Wondrous Weaning

My kids may be well past their weaning ages, but if there's one thing I remember vividly it's that weaning was a daunting mountain for me as a first time mum and that the information out there wasn't really in line with what I was looking for. I was concerned with low weight gain, and when presented with having to prepare purees, there was a whole range of vegetables that I'd never cooked in my life. As an almost vegetarian household I also had to make decisions about if, how and when to introduce meat to my child's diet. I remember the patchy information provided by the health visitor team, which effectively presented us with leaflets and 3 purees of varying consistency, and gave an opportunity to buy a masher and puree tool at discount prices.

I'm much more relaxed this time around, but weaning was still a worry. By now I'd heard of baby led weaning and when Snowflake refused the spoon, I didn't worry and just let her eat whatever I was having. She didn't eat much and still doesn't, but she delights in food now and gets utterly excited about the announcement of "dinner time".

In a way I felt a bit let down both times around with the support available at this critical time in a baby's life.
Put it into context, we are experiencing an explosion of childhood obesity, with 30% of primary aged children in Scotland being overweight or obese. It's not just about kids being a bit heavier than they should, obesity leads to shorter lives, and these short lives are not as fun filled (with a family history of obesity and obesity related illnesses, I know this all too well).

So it strikes me that a bit of support and information that makes sense at this crucial stage might be a good idea. I did a bit of research on what's been proven to be the good and the bad in weaning for later life health and found out some interesting facts that even after 5 1/2 years of being a mum were new to me.

The risk of obesity and overweight is increased significantly if a baby is breastfed for less than 4 weeks AND solids are introduced before 16 weeks. This increases the risk of obesity a staggering 6 times. There is also an increased risk of obesity if a baby is formula fed AND solids are introduced after 6 months, though not as pronounced. So for the formula fed infant it's important that solids are introduced no earlier than 17 weeks and no later than 26 weeks. For breastfed babies, there is no significant increase of obesity risk depending on when solids are introduced.

Now we all know the guidelines to introduce solids no earlier than 17 weeks but ideally no earlier than 6 months. However, a whopping 51% of infants in the UK are introduced to solids before they are 16 weeks (this statistic is quite recent, Bolling et al.: 2007). This means that half of our children are put at a six fold risk of obesity from when they are not even 4 months old.

Then there's the interesting subject of protein. I won't go into the details because you'll just get all bored on me, but the bottom line is that a weaning diet rich in protein significantly increases the risk of obesity and overweight. Protein would be dairy and meat. So a diet rich in Carbohydrates is much better, and it's important to keep protein intake below carbs intake (= too much cow's milk can be bad): "Children who were overweight at 5yrs consumed significantly higher protein as a percentage of energy than non overweight children." (Scaglioni et al.: 2000)

Third up is earliest weight gain - which may be linked to protein intake. Infants who cross growth centiles upwards are hat significantly higher risk of obesity and overweight. This is particularly prominent in the first weeks of life, but the effect carries on through the first year: "Emerging evidence therefore strongly supports the first few post-natal weeks as a critical window for programming long-term health in both humans and animals" (Singhal/Lanigan: 2007). Researches aren't clear what causes this upward movement, and as it's observed mainly in formula fed infants, it may be something to do with formula being too rich in protein (although there are another few suggested causes, such as breast milk ingredients keeping insulin receptors happy and formula fed babies not being able to fully self regulate food intake). Anyeay, I wish I'd known this one earlier, it would have spared me all the worry of both my girls moving downwards on their percentiles... All I was concerned about was to get them up as high as I could, and I'm sure this is an instinct most parents share.

I also looked into the approach to weaning and how this may make a difference. There is one small study that indicates that spoon fed babies tend to be at higher risk of obesity than infants who feed themselves (baby led weaning). However the study is so small and the difference between the groups not big enough to allow for any conclusions. At the same time, the results, even if limited, indicate that baby led infants choose carbohydrate rich foods above protein rich foods which may indicate that they make food choices which are healthier for them.

So the bottom line is that it's most important to ensure solids are not introduced before 17 weeks and that most of the energy of the weaning diet comes from carbohydrates and not from protein. For formula fed babies, it's better to introduce solids before 6 months (but no earlier than 17 weeks), while for breastfed babies it doesn't matter.

References:
1.Rebecca Kendall. Weaning: Risk Factors for the Development of Overweight and Obesity in Childhood - A Systematic Review (2011)
2. A. Singhal and J. Lanigan. Breastfeeding, early growth and later obesity (2007)
3. Susanna Huh. "Timing of Solid Food Introduction and Risk of Obesity in Preschool-Aged Children" (2011)
4. E. Townsend and NJ Pitchford. "Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample (2012)