Wednesday, May 9, 2012

Weaning: The Rules!

There are certain ‘rules’ about weaning. Some of the rules have good evidence behind them, some don’t. Not everyone agrees on the ‘rules’. It is worth noting that children need a different balance of diet than we do. A healthy adult diet is high in fibre and low in fats. A baby doesn’t need as much fibre (it will stop them from absorbing so many nutrients) and they do need a higher percentage of fat than we do. They need lots of calories to help them grow. Although, having said that, in the developed world we do have an epidemic of obesity, even childhood obesity, so don’t over feed your children as the long-term consequences will be devastating.
Here are some of the areas that you may read conflicting advice on so may be confusing:
Below the age of 5 you shouldn’t give whole or chopped nuts. This is as nuts, especially peanuts are a chocking hazard. They are pretty much the exact size of a child’s windpipe and therefore, especially bad for choking on. It’s fine to give puréed nuts, like in smooth peanut butter. Some people say you should avoid giving them if you are allergic to them but The European Society for Paediatrics, Gastroenterology, Hepatology and Nutrition (ESPGHAN) say :
‘Avoidance or delayed introduction of potentially allergenic foods, such as fish and eggs, has not been convincingly shown to reduce allergies, either in infants considered at risk for the development of allergy or in those not considered to be at risk.’
(They do recommend introducing foods one at a time in case they have an allergy so that you can tell what it is.)
This is also true of gluten. The advice used to be not give gluten (found in wheat, barley and rye so that’s bread and pasta) until at least 6 months of age. However, the advice has now changed and it can be given before 6 months. ESPGHAN say :
“It is prudent to avoid both early (before 4 months) and late (after 7 months) introduction of gluten and to introduce gluten gradually while the infant is still breast-fed because this may reduce the risk of coeliac disease, type 1 diabetes mellitus, and wheat allergy.”
This is not what the NHS says, they say you shouldn't give wheat based products to babies under 6 months. Well, who are you to believe? Personally, I gave my children wheat products under the age of 6 months. You are welcome to read both 'sides' of the argument. The ESPGHAN paper is quite long, the NHS weaning leaflet is not, it just makes a statement rather than giving any evidence. Doctors like evidence. Otherwise the NHS leaflet is a good leaflet which I recommend reading.
Generally agreed guidelines
Below one year of age you shouldn’t give children:

    • Salt or sugar. This helps set the child’s threshold for sweet and salty tastes later in life; it helps avoid dental caries (decay) and it doesn’t over-load the immature kidneys with lots of salt.
    • Low-fat products.
    • Cows’ milk as a main drink. It’s fine to have cows’ milk in part of a meal e.g. in mashed potato or as yoghurt.
    • Honey. Honey can contain the spores of botulinum (botox) which occurs naturally in the environment and is a muscle relaxant (hence why when you inject it into your forehead you don’t have any wrinkles because you can’t move your muscles.) However, if you ingest it, it can stop your respiratory muscles and you stop breathing. If the honey has been treated using high-pressure and high-temperature treatments, it should inactivate the spores but it might just be easier to avoid honey for a year.
    • Shellfish, pate, blue cheese and soft cheeses with rinds like brie (rather than Phillidelphia), soft eggs should only be given from 1 year. This is because this group of foods is good at harbouring bugs that can lead to food poisoning.
From 6 months you can give:

    • Well cooked eggs.
    • Citrus fruit (it’s very acidic for young babies).

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