In a new paper published in the BMJ, Dr Mary Fewtrell, consultant paediatrician at the UCL Institute of Child Health in London, and colleagues question whether an exclusive diet of breast milk up to six months, the current recommendation of the WHO, actually provides sufficient nutrition, especially in terms of iron, and whether there could also be a higher incidence of coeliac disease and food allergies if children are not introduced to certain solid foods before six months.
The authors also fear that prolonged exclusive breast feeding may reduce the window for introducing new tastes, particularly bitter tastes which may be important in the later acceptance of green leafy vegetables. This could encourage unhealthy eating in later life and lead to obesity, they say. Click here for the British Medical Journal paper.
However, breast feeding campaigners point out that all of the authors of the report receive funding from the baby food industry. The following is taken from Baby Milk Action press release on 14th January:
Three of the four authors of this study, Mary Fewtrell, Alan Lucas and David Wilson, receive funding from the baby food industry. Prof Lucas in particular plays a key role in advising the UK baby food industry, and has opposed the WHO recommendation for many years. In 2003 he went so far as to appear for the defence when one of the largest baby food companies, SMA Wyeth was successfully prosecuted for illegal advertising by Trading Standards.
(Click here, here, here and here for Baby Milk Action reports on the SMA Wyeth case.)
Baby Milk Action expects this new study and the media coverage it is generating to be used by companies in their attempt to weaken national policies and legislation requiring complementary foods to be labelled for use from 6 months. In the UK, baby food companies are already labelling complementary foods for use from 4 months of age despite Government policy recommending 6 months exclusive breastfeeding or formula feeding.
When looking at this data the following points should be borne in mind:
• The four authors are not attacking the recommendation that breastfeeding continue alongside complementary foods or the WHO recommendation of breastfeeding into the second year of life and beyond.
• This is not a report on new data - it is observational only.
• WHO's policy arose from a review of 3,000 studies on infant feeding.
• Keeping recommendations under review is good practice and randomised controlled trials in progress; this paper is pre-empting the results of these.
• The study implies that delayed introduction of solid foods may be linked to increased obesity - this is total conflict with the studies which show that early introduction - particularly of sugary foods is an important factor behind the obesity epidemic. Breastfeeding may actually help in the development of taste receptors.
• The argument to introduce solids at 4 months to prevent coeliac disease and allergies was summarised by ESPGHAN in late 2009 and was considered by many to be flawed. See our press release.
• The UK Scientific Committee on Nutrition (SACN) and the Committee on Toxicity (COT) are reviewing the evidence on solid foods and coeliac disease. The draft opinion is NOT FINAL BUT Is on the SACN website with the Agenda papers for next week's SACN meeting. See paper SMCN/11/01.
• SACN use international growth charts to describe the optimal pattern of infant growth in the UK (UK-WHO charts). These are based on studies of babies in 7 countries around the world and no significant difference was found between their growth profiles. The proposal from the four scientists that babies are treated differently depending on where they live conflicts with this research evidence. The mean age at introduction of solids to this cohort of breastfed infants in the WHO studies was 5.4 months (or "..about 6-months").
• The UK policy is to introduce complementary foods at around 6-months and progress responsively, in line with individual babies' progress and acceptance. Not all babies need solids at the same time: in every aspect of infant development there is a wide range of normal. Very importantly the introduction of the new policy in 2003 has been associated with a marked reduction in the numbers of mothers giving solids very early (i.e. before 4-months). Since it is widely accepted that very early introduction carries greater risk (particularly of coeliac disease), the UK policy could be considered from this perspective a success.
• The practice of 'baby-led weaning' is becoming more widespread, where babies are allowed to play with appropriately prepared solid foods and decide for themselves when to eat. Experience in this area suggests that babies naturally start to ingest complementary foods at around 6 months of age, when various developmental factors (hand-eye coordination, mastication ability etc) come together. This may be an evolved natural behaviour that has been lost through the practice of spoon feeding prepared paps. Further research is required in this area.
• Marianne Monie, Chair of the nationwide Breastfeeding Network, made an important point about the risk of swine flu: "The evidence supports introducing food when a baby is developmentally ready at around 6 months. Introducing food or infant formula before that time increases the risk of infections. Questioning the wisdom of the six-month guideline at a time when babies are at risk of catching swine flu is unfortunate, because exclusive breastfeeding reduces the risk of secondary infections that can be serious enough to need hospital admission. Parents should not feel pressured into rushing their baby onto solid food. Waiting until around six months gives another two valuable months of additional protection against chest and stomach infection."
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