Food Adventures, Tresillian, and Some Feeding Research

We have finally got through the list of allergy inducing foods without incident: citrus, tomato, strawberries, milk, eggs, shellfish, and today - peanuts!  

Yeah, I know it's salty, she just got a dab off my finger to taste.

Yay!  We have also tried a variety of spices - ginger, garlic, paprika, chilli, pepper - and she loves them.  Very pleased about that because we use a lot of these sorts of spices in our cooking.  Now I only have to avoid stuff like honey, unpasteurised cheeses, and added salt.

Amazingly, my husband and I seem to have come to complete agreement on the issue of eating.  I am happy to hold her arms down when I spoon feed her, because she has other ways of clearly letting me know if she wants to eat the food (turning her head away etc).  He is happy to let her taste any and all finger foods (minus choking hazards and the few inappropriate foods), and to be included in mealtimes in her highchair at the table.  We both agree that as she gets older, she should be offered healthy but tasty food at dinner, and if she doesn't eat her dinner we don't make her, but it just goes in the fridge for later in case she gets hungry.

At this stage, my husband gets her to take maybe 1-5 spoonfuls of a puree or baby cereal in the evenings, and then she has a go at various solids, but up until just a few days ago she has been swallowing very little.  Then yesterday, she ate 3 rice rusks and about a spoon's worth of tomato from the finger food.  Today she ate another rice rusk, again about a spoon's worth of tomato, and had a good go at some chicken (given that she only has a millimetre or so of two bottom teeth poking through).

The first finger food Bethany has succeeded in chewing and swallowing in any quantity.

However, introducing solids did not get off to a smooth start here.  At first I wanted to wait until six months, but then after I did some research decided it really didn't matter if I started at four months.  I thought this was good, since I wanted to get her onto solids fairly well in time for me to go back to work.  So at four and a half months started giving some finger food, baby-led weaning style, since she was already really good at sitting up at that age.  I also tried some purees, but she was very insistent on grabbing the spoon and refusing to let me get a spoon anywhere near her mouth, so I didn't do much of that.

Only, then my husband felt (accurately) that he was being left out of all the parenting decisions, so we decided that he ought to be in charge of solids, given that was feasible.  Having done some research, and because I'm a control freak, I still started arguing about when to introduce solids, and because he is also a control freak this only got his back up, and then he decided that she was not to have any solids at all except for tastes until 6 months, because that was the official WHO position.

If I didn't want to continue doing all the breastfeeds, he thought we should introduce formula - but after all my breastfeeding dramas I was not about to give up now.  I had committed to breastfeeding till 6 months, and since there did seem to be some evidence it reduced the risk of allergies if you did it while solids were being introduced, I wanted to continue at least until she was well onto solids too.  

Then come 6 months we had more arguments because my husband not only wanted to do purees, but to hold Bethany's hands down while he did it.  I know this is a fairly common practice, but in all my reading on sleep stuff, I had come across quite a few studies which linked childhood obesity to feeding practices which were strong in parental control.  The evidence seemed to support a hypothesis that babies who are allowed to set the pace of their feeds remain sensitive to internal hunger cues, whereas babies who are pushed to eat come to judge their hunger by social cues such as time of day and how much food is presented to them.  

Our compromise was that he would do purees and hold her hands down, but he would not force the food into her mouth if she was refusing it.  He was ok with this as he had heard somewhere that all a baby's nutrition comes from breastmilk for the for the first 12 months.  No idea where he heard this.  I had heard 25% solids, 75% breastmilk over 6-12 months, and then when I spoke to the child health nurse, she told me more solids than breastmilk by 7 months.  I was sure that had to be out of date, because if you delayed introducing solids till 6 months, loads of children would not be so comprehensively onto solids by 7 months - and I know of so many babies who hardly ate anything until 9-10 months and who were completely healthy.

Then yesterday, after yet another argument about sleep stuff, I rang Tresillian to see: a) what their sleep training method actually was; and b) if they had any tips about how my husband and I could reconcile ourselves to the same sleep goals.  (Tresillian, for anyone who doesn't know, is an advice service that also provides sleep schools), and the nurse I spoke to also repeated the 7 months should be more solids than breastmilk advice.

Quick aside here to vent - was not at all impressed with Tresillian. Ok, in hindsight I realise that mothers who prefer co-sleeping and dislike CC probably shouldn't ring Tresillian, but at the time I naively thought they might address issues and methods other than strict CC.  After all, they advertise themselves as providing 'expert parenting advice' generally.  This was how the conversation went:

Me: Hi, I have a 7 month old baby who wakes many times a night to feed.  I'm actually coping with this fine because I'm co-sleeping, but it's worrying my husband, who would prefer it if I slept in the bed with him.

Tresillian Nurse: I can understand why he would be upset.  I'd be upset if I was him too.

Me: (biting tongue) I was just wondering if you could give me some information. (Asked for information outlined above).

Tresillian Nurse: I know this is not really the method you want to use, but perhaps you have to ask yourself what will happen if you don't let her learn anything for herself.  And you have to think of your husband's feelings.

Uncharacteristically, I politely ignored all this and just continued to ask for the information.  But wow.  Seriously - this is a support line?  Cause from where I was sitting, it sounded an awful lot like a judgement line.  I dislike having my parenting judged by people who have never met me, or my husband, or my baby, or seen our parenting style in action.  I'm picky that way.  Plus to me personally, I found it disturbing that she would assume my delicate husband ought to be offended by sleeping alone, but assumed my 7 month old baby and I didn't have feelings of any relevance in the matter and we should just toughen the hell up?

Fortunately, the Tresillian lady did come up with the idea that I should have a chat with my local child health nurse, who very obligingly saw me for over an hour for a good discussion and helped me talk through my feelings and come up with some ideas.

Anyway, I mention Tresillian in this post about food because I was discussing how to approach night feedings if I am already trying to stretch out Bethany's day feeds in preparation for when I go back to work.  She said that if Bethany dropped her night feeding she wouldn't struggle for food - she'd just start taking more solids during the day (which sounds logical to me - it's just the method of achieving dropping the night feeds that is the tricky part).  I then queried what the balance should be between breastmilk and solids and she said more solids than breastmilk by this age.  I explained that didn't sound quite right and my reasoning, and she said that was what was on the Tresillian website and their information came from the WHO.

Later, I looked at the Tresillian website, and I have to say, I couldn't find her purported advice on solids anywhere, not even in their advice on how a 6-14 mth baby 'should' eat and sleep.  So then I looked at the WHO website, and the only specific thing I could find on the topic was a policy paper entitled Complementary Feeding: Family Foods For The Breastfed Baby, which on page 4 had this diagram:

As you can see, solids do not need to overtake breastmilk in the amount of nutrition they provide until around 12 months.  So there you go, the official advice from WHO on that topic.

Anyhoo, I was relieved, given that our baby is nowhere near taking in more solids than breastmilk.

Now for a summary of the information I came across on feeding methods and the timing of weaning:

Solids - Research on Infant/Child Feeding Methods and Later Eating Habits

In a study of 156 2-4 year old children, the following effects were found (Gregory et al):

• modelling healthy eating practices predicted lower food fussiness and higher interest in food one year later;
• pressuring a child to eat predicted lower interest in food one year later; and
• restriction of certain foods had no noticeable effect on the child's eating one year later, however other studies have shown that in older children (particularly girls) this practice lads to emotional eating in the absence of hunger.

In both children and adults, obesity is strongly correlated with eating in the absence of hunger and poor ability to sense when one is full (satiety responsiveness) (Carnell and Wardle).

One study found that it was crucial to introduce lumpy solids to a baby before 10 months of age, and indeed that the earlier that lumps were introduced, the more likely those babies were to be eating family foods at 15 months.  Babies who were kept on smooth purees until after 10 months were much more likely to be difficult to feed, and to be picky eaters who would eat only a small range of foods at 15 months (Northstone et al).

Children like what they know.  Children who are exposed to a limited range of foods tend to be less willing to try novel foods.  Also, repeated exposure to particular foods led to a preference for those foods (Cooke).  Repeated exposure does not mean repeated force-feeding, just repeated 'tastes'.

Research on Baby-Led Weaning


There is very little published research on the merits of baby-led weaning.  Gill Rapley, who wrote the book and advocates the method, apparently did her Masters on it, but I have not been able to get a copy of that.  There is an oft-told-of-study of 33 orphan babies who, when given the option to select their own food from a range of purees put before them, chose a balanced diet.  This is intended to give parents confidence with BLW.  I was interested to learn that this famous study, conducted in 1939 by paediatrician Clara Davis was never published in any detail, and no one has ever viewed the data collected (which was destroyed) or been able to verify the methodology (Strauss).  Also, it's important to recognise that the foods offered to the babies were all healthy - they weren't offered pureed chocolate cake, for example.

Much as I like to encourage my babies cues - and indeed, she is already excellent now at pulling food / cups towards her when hungry or thirsty, or pushing it away when she's not, and distinguishing between thirsty and hungry feelings - I don't think it would be wise to try and get her to voluntarily choose spinach over ice-cream, for example.

There is a recent study which shows that the majority of babies do have the physical skills to handle and eat fingerfood adequately by the time they need it nutritionally, and so have concluded from a nutritional perspective baby-led weaning is 'feasible' for the majority of babies (Wright et al).

Breastfeeding - Research on Infant/Child Feeding Methods and Later Eating

One study found that breastfeeding exclusively until 6 months and then maintenance of breastfeeding until after the introduction of solid food until at least 12 months tended to be associated with less childhood obesity.  Indeed, exclusive breastfeeding for 6 months had far more protective effect than any other factor considered. (Gungor et al).  

That said, a multivariate analysis in another study found that exclusive breastfeeding was not protective, it just appeared that way because it was associated with other protective factors (Reilly et al).  A review of studies of over 69 000 children found that even some breastfeeding signficantly lowered the risk of childhood obesity, even when adjusting for other factors (Savage et al). Very low amounts of sleep at 30 months (less than 11 hours a day) were also predictive of obesity (Reilly et al).

But why is breastfeeding protective?  Here are the possible hypotheses:  

1. Breastfeeding for 6 months is associated strongly with breastfeeding on demand, which requires the baby to regulate his or her own calorie intake, as well as to distinguish between thirst and hunger in the amount of sucking.  For example, in one study, mothers of breast-fed infants reported variation in their infant's hunger durin the day, whereas bottle-feeding mothers did not (Pridham).  In one study of 3-5 year old children, the children who were not overweight were those who instinctively ate less at lunch if they were given a high-calorie drink beforehand (but not when given a low-calorie drink), being those who were able to follow their internal hunger cues (Savage et al).
2. Breastfeeding on demand generally tends to be more frequent than scheduled breastfeeding, which means the baby takes in less in a feed, rather than stretching the stomach more earlier.  
3. Breastfeeding on demand promotes left-brain front cortical activity rather than right-brain assymetry (Jones et al) - this brain wave pattern is associated with a tendence to recognise and act on one's inner desires rather than repress those desires (I go the science of cortical assymetry in great detail in one of my sleep posts).    Someone with left-brain activity might recognise they are full and stop eating a half-full plate, whereas those with high right-brain activity may repress their own inner impulses and be more receptive to the social cue that it is appropriate to finish what is on one's plate.
4. Breastfeeding conditions the mother to trust and be receptive to the baby's cues when eating, so the mother is more likely to follow the baby's refusals of and interest in food - enhancing self-regulation of food intake (Fisher et al).
5. Formula has a higher protein content (Redsell et al).
6. More mothers from a higher socio-economic background choose to breastfeed, and they later tend to have healthier eating practices (Redsell et al).
7. Babies fed formula tend to be introduced to solids earlier (Redsell et al).

References


Carnell and Wardle, 'Appetite and adiposity in children: evidence for a behavioral susceptibility theory of obesity' (2008) American Journal of Clinical Nutrition Vol , p22.

Cooke, 'The importance of exposure for healthy eating in childhood: a review' (2007) J Hum Nutr Diet Vol 20, p294.

Davis, 'Results of the self-selection of diets by young children' (1939) Canadian Medical Association Journal Vol 41, p257.

Fisher et al, 'Breast-feeding through the first year predicts maternal control in feeding and subsequent toddler energy intakes' (2000) Journal of the American Dietetic Association Vol 100(6), p641.

Gregory et al, 'Maternal feeding practices, child eating behaviour and body mass index in preschool-aged children: a prospective analysis' (2010) International Journal of Behavioural Nutrition and Physical Activity Vol 7, p55.

Gungor et al, 'Risky vs Rapid Growth in Infancy: Refining Pediatric Screening for Childhood Overweight) (2010) Archives of Pediatric and Adolescent Medicine Vol 164, p1091.

Jones et al, 'Patterns of brain electrical activity in infants of depressed mothers who breastfeed and bottle feed: the mediating role of infant temperament' (2004) Biological Psychology Vol 67, p103.

Northstone et al, 'The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months' (2001) J Hum Nutr Dietet Vol 14, p43.

Pridham, 'Feeding behaviourof 6- to 12-month-old infants: Assessment and sources of parental information' (1990) The Journal of Pediatrics  pS174.

Redsell et al, 'Parents' beliefs about appropriate infant size, growth and feeding behaviour: implications for the prevention of childhood obesity' (2010) BioMed Central Public Health Vol 10, p711.

Reilly et al, 'Early life risk factors for obesity in childhood: cohort study' (2005) British Medical Journal DOI:10 p1136.

Savage, 'Parental Influence on Eating Behaviour: Conception to Adolescence' (2007) Law, Medicine and Ethics p22

Strauss, 'Clara M Davis and the wisdom of letting children choose their own diets' (2006) Canadian medical Association Journal Vol 175(10), p1199.

Wright et al, 'Is baby-led weaning feasible?  When do babies first reach out for and eat finger foods?' (2010) Maternal Child Nutrition Vol 10, p1111