Sunday, 30 July 2017

Why Starting Solids Matters

Baby Three has just passed six months, and we decided he was ready to start eating solid food, so I was delighted to receive a copy of Why Starting Solids Matters to review. Blog regulars will know that I love this Why it Matters series, and I also appreciated Dr Brown's previous book, Breastfeeding Uncovered, so I had high hopes of this one! It arrived just at the right time to inform our decisions about introducing Three to his first foods.

Dr Brown starts with a fascinating discussion of the history of infant feeding and the introduction of solids, in both far and near history. This is incredibly relevant because it informs our ideas about how and when we introduce solids today. I had no idea that our ancestors were introducing solids much, much later than we do today. Dr Brown's discussion of why we currently introduce solids at six months is highly pertinent. Despite the fact that the UK guidelines changed from four months to six months in 1994, twenty three years ago, I still know mothers who have given their children food early. When I asked why, I was told "because it says from four months on the packet." Interestingly, as Dr Brown explains, this is a violation of the WHO code, but not UK law. Dr Brown points out that there is a significant change in development between four and six months of age, such as the ability to sit unaided and the loss of the tongue thrust reflex, which are relevant to both puree and baby led weaning. Amy puts it beautifully: "babies develop externally to self-feed at about the same time they develop internally to cope with that food. It's as if Mother Nature intended it." These babies weaned early are at increased risk of infection, amongst other things, both because of the intake of food, and a reduction in the amount of breast milk consumed. Dr Brown also dismisses the idea that there is any "golden window of opportunity" that can be missed when introducing solid foods.

Dr Brown's discussion of the baby food industry is sadly reminiscent of that of the artificial milk industry: it is a tale of exploitation for profit, without concern for welfare. Like formula manufacturers inventing "follow on milk" to get around legislation prohibiting the advertising of infant milks, baby food manufacturers have created "stages" to encourage parents to move gradually through their range of products. Looking at the contents of prepared foods, it seems that many are unexpectedly high in sugar, and can contain surprisingly little of the main ingredient. While their occasional use may not be harmful, a diet of exclusively prepared baby foods would be too high in sugar and protein, and the manufacturers' suggested portion sizes exceed the recommendations. Furthermore, Dr Brown cites studies which have shown a negative correlation between the amount of prepared foods consumed, and the amount of fresh fruit and vegetables the child will consume at preschool and primary age.

Parents today might choose to eschew puree or spoon feeding their babies and instead follow the Baby Led Weaning (BLW) approach popularised by Dr Gill Rapley. This is an approach under which babies are fed family foods from six months, and feed themselves rather than being fed by the caregiver.  Dr Brown points out that there is yet little scientific data on BLW, either in support or criticism of it, but she herself is engaged in research into the impact of different throroughnesses of the approach. She highlights that there is no evidence on the benefits of puree of spoon feeding either: it is simply what has been done. The emergence of BLW has coincided with the change in recommended age for starting solids from four to six months, which makes the approach feasible. It is certain that later introduction of solids leads to reduced fussiness, a lower risk of overweight, and a lower risk of infection. Allowing babies to feed themselves means there is little risk of choking, since they develop the ability to move food around their mouths simultaneously with the development of their manual dexterity, and ability to pick up smaller and smaller items.

Dr Brown's main point is that more important than which method you chose, is that you feed your baby responsively. Like breastfeeding, we should follow our babies cues, and look to them to determine when and how much they should eat. I certainly agree with her statement that "responsiveness is a general parenting ethos rather than just about eating." This is an approach that hinges on trust: trust that you will provide what they need; trust that they will consume what they need. The idea is based on the fact that most children are born with the ability to be "satiety responsive:" i.e. to stop eating when they are full. However, social factors can override this over time. Preschool children are still able to self regulate, but primary aged children have been shown to be significantly less so. The idea of eating at set times can be a factor in this, as can encouraging children to finish what's on their plate, and celebrating with food. Restricting foods has been shown to be counterproductive, and pressuring children to eat can be harmful. The more you pressure a child to eat a food,t eh less they like it. Using food to shape behaviour as a bribe for eating other foods, as a reward or comfort, or withholding it as a punishment, is harmful for eating habits and puts children at increased risk of overweight. Bottle feeding faces more challenges to responsive feeding than breastfeeding, such as encouraging a baby to finish a bottle, or a baby gulping down more milk than they need because it is flowing into their mouth, whereas the breastfed baby must work to extract the milk. Breastfeeding parents must trust that baby is taking enough milk at the breast. Responsive milk feeding leads to satiety responsive toddlers.

Dr Brown's book ends with a ten point summary that can support most parents, and should be stuck in every red book. Her focus on responsive feeding shows us how we can take the practicalities of different family lives into account and look at the bigger picture of how we feed our babies and young children to their best advantage, and also how we can sidestep exploitation by commercial interests. I also love her voice; her tone of writing. This is yet another fantastic book from this series. I hope it finds its way into the hands of health visitors and parents across the country.