Solids at four months?

How, when and why to introduce foods other than breastmilk
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citymamma
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Post by citymamma » Fri Dec 03, 2010 10:21 pm

NightOwl wrote:
I think he has eaten one tiny sprig or broccoli (what would the word be!?!?)
The word you are looking for is floret.
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DS (Dec 08 ) BF 20 months

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Post by EmilyKate » Fri Jan 21, 2011 5:58 pm

Can anyone provide details/evidence of ASCIA's financial interests? Or link to the research so we can see which paper this discussion is based on? This thread dates back a long time in the research world. Things may well have changed since the original post was written.

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Post by breastfeedingisnormal » Fri Jan 21, 2011 6:02 pm

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Post by EmilyKate » Fri Jan 21, 2011 6:57 pm

Thanks.

Another question. The risks of introducing solids early have been mentioned in passing but what are the risks? I just want to gather as much info as possible before I decide.

I ask in the context of considering starting solids not for nutrition, not to increase his weight or to help him sleep - I just want to consider solids as fun and maybe (just maybe) it might reduce the chance of allergies (even though the jury isn't quite back with a decision yet). He has a strong family history of allergies from myself and DH.

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Post by breastfeedingisnormal » Sat Jan 22, 2011 7:31 am

Hi
Starting solids early, may increase the risk of infections like otitis media, gastro and pnuemonia. Perhaps the biggest risk is that the earlier kids start solids, the more likely they are to stop breastfeeding before 12 months. From an allergy point of view that means that they are less likely to be breastfeeding at the time when they are being exposed to new foods for the first time. There is emerging evidence that breastfeeding while starting new foods protects against allergies.
There are some important things to understand about the research upon which ASCIA bases its statement.
First NONE of the studies included an exclusively breastfed group so their statement may only apply to infants who have been exposed to formula at some stage in the first four months of life (and not to kids who have never been exposed to formula). It is possible that it is the early exposure to formula that makes the difference.
Second - the idea that the introduction of solids should not be delayed beyond six months is based on research that defines a six month old baby as one that hasn't yet turned seven months - and assumes that most mothers will stop breastfeeding around 6 months.
Third, notice that what ASCIA actually says is, introduce solids at around 4-6 months but not before 4 months. That doesn't mean AT 4 months. Given all the other (bigger, better resourced, not sponsored by nestle) public health bodies have examined the evidence and are still recommending 'at around 6 months', 5 and a half to 6 and half months still meets the 'around 4-6 months' recommendation.
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n
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Post by EmilyKate » Sat Jan 22, 2011 8:38 am

Thankyou

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Post by flaneur » Sat Jan 22, 2011 10:32 am

I've read through this thread, and am more confused than ever. There is obviously a lot of hostility around this topic, which I find quite sad, as I thought the ABA was supposed to be a supportive organisation. Comments such as "Well I guess your midwife, paed and child health nurse have all been doing lots of research to inform their advice. I imagine it took them a long time to examine all the evidence because it took a team of epidemiologists over 12 months to examine the evidence..." don't really help those of us trying to decide when to introduce solids, they only make me feel like the ABA is not for me.

I'm about to go back to work and am therefore trying to build up a supply of EBM for my husband to feed our 4 month old on the three days i'll be at work. I'm struggling to pump what I would consider "enough" and will not have time at work to pump for more than about 30 minutes once a day.

We thought this would be a good time to introduce some solids, along with bfing as much as possible.

Now i'm thinking we might have to introduce top-up feeds of formula instead, because apparently solids will cause all manner of problems and make me a terrible mother.

So - formula or solids? I guess the mummy guilt never ends!

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Post by Vahvempi » Sat Jan 22, 2011 10:56 am

Flaneur-There are a few topics that will ALWAYS bring out hostility. Thats what happens with touchy subjects unfortunately.
I think you should introduce solids when you feel it's the right/best time to.
Maybe try solids if you want when you go back to work, if it doesn't take off, try formula.
Sometimes there really isn't a right answer. You circumstances are preventing you from doing what the WHO reccomends and sounds like what you want to do too.
Do you have to go back to work when baby is 4m?...Can you take leave without pay/extended leave untill baby is older to start solids at the 'right' time?? Are you able to take two 15 min breaks to maybe get more EBM??
And your right, Mummy guilt never ends. Only you are making yourself feel guilty. Hopefully nobody will judge or criticise you for making obviously a very tough decision. If you're doing the best you can, you're doing a good job.

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Post by Vahvempi » Sat Jan 22, 2011 10:58 am

Just on the optimal age to introduce solids, Feebes has to wait till 7.5m to introduce solids as DD was prem. Does that mean that babies that were 'late' can start 'early'?? DS was 5 days over-due, does that mean I can start solids at 175 days instead of 180??

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Post by Feebes » Sat Jan 22, 2011 11:18 am

jmorpy wrote:Just on the optimal age to introduce solids, Feebes has to wait till 7.5m to introduce solids as DD was prem. Does that mean that babies that were 'late' can start 'early'?? DS was 5 days over-due, does that mean I can start solids at 175 days instead of 180??
That is an interesting POV jmorpy :-) , I had never thought of it like that when a baby is overdue.

But IMO though I think that the age is only adjusted for prem babies as their bodies/digestive systems etc aren't at the actual age, only the corrected age. I don't think it at all applies to babies that are overdue.

Lots of things have to get adjusted to the corrected age for prem babies, solids is just one of them.

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Post by breastfeedingisnormal » Sat Jan 22, 2011 2:07 pm

Yes, it is very confusing. This is an art, not a science. Hence the 'around six months' wording. Given the choice between introducing solids in the fifth month (after a baby turns four months but before five) and introducing formula, the evidence says that the risks associated with introducing formula are much greater. Quigley and colleagues (2009) conducted a large study amongst infants 0-8 months who admitted to hospital for gastro or pneumonia. They were trying to work out whether starting solids was associated with increased likelihood of hospitalisation. They also asked mothers what the babies' main milk had been in the past months. What they found was that there was no statistically significant relationship between having had solids in the last month and being hospitalised but those kids whose main milk had been formula in the past months were 1.5-2.5 times more likely to be hospitalised for gastro or pneumonia.
Other research (Hornell et al 2001a & 2001b) tells us that starting bottle fed foods (ie formula) leads to a much sharper decline in breastmilk intake and duration than starting solids does.

Quigley et al (2009) "Infant feeding, solid food and hospitalisation in the first 8 months after birth" ArchDisChild 94(2): 148-150
Hornell et al (2001a) "Introduction of solids and formula to breastfed infants: a longitudinal prospective study in Uppsala, Sweden" ActaPaed 90(5): 477-482
Hornell et al (2001b) "Solids and formula: association with pattern and duration of breastfeeding" Pediatrics 107(3): e38
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Post by EmilyKate » Sat Jan 22, 2011 2:07 pm

flaneur wrote:I've read through this thread, and am more confused than ever. There is obviously a lot of hostility around this topic, which I find quite sad, as I thought the ABA was supposed to be a supportive organisation. Comments such as "Well I guess your midwife, paed and child health nurse have all been doing lots of research to inform their advice. I imagine it took them a long time to examine all the evidence because it took a team of epidemiologists over 12 months to examine the evidence..." don't really help those of us trying to decide when to introduce solids, they only make me feel like the ABA is not for me.
Hi flaneur! Well put. I was feeling exactly the same way as you. For an ABA counsellor to undermine the expertise of health professionals is appalling and unprofessional. This was exactly why I wanted to know what study this thread has been based on. I suspect the evidence that has come to light more recently is not being considered in the information provided here. Yes, the WHO and NHMRC haven't changed their guidelines yet, but I don't imagine they would change their guidelines overnight anyway.

Like you flaneur, I'm just trying to work out what is best for my bub and the ABA are only one voice you need to consider in my opinion.

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Post by EmilyKate » Sat Jan 22, 2011 2:08 pm

And can I add;

Can of worms; opened!

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Post by EmilyKate » Sat Jan 22, 2011 2:10 pm

Simultaneous post BIN! Thanks for the references - will go and read now.

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Post by breastfeedingisnormal » Sat Jan 22, 2011 2:18 pm

I posted this on another thread. This was the WHO's response to this question just last week. They have considered all of the evidence, even the most recent stuff and this is what they have to say about it:
WHO's global public health recommendation is for infants to be exclusively breastfed for the first 6 months of life to achieve optimal growth, development and health. Thereafter, infants should be given nutritious complementary foods and continue breastfeeding up to the age of 2 years or beyond.

WHO closely follows new research findings in this area and has a process for periodically re-examining recommendations. Systematic reviews accompanied by an assessment of the quality of evidence are used to review guidelines in a process that is designed to ensure that the recommendations are based on the best available evidence and free from conflicts of interest.

The paper in this week's BMJ is not the result of a systematic review. The latest systematic review on this issue available in the Cochrane Library was published in 2009 ("Optimal duration of exclusive breastfeeding (Review)", Kramer MS, Kakuma R. The Cochrane Library 2009, Issue 4). It included studies in developed and developing countries and its findings are supportive of the current WHO recommendations. It found that the results of two controlled trials and 18 other studies suggest that exclusive breastfeeding (which means that the infant should have only breast milk, and no other foods or liquids) for 6 months has several advantages over exclusive breastfeeding for 3-4 months followed by mixed breastfeeding. These advantages include a lower risk of gastrointestinal infection for the baby, more rapid maternal weight loss after birth, and delayed return of menstrual periods. No reduced risks of other infections or of allergic diseases have been demonstrated. No adverse effects on growth have been documented with exclusive breastfeeding for 6 months, but a reduced level of iron has been observed in developing-country settings.

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