protective against the development of overweight and obesity, with recent evidence from WHO Europe, after consideration of data from over 100,000 children in 22 European countries, concluding that: 'Breastfeeding has a protective effect: obesity is less frequent among children breastfed for at least 6 months.' This is supported by evidence from the UK Millennium Cohort Study which reported that study participants who were breastfed as infants had lower odds of being overweight or obese at age 14.'

In March 2018, at a conference entitled " Infant feeding: Policies, politics and best practice' at the Royal Society of Medicine, Professor Charlotte Wright, paediatrician and epidemiologist, stated: "Early solids doesn't enhance growth but displaces milk and puts baby at risk.
The world over, parents view the starting of solids as evidence of their child maturing, developing, moving on, and because of this are tempted to start them early. It is really important to resist this assumption, the danger being that introducing solids early will reduce the child's intake of breastmilk, which is really all they need for the first six months. Introducing anything else before this age increases the child's risk of infection, with a number of UK cohort studies showing that exclusively breastfed infants are healthier than partially or non-breastfed babies. There is a push, particularly from the formula industry, for the recommendation to be changed from six months back to four-six months. We've reviewed all of the challenges and found no evidence for them. One argument is that waiting to six months to introduce solids runs the risk of children not having enough to eat and particularly not enough iron, but it actually has been found to have no increase risk of adverse weight gain or iron deficiency anaemia."
Developmental signs of readiness for solids include:

Baby can sit up well without support and hold their head steady.

Baby can co-ordinate their eyes, hands and mouth so they can look at the food, pick it up and put it in their mouth by themselves.

Baby has lost the tongue-thrust reflex and does not automatically push solids out of his mouth with his/her tongue.

Baby is ready & willing to chew. ⁣

Baby is developing a "pincer" grasp, meaning they can pick up food or other objects between thumb & forefinger.⁣

⁣ Baby is eager to participate in mealtimes & may try to grab food & put it in their mouth.⁣

As well as waiting until a baby is 6 months old, it's also recommended to wait until a baby is showing all the developmental signs of readiness.

Showing interest when adults eat doesn't necessarily mean a baby is ready for solids. Anything parents do is fascinating to their baby. A baby who has never had solid food doesn't know what it is, so can't know what they're missing. In this video: https://youtu.be/FefI1J-iDY4 4-month-old baby Sofia is interested in her mother's glass of wine, but that doesn't mean she's ready for alcohol.
Links: https://kellymom.com/nutrition/starting-solids/babyfoodcalories/ https://www.ncbi.nlm.nih.gov/pubmed/15384567 https://www.gov.uk/government/publications/feeding-in-the-first-year-of-life-sacn-report https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5d2ef0605808300001efe136/1563357283396/EFSA_consultation_First+Steps_+July19.pdf https://www.karger.com/Article/FullText/500425 https://cls.ucl.ac.uk/wp-content/uploads/2017/12/MCS6-Briefing-02-Overweight-and-obesity.pdf
Understandably new parents are eager to start their baby on solids as it's an exciting new stage. However, preparing food on a daily basis is hard work, and requires much more planning than when a baby is only drinking breastmilk or formula. The novelty soon wears off. A big advantage of delaying solids until your baby is completely ready, is that it means less work, especially as at 6 months babies will be developmentally ready and able to eat many of the same foods as the rest of the family.
Is baby ready for solid foods? (Developmental signs of readiness) * KellyMom.com Your baby's first solid foods - NHS
http://www.rcpch.ac.uk/growthcharts/

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The WHO and the NHS recommend exclusive breastfeeding for the first 6 months, with solids introduced from then on, alongside continued breastfeeding. In this article I explore the evidence behind the recommendation to wait until your baby is 6 months old before introducing solids.

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Author, Speaker, Researcher supporting new parents through pregnancy, birth and caring for babies

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Benefits of skin to skin last for decades

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Benefits of skin to skin last for decades

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When you become a parent for the first time, there is an undeniably steep learning curve. Add to that the struggle of sorting through fact and fiction when it comes to advice and- whew -it's enough to make you more tired than you already are with that newborn in the house.

Just like those childhood games of telephone when one statement would get twisted by the time it was told a dozen times, there are many parenting misconceptions that still tend to get traction. This is especially true with myths about bottle-feeding-something that the majority of parents will do during their baby's infancy, either exclusively or occasionally.

Here's what you really need to know about bottle-feeding facts versus fiction.
1. Myth: Babies are fine taking any bottle
Not all bottles are created equally. Many parents experience anxiety when it seems their infant rejects all bottles, which is especially nerve wracking if a breastfeeding mom is preparing to return to work. However, it's often a matter of giving the baby some time to warm up to the new feeding method, says Katie Ferraro, a registered dietician, infant feeding specialist and associate professor of nutrition at the University of California San Francisco graduate School of Nursing.

"For mothers returning to work, if you're breastfeeding but trying to transition to bottle[s], try to give yourself a two- to four-week trial window to experiment with bottle feeding," says Ferraro.
2. Myth: You either use breast milk or formula
So often, the question of whether a parent is using formula or breastfeeding is presented exclusively as one or the other. In reality, many babies are combo-fed-meaning they have formula sometimes, breast milk other times.

The advantage with mixed feeding is the babies still get the benefits of breast milk while parents can ensure the overall nutritional and caloric needs are met through formula, says Ferraro.
3. Myth: Cleaning bottles is a lot of work
For parents looking for simplification in their lives (meaning, all of us), cleaning bottles day after day can sound daunting. But, really, it doesn't require much more effort than you are already used to doing with the dishes each night: With bottles that are safe for the top rack of the dishwasher, cleaning them is as easy as letting the machine work for you.

For added confidence in the sanitization, Dr. Brown's offers an incredibly helpful microwavable steam sterilizer that effectively kills all household bacteria on up to four bottles at a time. (Not to mention it can also be used on pacifiers, sippy cups and more.)
4. Myth: Bottle-feeding causes colic
One of the leading theories on what causes colic is indigestion, which can be caused by baby getting air bubbles while bottle feeding. However, Dr. Brown's bottles are the only bottles in the market that are actually clinically proven to reduce colic thanks to an ingenious internal vent system that eliminates negative pressure and air bubbles.
5. Myth: Bottles are all you can use for the first year
By the time your baby is six months old (way to go!), they may be ready to begin using a sippy cup. Explains Ferraro, "Even though they don't need water or additional liquids at this point, it is a feeding milestone that helps promote independent eating and even speech development."

With a complete line of products to see you from newborn feeding to solo sippy cups, Dr. Brown's does its part to make these new transitions less daunting. And, for new parents, that truly is priceless.
This article was sponsored by Dr. Brown's. Thank you for supporting the brands that support Motherly and mamas.

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It's science: Skin-to-skin time benefits your baby-even 20 years later

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If the feeling you get when you snuggle a baby could be bottled and sold, this world would probably be a better place-research basically proves. Between the way those snuggles release heartwarming oxytocin to the benefits they have on babies' growing brains, let's all agree there really is no such t...

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NCT information on swaddling

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This article discusses swaddling - how to do it as well as the arguments for and against.

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"He sleeps really well but only when he's laying on my chest, he hates his moses basket" "She cries every time we lay her on her play mat" "He hates going in his pram, he cries the second we put him in it".
If I had a pound every time I heard these from a new parent I'd be a very rich lady by now! What amazes me though is that society in general doesn't get it, they don't get why so many babies need to be held by us to settle and what perplexes me even more is that we do spend so long trying to put them down! We spend more than time though, the 'putting babies down' industry is worth millions, rocking cribs, battery swings, vibrating chairs, heartbeat teddies and the list goes on..................having been a first time parent who bought all four of the items listed above I am embarrased to admit now it honestly didn't enter into my head that perhaps the answer was to *not* put my baby down and I certainly didn't consider why these things might help. It took me a long time to understand and empathise with my baby, to see the world through his eyes so to speak.
"Empathy: the intellectual identification with thoughts, or attitudes of another." or vicarious experiencing of the feelings, "Birth suddenly disrupts this organization. During the month following birth, baby tries to regain his sense of organization and fit into life outside the womb. Birth and adaptation to postnatal life bring out the temperament of the baby, so for the first time he must do something to have his needs met. He is forced to act, to "behave." If hungry, cold, or startled, he cries. He must make an effort to get the things he needs from his caregiving environment. If his needs are simple and he can get what he wants easily, he's labeled an "easy baby"; if he does not adapt readily, he is labeled "difficult."" - Dr. William Sears.
To empathise with our newborns feelings we need to put ourselves in their place, to imagine experiencing their world - but which world? The world they have spent most of their life in, their 'womb world' or the world they are in now - our world. To fully understand we must appreciate the enormous transition they have made - a concept known to many as 'The Fourth Trimester' -some make the womb to world transition easily, others less so and it is this latter group in particular "the clingy babies" we can learn so much from through this concept.

So lets quickly compare the two different 'worlds' your baby has lived in:

Pretty different huh? On top of this the big thing to understand is that in utero the baby's world was constant, each day was the same, the stimulation didn't change, but now they are born each day is different - ever changing, ever stimulating!

The concept of the fourth trimester helps us to understand the transition a newborn must make over their first few weeks earthside and once we understand we find so many ways we can help - but to me the most important facet of the fourth trimester is parental understanding and empathy, once that exists everything else will flow naturally.
Movement
Here are some common newborn calming techniques that tend to work quite well, but remember each and every baby is different, if you don't already know, you will soon learn what your baby likes best and that's what matters, that it is unique to *your* baby. Prescriptive 'do this/don't do this' baby calming lists don't help anybody - because they forget they are dealing with individuals - both parents and babies! Some things on this list will be inappropriate for you and your baby, some simply won't work, some you won't like - and that's OK! because really it isn't about these tips it's about you and your baby getting to know each other!
Skin to Skin Contact
The womb is a constantly moving space, Braxton Hicks would squeeze your baby at the end of pregnancy and each time you moves your baby was wobbled around inside. Imagine how walking upstairs feels for a baby in utero! Babies tend to love movement but so often we put them down somewhere completely still. You could try dancing, swaying from side to side, going for an exaggerated quick walk or bumpy car ride.
Bed-Sharing
Such a brilliant baby calmer! Being in contact with your warm, naturally (un)scented, skin is heaven for a baby, it helps to stabilise their body temperature, heart rate and stress hormones and stimulates the release of oxytocin - the love and bonding hormone - in you both. Topless cuddles, shared baths, baby massage and bedsharing are all great skin to skin experiences for your baby and you.

Sharing a bed with your baby is an amazing way of getting more sleep for everyone, babies are generally much calmer and sleep more easily if they sleep with you in your bed, yet it is such a taboo topic and although 60% of parents will share a bed with their baby at some point it's a subject that makes society very uncomfortable, but...it is an *amazing* baby calmer! It's really important that you think about how bedsharing will work and follow some important safety guidelines HERE.
Swaddling
For more on bedsharing and other ways to improve your newborn's sleep, watch my free webinar here:

Imagine how snug your baby was at the very end of your pregnancy inside of you - now imagine how strange it must feel to them after they have been born and have so much space around them! The absolutely best thing you can do is to envelop your baby in your arms, but for times when you don't want to or indeed can't then swaddling is an option. Swaddling is becoming increasingly popular, however there are important safety guidelines to be followed if you choose to swaddle your baby, if you are breastfeeding please make sure feeding is established before swaddling and take care not to miss your baby's hunger cues if you are feeding on demand:
** The American Academy of Paediatrics recommends swaddling for babies 0-14wks. Babywearing

Never swaddle over your baby's head or near his face

Never swaddle your baby if he is ill or has a fever

Make sure your baby does not overheat and only swaddle with a breathable/thin fabric

Only swaddle your baby until he can roll over**

Always place your baby to sleep on his back

Do not swaddle tightly across your baby's chest

Do not swaddle tightly around your baby's hips and legs, his legs should be free to "froggy up" into a typical newborn position.

Lastly start to swaddle as soon as possible, do not swaddle a 3 month old baby if he has not been swaddled before.

Wearing your baby in a sling is one of the ultimate ways to keep them calm and happy. It increases the time a baby spends in a state of "quiet alertness" - a time of contentment when they learn the most. When a baby is in utero they spend 100% of their time in physical contact with us - yet the moment they are born this is estimated to drop to only 40%! Babywearing also means 2 free hands!

Choose your sling carefully. A good sling will be easy to use and will support both yours and your baby's spine whilst not placing any pressure on your baby's growing hips - newborns should always be carried facing inwards with a "frog leg" pose, not a crotch dangle pose so commonly used by commercial baby carriers. Also seek to carry in an 'in arms' position - i.e: how your baby would be held if you were holding them!

Babywearing is a great way for dads to bond with babies!
Position
It is quite common for a baby to cry once placed in a sling, this does not mean that they hate the sling - it just means that you need to move, so get dancing! As with swaddling,babywearing is becoming increasingly popular, however there are important safety guidelines to be followed, the TICKS acronym below neatly sums them all up:

The "tiger in the tree" position below, taken from baby yoga, is often magical, stopping a crying baby in an instant!
Feed
Noise
Babies love sound, but for many not the sound you might think. For many babies a hoover is much more calming to a baby than a lullaby. A special white noise recording, such as , can be played on loop whilst your baby sleeps to help keep them calm.
Deep Bathing
If your baby is hungry nothing will calm him, so watch for his hunger cues. Feeding is always better if it is baby led, not led by a routine - whether you are breast or bottle feeding. Remember as well that your baby may not always be hungry for a full feed, they may want a quick drink, a quick snack or just some comfort sucking. Babies also find sucking the ultimate relaxation and comfort tool. Sucking helps a baby's skull bones to return to their normal position after birth as well as providing them with comfort and security. If you are not breastfeeding you might find your baby will relax when given a dummy/pacifier.
Outside
The womb is a wet, warm place. The world as we know it is dry and cold! Sometimes a nice deep, warm bath can stop a baby's tears in seconds - even better if mummy or daddy goes in the big bath with baby too as skin to skin contact is a wonderful baby calmer.
What have you found calms your newborn? The NEWLY UPDATED Gentle Sleep Book - out now! If you would like to understand and learn how to improve your baby's sleep WITHOUT cry-based conventional sleep training, this is the book for you! p.s: Come and chat with me on Facebook, Twitter and Instagram Or watch my videos on YouTube You can also sign up for my free parenting newsletter HERE.
If all else fails many babies stop crying the minute they hit the open air - I'm not sure if this is because we are usually moving (e.g.: walking over cobbles with the buggy/ bouncing in a sling and the drone and movement of a car) or because of the change in air - but it works!

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The Fourth Trimester - AKA Why Your Newborn Baby is Only Happy in Your Arms

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"My baby is only happy in my arms, the minute I put her down she cries" "He sleeps really well but only when he's laying on my chest, he hates his moses basket" "She cries every time we lay her on ...

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The efficacy of osteopathic treatment for babies:

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The efficacy of osteopathic treatment for babies:

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The Dangerous Game of the Feeding Interval Obsession

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Some how, some where, new mothers got the message that the gap between when a baby stops a breastfeed and the time they start to need another one matters a very very great deal. 24 hours a day. It...

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Average weight gain for the breastfed baby: 

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Average weight gain for the breastfed baby: 

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KellyMom.com - Breastfeeding and Parenting

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Average Weight Gain for Breastfed Babies - KellyMom.com

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A few things to keep in mind when evaluating weight gain A 5-7% weight loss during the first 3-4 days after birth is normal. A 10% weight loss is sometimes considered normal, but this amount of weight loss is a sign that the breastfeeding needs to be evaluated. It’s a good idea to have a routine wei…

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The best way to tell if a baby is getting enough milk, in the early days, is to keep track of their nappies:

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The best way to tell if a baby is getting enough milk, in the early days, is to keep track of their nappies:

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On days 5-6

Wees: Five or more heavy nappies per day.

Poos: At least two soft, yellow poos per day. They're yellow, because there is no more 'mec' in the bowel.

False menstruation or pseudo menstruation is harmless. It is a very light bleed from the vagina in some baby girls. It comes from the effects of your own hormones on her system, and it soon stops.

After the first week: babies continue to wee and poo several times each day for the first few weeks.

After about six weeks, some (not all) babies poo much less often. Breastfed babies may go many days without producing any poo at all after this time - that's normal, too. As long as your baby is growing well, and the poo he produces is soft, you don't need to be worried. Ask your health visitor about this, if you need to.

What's a 'heavy nappy'?

Try this test - pour three tablespoons of water (45ml) into a dry nappy, and pick it up. That's how heavy your baby's nappy will be, after the first five to six days.

How do I know if my baby is weeing often enough when disposable nappies just absorb the wee?

All babies should produce several heavy nappies every day. If you use disposable nappies, do the 'heavy nappy' test with water so you know what you are looking for. You can also place a cloth inside the nappy, which will stay wet when your baby wees. Any questions about your baby's health or feeding, just ask your midwife.

Urates, sometimes known as brick dust because that's what it looks like: tiny orange or pinkish crystals. They are harmless: they are salts in the urine, and tend to show up in the very early days. Most babies will pass them once only. They can be a sign your baby needs a little help to feed more often or more effectively. Ask you midwife.

Further information

Our support line offers practical and emotional support with feeding your baby and general enquiries for parents, members and volunteers: 0300 330 0700.

You might find attending one of NCT's Early Days groups helpful as they give you the opportunity to explore different approaches to important parenting issues with a qualified group leader and other new parents in your area.

Make friends with other parents-to-be and new parents in your local area for support and friendship by seeing what NCT activities are happening nearby.

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Newborn baby poo in nappies: what to expect | Baby & toddler articles & support | NCT

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Wees: Five or more heavy nappies per day. Poos: At least two soft, yellow poos per day. They're yellow, because there is no more 'mec' in the bowel. False menstruation or pseudo menstruation is harmless. It is a very light bleed from the vagina in some baby girls.

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Here’s an excellent UNICEF leaflet called “Building a Happy Baby” on parenting facts and myths: 

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Here’s an excellent UNICEF leaflet called “Building a Happy Baby” on parenting facts and myths: 

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This leaflet offers advice and information for parents on getting to know their baby and setting up the foundations for a close and loving relationship.

We now know that building a strong relationship between parents and their new baby will give them the best possible start in life, and will help them to grow up happy and confident. This leaflet, which is free to download, helps parents to develop that strong relationship, starting in pregnancy and continuing into the early days, weeks and months of a baby's life.

Health professionals may want to use this leaflet in conjunction with the Baby Friendly guide to antenatal and postnatal conversations, and accompanying signature sheets.

Printed copies cost £15 per pack (1-9 packs) or £11 per pack (10 or more packs). There are 50 leaflets per pack and this price includes P&P within UK. Order using the Baby Friendly Resources order form, which you can download from our Resources page.

Find more relationship building resources

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Building a happy baby: A Guide for Parents Leaflet - Baby Friendly Initiative

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We now know that building a strong relationship between parents and their new baby will give them the best possible start in life, and will help them to grow up happy and confident. This leaflet, which is free to download, helps parents to develop that strong relationship, starting in pregnancy and continuing into the early days, weeks and months of a baby's life.

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The amount of close and comforting contact between infants and their caregivers can affect children at a molecular level: 

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The amount of close and comforting contact between infants and their caregivers can affect children at a molecular level: 

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Faculty of Medicine, University of British Columbia

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The amount of close and comforting contact between infants and their caregivers can affect children at the molecular level, an effect detectable four years later, according to new research from the University of British Columbia and BC Children's Hospital Research Institute.

The study showed that children who had been more distressed as infants and had received less physical contact had a molecular profile in their cells that was underdeveloped for their age - pointing to the possibility that they were lagging biologically.

Although the implications for childhood development and adult health have yet to be understood, this finding builds on similar work in rodents. This is first study to show in humans that the simple act of touching, early in life, has deeply-rooted and potentially lifelong consequences on the epigenome - biochemical changes that affect gene expression.

"In children, we think slower epigenetic aging could reflect less favorable developmental progress," said Michael Kobor, a Professor in the Department of Medical Genetics who leads the "Healthy Starts" theme at BC Children's Hospital Research Institute.

The study, published Nov. 22 in Development and Psychopathology, involved 94 healthy children in British Columbia. Researchers from UBC and BC Children's Hospital asked parents of 5-week-old babies to keep a diary of their infants' behavior (such as sleeping, fussing, crying or feeding) as well as the duration of caregiving that involved bodily contact. When the children were about 4 ½ years old, their DNA was sampled by swabbing the inside of their cheeks.

The team examined a biochemical modification called DNA methylation, in which some parts of the chromosome are tagged with small molecules made of carbon and hydrogen. These molecules act as "dimmer switches" that help to control how active each gene is, and thus affect how cells function.

The extent of methylation, and where on the DNA it specifically happens, can be influenced by external conditions, especially in childhood. These epigenetic patterns also change in predictable ways as we age.

Scientists found consistent methylation differences between high-contact and low-contact children at five specific DNA sites. Two of these sites fall within genes: one plays a role in the immune system, and the other is involved in metabolism. However, the downstream effects of these epigenetic changes on child development and health aren't known yet.

The children who experienced higher distress and received relatively little contact had an "epigenetic age" that was lower than would be expected, given their actual age. A discrepancy between epigenetic age and chronological age has been linked to poor health in some recent studies.

"We plan to follow up on whether the 'biological immaturity' we saw in these children carries broad implications for their health, especially their psychological development," says lead author Sarah Moore, a postdoctoral fellow. "If further research confirms this initial finding, it will underscore the importance of providing physical contact, especially for distressed infants."

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bc children s hospital research institute

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Holding infants - or not - can leave traces on their genes

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The amount of close and comforting contact between infants and their caregivers can affect children at the molecular level, an effect detectable four years later, according to new research from the University of British Columbia and BC Children's Hospital Research Institute.

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Although not everyone agrees with swaddling babies, many cultures have used this practice throughout history, as it is thought that the feeling of being 'contained' or held within the blanket can help babies to feel settled or less fretful and can also help them to sleep.

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Here’s some information on baby massage for colic:

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Here’s some information on baby massage for colic:

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Using Infant Massage to Relieve Colic | Isis Parenting

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Here’s a thought-provoking article about nappy changing:

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Here’s a thought-provoking article about nappy changing:

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We are conflicted about nappy changing these days. As a society, it makes us uncomfortable. It is distasteful, involving dirty, smelly bodily substances. It is anxiety provoking, requiring the exposure of babies' genitals. It is inconvenient, necessitating a pause in the midst of whatever other activity a parent has underway. And it frequently emotional, with babies refusing to lie still or staring intently into their caretaker's face.

For all these reasons, nappy changing is something we don't usually talk about in polite circles. It may be a necessity of life with a baby, but it's not exactly a subject for the dinner table, is it? It might therefore seem too inconsequential a topic for a whole article, especially when you consider that other pieces in this blog series have focused on 'serious' subjects, like terrorism and abuse and brain development.

Yet, to my mind, that is exactly the reason for writing a piece on nappy changing. Babies' brains grow more rapidly during the period of life during which they need their nappies changed than will ever be the case again. Approximately 1000 synaptic connections are formed every second during this period. Astounding. And it is the emotional experiences that babies have over and over again that build the most robust neural pathways. Nappy changing is undoubtedly an activity that babies encounter repeatedly. Indeed, over just the first six months, there are approximately 10 changes per day, each lasting, say, 5 minutes. That's 9000 minutes or 540,000 seconds, and thus half a billion synapses.

So nappy changing isn't quite as inconsequential as we might at first have thought. It has an impact on babies' brain development. More specifically, the emotional experiences that caretakers give babies whilst changing their nappies are being built into babies' brains.

I thought, therefore, that it would be interesting to reflect on the ways in which modern society encourages us to approach the task of nappy changing. This is an appropriate moment for such reflection, given that Real Nappy Week is taking place this very week in London. Most people won't have any idea there is a group of committed individuals who want to celebrate the benefits of real cloth nappies. This article is my way of supporting their efforts.

So what are some of the big messages we get about nappy changing in today's society?

One message is that nappies are disgustingly funny. Take, for example, the videos that regularly travel the web that show fathers wretching whilst changing nappies. In August 2015, a tattooed, uniformed father gained international attention when the video of him vomiting as he soldiered on with nappy changing went viral, featuring eventually on television and in newspapers.

Why is it always Dads? I know that we regard ourselves as having 'moved on' as a society, because once upon a time fathers never changed nappies at all. But this humiliating form of humour says something darker about the way we frame modern masculinity. We are either laughing at dads' incompetence - or turning them into heroes for coping with something ordinary. Indeed, if you want a gag gift for new fathers, you can buy a 'doodie apron', which comes complete with nose peg, face mask and gloves, all designed to help a father keep the disgusting productions of his baby's body at bay.

I know it's supposed to be funny. And I know I sound like I need to get a life if I'm not laughing at the innocent joke. But I find myself wondering about the baby's experience. Is the baby scared when confronted with Dad clad in a face mask? Does the baby feel ashamed when Dad looks disgusted in reaction to the substances that her body produces? Does the baby feel embarrassed when parents start laughing whilst filming 'poo faces' to send to Pampers as part of an advertising campaign?

Here's my point: we feel okay about all this laughter because we think it's only about the adults. We don't think it matters to the babies. We wouldn't laugh at older people with dementia who are pooing, because we would think that was disrespectful. But when it comes to babies, we think they don't notice. That why the joking seems innocent and can't do harm to anybody.

Except it's not true. Babies are born with a connected brain. That means they are already aware of and attuned to and reading other people's emotions, facial expressions and behaviour. Babies learn about themselves by the way we treat them. This includes the way we treat them during activities as 'inconsequential' as nappy changing. If we react often enough to babies' bodies with disgust, then they start to see themselves as disgusting. It is ominously fascinating to realise that we can build a sense of shame into our child's brain by the way we treat them during nappy changing. As parent, we can do that without ever realizing or intending to. And modern society makes it more, not less, likely that we will do just that.

What's another message that we get in today's world about nappy changing? How about this one: the less it happens, the better. Pampers and Huggies make disposable nappies d esigned to last 12 hours without the need for a change. The idea is that parents don't have to be interrupted in the midst of other activities with their wee ones. Babies can remain strapped into car seats and strollers and carry cots. They don't have to risk being woken at night.

Modern society creates more and more devices that reduce babies' opportunities to feel their parents' touch. Of all the senses, touch is the most important for babies. It is the first sense to develop in the womb and the most developed at birth. Skin is our largest organ, and the sensations that skin sends to the brain are so powerful that they act as pain relief. In our evolutionary history, babies spent much more time experiencing touch, strapped as they were to a parent's body during the day and sleeping next to a parent's body at night. Modern babies experience an extremely different type of infancy than did our forebears.

Yes, babies adapt to the modern world. Skeptics will reply that babies are clearly surviving in today's world of nappies, transport devices and sleeping arrangements. I agree, they are. But I also know that without sufficient touch and physical attention, babies die. That was one of the points to come out of studies of Romanian orphans. Infant humans depend on the physical presence of another human being in order to survive.

Could the decreasing amount of touch that modern babies receive be one of the reasons that our society is witnessing an increase in behavioural problems associated with emotional regulation? The most fundamental pathways that the brain is forming during the early years are the ones that enable to us to cope with - that is, regulate - our emotions.

So maybe it would be better if disposable nappies weren't quite so efficient? Maybe it would be better for babies' emotional health if nappy companies could find ways to inform parents about the crucial importance of touch and cuddling and feeling Mum's warm fingers on your skin - even while they search for ways to keep urine from reaching a baby's skin.

That's one of the aims of Real Nappy Week. The celebrations aren't designed only to highlight the value of non-disposable nappies, but to get us as a culture to rethink the whole business of nappy changing.

So what's one final modern-day message to which we might pay attention? How about the way in which our fear of sexual abuse now overlaps with nappy changing?

Many nurseries now have a policy that requires two members of staff to be present when nappies are changed, in order to guard against the risk of inappropriate touch. We are scared that the people who have been vetted to take care of our children might harm them, and nakedness makes nappy changing seem a particularly vulnerable setting.

Videos that instruct new parents on how to change nappies are frequently shot from an angle that avoids revealing babies' genitals, or are edited so that the genitals are blurred out. How ironic that the very parts of the body that generate the need for a nappy change cannot be shown on film. In our struggle to come to terms with the very real risks that children face of being sexually abused, we have further sexualised our youngest children.

In the run-up to Real Nappy Week, my team released our brief film 'dance of the nappy'. The film is excerpted from our longer feature-length film, 'the connected baby', first released in 2011 with funding from the British Psychological Society. We estimate that the longer film has now been viewed by 100,000 people, but this is the first time we have released an entire segment for public viewing on YouTube.
The film shows the intricate emotional dance that goes on between a 5-week-old baby and his mother during an ordinary nappy change. The baby's emotional responses to his mother's movements and facial expressions are so nuanced that it would be easy to miss them. That's why we wanted to make the film: because such moments of connection are happening for babies across the world, but it is easy for parents to overlook them because they are so subtle and fleeting. Video footage makes it possible to slow everything down and reveal what is not apparent to the naked eye.

After filming that session, I realised the baby's genitals were in full view. The mother realised it too. She commented on it at the time, whilst we were filming. Later, during editing, she confirmed that she was comfortable with retaining the footage. But I had to ask myself: was I comfortable with it? Was it appropriate in today's society to show a 5-week-old baby's genitals on a movie screen? What would I say if someone challenged my decision? What if, later, when the baby is grown, he resents having had his bum shown off to the world? What if I was accused of encouraging inappropriate touch because his genitals appear briefly but undeniably?

My decision was not to change anything. I decided that real-life nappy changing means exposing and cleaning baby's genitals. I decided that merely alluding to that, by editing out that footage, actually feeds our modern day fear that genitals are inherently sexual, even those of a 5-week-old baby. I decided that I was making a film that was trying to show how connection is possible at all points in a baby's day, including during an activity as 'disgusting' as changing a pooey nappy. Because that's exactly what the film shows - not just a Number One, but a Number Two. And the interaction between the mum and her baby is still loving and affirming. The baby gets no sense that his bodily excrement is shameful to her. After weeks of fretting, I decided I could defend such a scene to the world.

This week, I was reminded about my early worries. Since our public release on YouTube last week, I have received queries from three people, expressing unease that the film shows 'everything'. I was relieved to realise that I now welcomed such debate, rather than feared it. Those weeks I had spent agonizing had been valuable, for they enabled me to articulate the position I take in this debate.

And here is my position: Something is emotionally askew in our modern society. On the one hand, the global company Pampers can make an award-winning film that is intentionally designed to make us laugh at babies' unease and discomfort when they poo. On the other hand, we can be made uncomfortable by a film that shows the real poo and the parts of a baby's body that produced it. Something is awry in our reasoning.

I like the idea that a scene of something as tediously ordinary as a pooey nappy can become a radical act. A baby boy's bum can make us reflect in new ways on our own humanity.

So, to the grown man of the future who was once that baby boy, let me offer my thanks and my apologies now. It was your bum that offered us this gift of reflection. Your mother says in the film: "One day you might really hate that I did this in front of the camera." I hope you don't. Because every time I show this film, I offer you a silent, grateful thanks for the trust you placed in us that day.

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Changing nappies is as much about babies' brains as their bottoms

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We are conflicted about nappy changing these days. As a society, it makes us uncomfortable. It is distasteful, involving dirty, smelly bodily substances. It is anxiety provoking, requiring the exposure of babies' genitals. It is inconvenient, necessitating a pause in the midst of whatever other activity a parent has underway.

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I run monthly 'Introducing Solids' workshops, which focus on Baby Led Weaning; if you're interested, please send me an email when your baby is 4 or 5 months old. 

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I run monthly 'Introducing Solids' workshops, which focus on Baby Led Weaning; if you're interested, please send me an email when your baby is 4 or 5 months old. 

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As well as covering the principals of Baby-Led Weaning, I discuss everything parents need to know about introducing solids in detail. We discuss the theories and practicalities, such as the evidence about when to start introducing solids, which foods to give and which to avoid, the difference between gagging and choking, allergies, and how to avoid picky eating.

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Co-sleeping and SIDS:

While some young babies settle easily in a cot or Moses basket between feeds, others do not. Some parents who choose not to co-sleep may decide to encourage their baby to learn to sleep independently using the controlled crying method, which is not recommended. This approach can be distressing for the parents and their baby, be detrimental to the baby’s growth and development and can undermine breastfeeding.

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A randomized controlled trial of burping for the prevention of colic and regurgitation in healthy infants. - PubMed - NCBI

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Child Care Health Dev. 2015 Jan;41(1):52-6. doi: 10.1111/cch.12166. Epub 2014 Jun 9. Randomized Controlled Trial

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Revised
Reflux, spitting up or possetting are all names used to describe babies bringing back some of the milk that they swallowed earlier. Some spitting up is quite normal in young babies, this may simply be how they deal with too much milk or anything that doesn't agree with them .

Reflux is very common

Reflux -full name gastroesophageal reflux (GER)-in newborns is very common. In Breastfeeding and Human Lactation, the authors explain that infants with reflux are generally happy and thriving babies who spit up at least once or more per day most days. One study found 73% of babies spit up in their first month of life and that babies who were exclusively breastfed spit up less often than infants who received mixed feeding.

Unless your baby has the more severe symptoms of gastooesophageal reflux disease (GERD) discussed below, the only problem with a lot of spitting up might be that you have more laundry to do.

Why do babies spit up?

Dr Jack Newman, Canadian paediatrician and breastfeeding expert explains how spitting up regularly may have a protective function if the baby is otherwise happy and gaining weight:

Breastmilk is full of immune factors (not just antibodies, but dozens of factors that interact with each other) that protect the baby from invasion by bacteria and other microorganisms (fungi, viruses, etc.) by forming a protective layer on his mucous membranes (the linings of the gut, respiratory tract and other areas). This protective layer prevents micro-organisms from invading the body through these mucous membranes. A baby who spits up gets extra protection, first when the milk goes down to the stomach, and again when he spits it up.

Vomiting due to illness or other medical reasons is not the same as reflux and will be more forceful and your baby will seem poorly, contact your health care professional if you have any concerns.

Causes of reflux in babies

Although some spitting up is normal, and may have a protective function, certain factors may worsen symptoms.

1. Immature sphincter muscle?

Reflux is sometimes attributed to an immature sphincter muscle which is said to strengthen as the baby grows through their first year . However author Linda Palmer describes this "immaturity" as a perfectly normal phenomenon considering 70% of babies have a "weak" lower esophageal sphincter saying: "This is not an error; it is normal". And fellow author Maureen Minchin says the oesophageal sphincter is "beautifully evolved".

2. Cows' milk allergy and reflux

Studies have shown a link between reflux and having an allergy or intolerance to cows' milk protein (Palmer, 2015). There could also be a sensitivity to some other food allergen, excess caffeine or second hand smoke ( Kelly Bonyata, 2011). If a mother tries removing dairy products from her diet, the symptoms of reflux will improve if her baby is sensitive to cows' milk protein. See Milk Allergy in Babies and Elimination Diet for further information.

If a baby is reacting to his mother's diet it makes little sense to move to formula as an answer. The cows whose milk is modified into industrial formula also eat foods that could be potential allergens such as grasses (grains), corn, soy, or wheat (Palmer, 2015).

3. Fast flow and oversupply

Babies may spit up more if they're getting too much milk (often called oversupply) or too much milk too quickly. If your baby gulps and gasps or lets go of the breast just after you have a let-down because the flow seems too fast for him, you could try taking him off the breast for a moment or two until the flow slows a little. A container or towel can catch the milk and once the flow has slowed your baby may be better able to cope with his feed. For more coverage on the subject of true oversupply and fast flow see #4 below and our article on oversupply.

4. Tongue function

How well a baby can handle milk flow can depend on whether they have a deep latch and a good tongue function. Your IBCLC lactation consultant can check whether your baby's latch, positioning or tongue function could be improved or whether any steps need to be taken to manage your supply. The tongue moving in the right direction is thought to set the stage for the swallowing reflex down the oesophagus and into the stomach and beyond. Alison Hazelbaker says being tongue-tied could interrupt this reflex action and could lead to sluggish digestion, inflammation, gas, trouble pooping and may cause symptoms of reflux, colic or secondary lactose intolerance in babies . Poor tongue function may lead to excessive swallowing of air according to some practitioners. American surgeon Scott Siegel calls this aerophagia induced reflux (AIR) and calls for more research .

Is reflux in newborns the same as acid reflux in adults?

No, most infant reflux and silent reflux (when the regurgitated milk comes part way up the oesophagus then goes back down to the stomach) is not acidic . Author Linda Palmer explains:

Milk (human, formula, or cow) is quite alkaline, as opposed to acidic, and baby tummies themselves are low in acid, compared to child or adult stomachs. Half of all infants visibly spit up at least once per day. Even more babies experience silent reflux, which is when stomach contents spill only partway up the throat and go down again without coming out of baby's mouth. Most infant reflux is not highly acidic and likely not uncomfortable nor damaging to esophageal tissues.

This ties in with Dr Jack Newman's reasoning above that spitting up is probably beneficial (and normal) due to all the protective factors in breastmilk washing up and down the food pipe. Rarely, babies suffer from more severe forms of reflux. It also ties in with studies that have not found acid reducing medication effective .

Severe forms of reflux

A rare form of reflux called gastro-oesophageal reflux disease (GERD) may cause pain and other problems .

Some babies with allergy can suffer from an inflamed oesophagus (eosinophilic esophagitis) causing reflux and difficulty swallowing (Minchin, 2015).

In a small number of cases, reflux is a sign of something more serious such as a blockage (e.g. pyloric stenosis)

What is GERD?

The acronym for gastro-oesophageal reflux disease is GORD or GERD depending where you are in the world and how you spell oesophagus. Sources suggest only one in 300 infants actually has GERD needing treatment yet the number of babies given acid-reducing medication tends to be very much higher than this figure .

Symptoms of GERD

There isn't a set of symptoms that is definitely diagnostic of GERD in babies. Of the potential symptoms and signs associated with GERD many can have other causes giving potential for GERD to be over diagnosed. Symptoms often described include:

1. Bringing up large amounts of milk after most feeds, or frequent burping or hiccups-symptoms that could also be due to allergy or normal baby behaviour.

2. Poor weight gain or other feeding difficulties such as pulling at the breast and fussing, refusing to feed or conversely, feeding continuously for comfort-small volumes of milk are said to act like an antacid. Note; these symptoms are also seen with low milk supply.

3. Being in pain or fussy and irritable between feeds, having difficulty sleeping, lying flat or waking with screams. Or back arching and twisting the neck between feeds (Sandifer's Syndrome). Note: unexplained crying can be from other causes and may not be due to abdominal pain . Underweight babies can present as "fussy" due to hunger (see below).

4. Associated breathing problems, chest infections, pneumonia, asthma, wheezing or apnea-note similar symptoms may sometimes be seen with allergies.

5. A sore throat, or inflammation to the food pipe with gagging, choking, coughing or difficulty swallowing, may have hoarse sounding cries. May have bad breath or acid damage to teeth. Some of these symptoms could also be related to allergy or oversupply.

Fussy baby, hungry baby?

A baby fussing during feeds, pulling at the breast, refusing the breast, not wanting to lie flat, or being fretful can have other causes. A possible reason can be if your baby is not getting enough milk and is not gaining weight normally, and Dr Jack Newman notes that symptoms of reflux may be associated with low milk supply. Oversupply and food allergy can also be confused with not enough milk and rigid approaches to a perception of "oversupply" can quickly become "not enough milk" (Newman, 2014). True oversupply can sometimes cause symptoms of lactose overload. Other causes for fussing in babies are described in Fussy Breastfed Baby. If you are not sure what is making your baby fuss, always check with your health professional and find an IBCLC lactation consultant to help you if it could be connected to feeding issues.

Helping reflux

Frequent small feeds, keep baby upright, burp baby

General suggestions include:

1. Upright positions for feeding, carrying and gentle handling. Try frequent smaller breastfeeds rather than large feeds further apart (Womanly Art of Breastfeeding, 2010)

2. Conversely breastfeeding in a laid back position may help (Wambach & Riordan, 2015)

3. Look at mum's diet and consider if an Elimination Diet could help if allergies are involved

4. If oversupply is suspected check positioning, tongue function and breastfeeding management with your lactation consultant

5. Burping your baby regularly may help prevent milk travelling back out with gas bubbles

6. Baby lying on his left side may be more comfortable (Minchin, 2015).

7. Comfort sucking on an empty breast

Thickened feeds not recommended

Breastfeeding authors Wambach and Riordan discuss the drawbacks of thickening milk feeds to help reflux:

Occasionally providers will suggest thickened feedings with cereal. When cereal is added to breastmilk, enzymes break it down very quickly, and it is an ineffective thickening agent. Furthermore, thickened feedings have not been found to be effective. The frequency of reflux episodes may be reduced, but exposure of the oesophagus to acidic gaseous material is increased, probably because thickened gastric contents do not clear as quickly (Bailey et al, 1987). In addition use of cereal-thickened feedings is associated with coughing in infants with GERD (Orenstein et al., 1992).

Author Maureen Minchin describes thickeners as food additives carrying risks that should have no place in the treatment of complicated reflux. She shares that in 2012 commercial thickener "Simply Thick" was linked to the deaths of seven babies.

Medication

Medications such as antacids prescribed by your doctor can reduce the acidity of gastric secretions and offer short term acid reduction and symptom relief for GERD. However as discussed above, most baby reflux is not acidic and medication will not be helpful for normal reflux:

In the case of infants, most reflux is buffered by frequent feeds and seldom is of acid pH,19 which seems to have been largely ignored by prescribers of medication.

The largest randomized, controlled study to date in infants showed that for symptoms purported to be those of GERD, a PPI [proton pump inhibitor] was no better than placebo.

The Breastfeeding Network in the UK has a reflux information sheet discussing suitable medications when truly needed. However adverse events associated with some medications may outweigh their benefits ( Vandenplas 2009). For example reflux medications and simple antacids can cause constipation in babies (Palmer, 2015 p 179) or may affect digestion and result in food intolerances (Minchin, 2015). If medication for GERD doesn't help, contacting a lactation consultant may help rule out any other causes for fussiness that may be connected to breastfeeding.

Colic remedies?

The symptoms of colic (unexplained crying and tummy ache in an otherwise healthy baby) have similarities with reflux or silent reflux. Parents may come across suggestions to try gripe water or Infacol for a fussy baby (traditional "cures" for colic). Author Linda Palmer warns that gripe water may contain a lot of sugar and "cures nothing" and re simethicone drops (Mylicon, Infacol) she says studies indicate "they work no better than placebos".

Probiotics?

Probiotics are live bacteria and yeasts that are widely promoted as having health benefits when these "friendly bacteria" are added to our diet. There is more about probiotics generally on the NHS website which points out that there is little evidence for many of the health claims surrounding them. Could probiotics help reflux in babies? In her book author Linda Palmer says although probiotics may be useful for healing a baby's damaged gut in certain circumstances, they are not a cure for colic and reflux. There is still much to learn about probiotics and how they could affect babies for better or worse. For a discussion of the pros, cons and unknowns about probiotics for babies see Are Baby Biotics Bugging You? by Maureen Minchin or her book Milk Matters which is reviewed here.

Cranial Work

Some parents have felt that baby massage and cranial osteopathy helped with their babies' symptoms of colic and reflux ( NCT, 2017).

Summary

Spitting up is a normal event for babies and doesn't usually cause them a problem although more severe forms are possible e.g. GERD. Certain underlying causes such as allergy, oversupply, lactose overload and poor tongue function can make reflux worse. Working with an IBCLC lactation consultant alongside your health professional can help find ways to reduce reflux or identify other possible reasons for an otherwise healthy breastfed baby to be miserable and fussy.

1. A ring of muscle between the stomach and the food pipe preventing spillage of the stomach contents

2. Tongue-Tie Morphogenesis, Impact, Assessment and Treatment, Alison Hazelbaker, 2010, p 89

3. Pyloric stenosis is the narrowing of outlet between the stomach and small intestine. It causes projectile vomiting and is more common in formula fed babies. Author Maureen Minchin says there is considerable evidence that it is due to inflammation and damage from cows' milk.

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Reflux in Newborns - Breastfeeding Support

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Revised Reflux, spitting up or possetting are all names used to describe babies bringing back some of the milk that they swallowed earlier. Some spitting up is quite normal in young babies, this may simply be how they deal with too much milk or anything that doesn't agree with them .

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As of November 2016, UNICEF changed its guidance, and now recommends giving breastfed babies vitamin D supplementation from birth: 

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As of November 2016, UNICEF changed its guidance, and now recommends giving breastfed babies vitamin D supplementation from birth: 

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Here are some vitamin D drops recommended by a dietitian: 

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Here are some vitamin D drops recommended by a dietitian: 

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Baby Ddrops® | Vitamin D Drops | Ddrops® UK

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Your source for odourless, tasteless & preservative free vitamin D drops in the UK. Ddrops is a purified vitamin D3 supplement.

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If you decide to give your baby a bottle, whether of breastmilk or formula, it's crucial to practise PACED BOTTLE FEEDING, in order to protect your baby's ability to self-regulate:

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If you decide to give your baby a bottle, whether of breastmilk or formula, it's crucial to practise PACED BOTTLE FEEDING, in order to protect your baby's ability to self-regulate:

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Paced Bottle Feeding For The Breastfed Baby

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Baby wearing (using a baby carrier or sling) is a very useful parenting tool: 

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Baby wearing (using a baby carrier or sling) is a very useful parenting tool: 

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Messager Babywearing slings pull out_2-6

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Many parents and babies love introducing solids using the Baby Led Weaning method: 

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Many parents and babies love introducing solids using the Baby Led Weaning method: 

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Article summary

Introduction

How should solid foods be introduced to infants? Do different weaning methods impact on food preferences and health-related outcomes? These questions are currently unanswered. To date, the focus on weaning has been on when, rather than how, to wean. 1 Recently, much media attention has centred on baby-led weaning, 2 3 which emphasises infant self-feeding with solid finger foods from the outset rather than parental spoon feeding with purees. Baby-led weaning is suitable for most infants 4 and is associated with (1) reduced maternal anxiety about weaning and feeding 5 and (2) a maternal feeding style, which is low in control. 6 However, the impact of this weaning method on food preferences and health-related outcomes is not known. Thus, we examined the influence of different weaning styles on food preference, body mass index (BMI) and picky eating in early childhood.

Methods

Parents of 155 children (aged 20-78 months) were recruited to the study between June 2006 and January 2009. The baby-led group (n=92) was recruited through an advert posted on relevant internet sites; the spoon-fed group (n=63) was recruited from our toddler laboratory database.

Participants completed a questionnaire (a standard research tool for examining food preferences 7) concerning the following: (1) infant feeding and weaning style. (2) Child's preference (rated from 1 'loves it' to 5 'hates it') for 151 foods (adapted from Wardle et al 8), which was analysed by standard food categories, for example, carbohydrates, proteins, dairy, 9 and included a category called 'meals' for whole meals like lasagne. 8 See supplementary information in etable 1 for details. (3) Exposure (frequency of consumption) rated from 1 'more than once a day' to 7 'less than once per month', as this is closely related to food preferences. 10 11 (4) Picky eating (a single item requiring a 'yes/no' response to 'Would you classify your child as a picky eater?'). (5) Child height and weight for BMI calculation (weight in kilograms divided by the square of the height in metres). In the spoon-fed group, these measurements were made using standardised procedures when assessed in our laboratory. We calculated BMI z-scores using the WHO Growth Standards. 12 BMI percentile ranks were calculated using the Centers for Disease Control and Prevention (CDC) Child and Teen BMI Calculator 13 and the National Health Service (NHS) Choices BMI Calculator 14 (which uses UK90 reference data for children older than 4 years 15 and WHO Growth Standards data for children younger than 4 years). 12 (6) Socioeconomic status (via postcode using the Income Deprivation Affecting Children Index (IDACI) score and rank for 2007 and National Statistics 2001 Area Classification of Super Output Areas and Data Zones)). 16 These measures are frequently used in social and health-related research with children and by government departments. 17 Socioeconomic status has been shown to influence eating practices and behaviours. 18−20 (7) Marlowe-Crowne Social Desirability Scale (short form). 21 Parents who returned a completed questionnaire were entered into a prize draw for £50. Ethical approval was granted by the University of Nottingham School of Psychology Ethics Committee. Parents completed a consent form prior to participation in the study.

Data were analysed using PASW Statistics V.18.0. 22 Pearson's correlations and t tests were used to examine relationships between outcome measures and groups, respectively. Non-parametric tests (Spearman's rank correlations, Mann-Whitney U) were used when there was significant skew or problems with homogeneity (Bonferroni-corrected for multiple comparisons). Missing food preference data were accounted for in the calculation of averages across categories. Cases with other missing data (eg, BMI) were excluded from analyses. Preliminary analyses showed that exposure and preference ratings were not contaminated by socially desirable responding and only liking for vegetables was significantly related to socioeconomic status (IDACI score) (r s=−0.25, p=0.005) (higher social class associated with increased liking for vegetables).

As no formal definition of baby-led weaning exists, 6 parental self-report of weaning style was used to generate weaning groups. To verify the veracity of self-reported weaning style, responses to items concerning weaning methods were interrogated. This confirmed that the baby-led group were more likely to have handled food from the introduction of solid foods, were given finger foods earlier and fewer had been spoon-fed with pureed foods at all ( table 1). Thus, the two groups differed significantly on criteria typically used to characterise baby-led weaning. 6

Results

The baby-led group was significantly younger than the spoon-fed group ( table 1), and overall age and preference were significantly correlated (collapsed across food categories, r s=0.28, p=0.001; and for the individual food categories of dairy, r s=0.35, p<0.0001; snacks, r s=0.21, p<0.009 and meals, r s=0.26, p=0.001). To control for this effect of age, a case-controlled age-matched sample of 74 participants (37 pairs) was generated to analyse the food preference data (see table 2 for details).

Between the two weaning groups, significant differences in preference were found for only one food category-the baby-led group liked carbohydrates more than the spoon-fed group (t (72)=−3.11, p=0.003, d=−0.53). Indeed, carbohydrates were the most liked food category for the baby-led group, whereas sweet foods were most liked by the spoon-fed group ( table 2). The baby-led group also liked proteins (t (72)=−2.71, p=0.008, d=−0.63) and whole meals (U=448.00, p=0.02, d=−0.40) more than the spoon-fed group, but these differences did not survive Bonferroni adjustment.

Next, we investigated the effects of exposure on food preferences in the matched sample 10 11 ( table 3). Across groups, comparisons revealed increased exposure to vegetables, fruit, carbohydrates, protein, meals and sweets in the spoon-fed group. Exposure was significantly associated with liking for dairy foods (r s=0.58, p<0.0001), snacks (r s=1, p<0.001), vegetables (r s=0.47, p<0.0001) and proteins (r s=0.44, p<0.0001). No association was found for carbohydrates (r s=0.19, p=0.11), sweet foods (r s=0.19, p=0.11), fruits (r s=0.10, p=0.39) and meals (r s=0.17, p=0.14). This suggests that for carbohydrates, the only food category with significant group differences, weaning style was more influential than exposure on preference ratings.

Finally, we investigated the influence of weaning method on health-related outcomes. BMI scores (percentile rank) differed significantly between groups ( table 1)-lower BMI were associated with baby-led weaning in the whole sample. (This difference was also evident in the matched sample-NHS percentile rank (U=276.50, p=0.008) and CDC percentile rank (U=268.50, p=0.005)). As shown in table 1, the mean BMI percentile rank for the baby-led group was close to the expected average (percentile rank of 50) for both the NHS and CDC classification systems. In contrast, the mean percentile rank for the spoon-fed group was above the average level, indicating that more children in this group were likely to be classed as overweight.

BMI z-scores were also found to differ significantly between the weaning groups (see table 4). To investigate this further, we determined the number of children in each group classified as significantly underweight (z-score more than −2) and those who were obese (z-score of more than +2)-clinically the most concerning cases. Using this criterion, we found there to be an increased incidence of obese children in the spoon-fed group (n=8) as compared to the baby-led group (n=1). In contrast, more children in the baby-led group were classified as significantly underweight (n=3) compared to the spoon-fed group (n=0) (Fisher's exact test, p=0.02, two-tailed). A similar pattern of results was found when child BMI was classified according to percentile rank (see table 4).

BMI (WHO z-score) was not correlated with socially desirable responding in the baby-led group (where self-report of height and weight measurements was used, r s=−0.13, p=0.29). Also BMI (WHO z-score) did not correlate with socioeconomic status (IDACI score) (r s=−0.07, p=0.51) or breastfeeding duration (r s=−0.10, p=0.29) in the whole sample. (There was also no correlation between BMI scores and breastfeeding duration in the matched sample (r s=−0.11, p=0.43)). The same pattern of results was found when using the BMI percentile rank measures. (No difference between the two weaning groups was found in the prevalence of picky eaters ( table 1)).

Discussion

Understanding the factors that contribute to healthy nutrition in early childhood is crucial as this could be the optimal time to modify food preferences so as to foster healthy diets in obesogenic food environments. 10 Our findings show that baby-led weaning has a positive impact on the liking for carbohydrates-foods that form the building blocks of healthy nutrition (ie, those found at the bottom of the food pyramid). 9 This is a significant finding since, to date, the factors thought to be most influential on early food preferences are sweetness and familiarity (exposure). 10 Consistent with previous research, the spoon-fed group preferred sweet foods most, whereas the baby-led group most preferred carbohydrates (even though significantly higher exposure to carbohydrates was reported in the spoon-fed group).

Children weaned using the baby-led method are more likely to encounter carbohydrates in their whole food format earlier than spoon-fed children as these foods are ideal early finger foods (eg, toast and pitta breads) so age of introduction may impact on behaviour. However, our data show that exposure per se did not influence preference for carbohydrates, so another factor must be driving preference here. Presenting carbohydrates to infants in their whole food format, such as toast, rather than a pureed form may highlight awareness of perceptual features (such as texture) that is masked when food is pureed. Previous research has shown that food presentation significantly influences food preferences, 23 so it is possible that differences in the presentation of foods across the two weaning groups impacted on preferences. It is also possible that carbohydrates are easier to masticate compared to some other foods such as meat (which may be easier to eat when pureed and spoon-fed). Interestingly, the baby-led group showed increased preference for all food categories except sweets compared to the spoon-fed group (although this was only significant for carbohydrates).

Our results also showed that baby-led weaning was associated with lower BMI (in terms of mean percentile rank) that could not be accounted for by differences in birth weight, parental BMI or socioeconomic status. The analysis of BMI z-scores revealed an increased incidence of underweight (the baby-led children (3/63)) and an increased incidence of obesity (the spoon-fed children (8/63)). It should be noted that there was some missing data on BMI in the baby-led group (32%). However, in both groups, the vast majority of the children were of an average/healthy weight (see table 4). In contrast to past literature, 24 breastfeeding duration and BMI were not significantly associated. This discrepancy may be due to the fact that the vast majority of the mothers in this sample breastfed their babies and for much longer periods of time than might be expected from past research. 25 Nonetheless, duration of breastfeeding may have a mediating effect, which requires investigation in relation to the impact that weaning style has on BMI. No difference in the prevalence in picky eating was found across groups. Moreover, 93.5% of the baby-led group reported that their child had never experienced a choking incident (a serious concern for parents and practitioners). 2

Our results suggest that baby-led weaning promotes healthy food preferences in early childhood that could protect against obesity. This finding is of note given the serious problems with childhood obesity facing many modern societies. 26 The baby-led approach was, however, associated with a higher incidence of underweight relative to the spoon-fed group. The factors underlying this require exploration in future research.

To the best of our knowledge, this is the first study to have examined the impact of weaning method on food preferences and health outcomes in early childhood. Future research should determine whether our findings hold for more specialist populations, such as babies born prematurely or with specific health difficulties. Moreover, careful consideration should be given to the classification of weaning method. In the present study, we relied on parents identifying themselves as having used baby-led weaning (and we checked the reliability of this self-report by asking some specific questions about their weaning practices). This gave rise to a dichotomous variable-either the parents used baby-led weaning or they did not. However, it may be more sensitive to consider weaning methods as a continuum where parents rate the percentage use of pureed foods in their child's diet over time. 5 In addition, previous studies have shown that parents who used the baby-led approach to weaning are less controlling and more willing to hand control over to the child when introducing solid foods. 6 Future research needs to address the contribution of this factor into any effect of weaning method on food preferences.

A large controlled prospective study is now required, which examines weaning practices in tandem with the other key factors, including BMI, milk feeding practices (breast vs bottle/formula fed), socioeconomic status, locus of control and picky eating. 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.

Acknowledgments

Dr Sarah Knowles BSc (Hons), MSc, PhD (now at School of Community-Based Medicine, University of Manchester, UK) assisted with data collection and input. Joanne Pybis BSc (Hons), MSc (now at British Association for Counselling and Psychotherapy) assisted with the data collection for the spoon-fed group as part of her PhD research funded by the Economic and Social Research Council (ESRC). We thank the parents who took part in the study from the Nottingham Toddler laboratory, the 'I Want My Mum forum' and the 'Baby-Led Weaning forum'. We thank Professor Paul McGraw and Dr Scott Campbell for comments on an earlier draft of this paper.

View Abstract

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Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample

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Objective The impact of different weaning methods on food preferences and body mass index (BMI) in early childhood is not known. Here, we examine if weaning method-baby-led weaning versus traditional spoon feeding-influences food preferences and health-related outcomes.

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UNICEF and the NHS recommend not introducing solids until a baby is at least 6 months old. Breastfed babies don't need anything except breastmilk (not even water) for at least 6 months: 

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UNICEF and the NHS recommend not introducing solids until a baby is at least 6 months old. Breastfed babies don't need anything except breastmilk (not even water) for at least 6 months: 

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Is baby ready for solid foods? (What do the experts say?) * KellyMom.com

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Health experts and breastfeeding experts agree that it's best to wait until your baby is around six months old before offering solid foods. There has been a large amount of research on this, and most health organizations have updated their recommendations to agree with current research.

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How to make up a bottle of formula safely: 

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How to make up a bottle of formula safely: 

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Good hygiene is very important when making up a formula feed.
Your baby's immune system is not as strong as an adult's. That's why bottles, teats and any other feeding equipment need to be washed and sterilised before each feed.

This will reduce the chance of your baby getting an infection, in particular diarrhoea and vomiting.

Step-by-step guide to preparing a formula feed

Step 1: Fill the kettle with at least 1 litre of fresh tap water (do not use water that has been boiled before).

Step 2: Boil the water. Then leave the water to cool for no more than 30 minutes, so that it remains at a temperature of at least 70C.

Step 3: Clean and disinfect the surface you are going to use.

Step 4: It's important that you wash your hands.

Step 5: If you are using a cold-water steriliser, shake off any excess solution from the bottle and the teat, or rinse them with cooled boiled water from the kettle (not tap water).

Step 6: Stand the bottle on the cleaned, disinfected surface.

Step 7: Follow the manufacturer's instructions and pour the amount of water you need into the bottle. Double check that the water level is correct. Always put the water in the bottle first, while it is still hot, before adding the powdered formula.

Step 8:

Credit:

Pete Titmuss / Alamy Stock Photo

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Loosely fill the scoop with formula powder, according to the manufacturer's instructions, then level it using either the flat edge of a clean, dry knife or the leveller provided. Different tins of formula come with different scoops. Make sure you only use the scoop that comes with the formula.

Step 9: Holding the edge of the teat, put it into the retaining ring, check it is secure, then screw the ring onto the bottle.

Step 10: Cover the teat with the cap and shake the bottle until the powder is dissolved.

Step 11: It's important to cool the formula so it's not too hot to drink. Do this by holding the bottle (with the lid on) under cold running water.

Step 12: Test the temperature of the formula on the inside of your wrist before giving it to your baby. It should be body temperature, which means it should feel warm or cool, but not hot.

Step 13: If there is any made-up formula left in the bottle after a feed, throw it away.

Dos and don'ts of making up formula feeds

Do follow the manufacturers' instructions very carefully, as they vary as to how much water and powder to use.

Do not add extra formula powder when making up a feed. This can make your baby constipated or dehydrated. Too little powder may not give your baby enough nourishment.

Do not add sugar or cereals to your baby's formula.

Never warm up formula in a microwave, as it may heat the feed unevenly and burn your baby's mouth.

Reducing the risk of infection

Even when tins and packets of powdered infant formula are sealed, they can sometimes contain bacteria.

Bacteria multiply very fast at room temperature. Even when a feed is kept in a fridge, bacteria can still survive and multiply, although more slowly.

To reduce the risk of infection, it's best to make up feeds 1 at a time, as your baby needs them.

Use freshly boiled drinking water from the tap to make up a feed. Do not use artificially softened water or water that has been boiled before.

Leave the water to cool in the kettle for no more than 30 minutes. Then it will stay at a temperature of at least 70C. Water at this temperature will kill any harmful bacteria.

Remember to let the feed cool before you give it to your baby. Or you can hold the bottle (with the lid on) under cold water from the tap.

Do not use bottled water to make up formula feeds

Bottled water is not recommended for making up feeds, as it's not sterile and may contain too much salt (sodium) or sulphate.

More information

Find out more about bottle feeding and answers to common questions about formula feeds.

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Good hygiene is very important when making up a formula feed. Your baby's immune system is not as strong as an adult's. That's why bottles, teats and any other feeding equipment need to be washed and sterilised before each feed. This will reduce the chance of your baby getting an infection, in particular diarrhoea and vomiting.