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When Should I Start Giving My Baby Solid Foods (Weaning)?

baby first foodYou should start giving your baby solid foods, often called ‘weaning’, when they are around six months old. Health experts agree that this is the best age. Before this, your baby’s digestive system is not developed enough to cope with solid foods.

If you’re breastfeeding, feeding only breast milk up to around six months will give your baby extra protection against infection. Breastfeeding beyond six months alongside solid foods will continue to protect your baby for as long as you carry on.

If you’re bottle feeding, you should give your baby infant formula until around six months and continue it afterwards along with solid foods.

If your baby seems hungrier at any time before six months, give them extra milk feeds.

Babies born early (prematurely) may be ready for solids at different times. Ask your health visitor (or pediatrician or pediatric nurse practitioner*) for advice about what’s best for your baby.

How I know if my baby is ready for solids?

Signs that your baby is ready for solids include:

  1. They can stay in a sitting position and hold their head steady.
  2. They can co-ordinate their eyes, hands and mouth so that they can look at the food, pick it up and put it in their mouth, all by themselves.
  3. They can swallow food. Babies who aren’t ready will push their food back out, so they get more round their face than they do in their mouths.

Baby food

Your baby’s first solid foods should be smooth, simple foods they can easily digest, such as vegetables, fruit or rice. You could try:

  • mashed or puréed cooked parsnip, potato, yam, sweet potato, apple or pear
  • mashed or puréed rice or baby rice (mix the rice with a bit of your baby’s usual milk)
  • pieces of soft fruit or vegetables that are small enough for your baby to pick up

It can be useful to have a few jars, tins or packets of ready-prepared baby food in the cupboard, but it’s not recommended that you use them all the time.

Read more information, tips and advice about your baby’s first solid foods, including foods to start with and foods to avoid.

Read the answers to more questions about children’s health.

Further information:

Photo credit: Rex Austin Barrow; CC license
* Editors Note: a health visitor is a qualified nurse with extra training in child and family care. Their services are provided as part of the UK Healthy Child Programme. Clarification provided for our US audience.

March 12, 2015 | Filed Under Community | 7 Comments 

Smoking Bans May Help Cut Premature Births

smoking-bans-reduce-premature-births“Smoking ban ‘cuts premature births’,” BBC News has reported. Despite the BBC News headline, this research only showed an association between the smoking ban and a reduction in premature births. It didn’t show direct cause and effect.

The research that the BBC News story is based on recorded premature birth trends in Belgium around the time of a public smoking ban there. While not directly comparable to the bans in the UK countries, Belgium is a useful example to look at as they introduced public smoking bans in stages between 2006 and 2010.

The fact that there were three distinct steps means the beneficial impact of public smoking bans can be assessed more precisely.

The study found the number of preterm births dropped after each consecutive smoking ban, but can’t prove the smoking ban itself cut these rates. Other factors may also have been involved. For example, improvements in antenatal (prenatal*) care may have reduced the rate of premature birth.

The fairest summary of the findings is that they provide some circumstantial evidence that smoking bans may reduce premature birth rates. They do not provide conclusive evidence of a link.

What has the (UK*) smoking ban done for us?

As well as potentially having a positive effect on the rate of premature births, there are reports that the 2006 smoking ban in England and Wales has contributed to:

Where did the story come from?

The study was carried out by researchers from the University of Leuven and Hasselt University in Belgium, and was funded by the Flemish Scientific Fund and Hasselt University.

The study was published as an open-access article in the peer-reviewed British Medical Journal.

Despite the slightly simplistic headline, the BBC News story offers an appropriate interpretation of the results. The BBC explains that the study found an association but could not prove that the ban was the cause of the observed drop.

Before and after studies are a simple way to assess the impact of policies. However, the fact that other factors or trends may have occurred at the same time as the policy was implemented can sometimes bias results.

What kind of research was this?

This was an observational study (before and after study) looking into the association between a public smoking ban and the number of preterm births in Belgium.

Belgium’s smoking ban was introduced in three phases:

  • In public spaces and most workplaces in January 2006
  • In restaurants in January 2007
  • In bars serving food in January 2010

Smoking during pregnancy has been found to impair the baby’s growth and to be associated with preterm birth. Evidence relating to the effects of secondhand smoke exposure and risk of preterm birth is less consistent.

The researchers were interested to see if a smoking ban applied in phases across the region would be associated with the number of preterm births. Observational studies over several time points can be helpful in defining trends and links between two factors. If effects are large and interpreted alongside other studies they can build a case that one factor (in this case, public smoking bans) may be strongly linked to an outcome (preterm birth).

What did the research involve?

Researchers collected data on births in Flanders (a region in Belgium) from 2002 to 2011.

Births before 24 weeks’ gestation, after 44 weeks’ gestation and multiples births were not included in the analysis.

They researchers used these data to determine the annual risk of preterm birth in the years preceding the public smoking ban, during the three phases of the ban and immediately after the ban. They analysed the trend in this risk over time.

A second analysis was conducted to determine the percentage change in risk of preterm birth after the introduction of each phase of the smoking ban. Several potentially confounding factors were considered during this analysis, including:

  • Those related to the mother or pregnancy (infant sex, the mother’s age, number of previous children, living in an urban or rural area, socioeconomic status)
  • Those related to the environment (temperature and humidity, pollution)
  • Those related to other population-level health factors (such as flu epidemics)

What were the basic results?

Between 2002 and 2011, there were 606,877 births that were included in the study. Of these, 32,123 (7.2%) were classified as preterm births (occurring before 37 weeks’ gestation).

When examining the unadjusted percentage of births that were considered preterm, the researchers found that the rate in the four years prior to the smoking ban was relatively stable (although there was a slight reduction seen between 2004 and 2005).

After the first phase of the ban (2006 to 2007), the percentage of births classified as preterm dropped, and a further drop was seen in the year after the second phase ban (2007 to 2008).

A slight upturn was seen in early 2008, followed by another decline through 2009. After the third phase of the smoking ban was introduced in January 2010, an additional drop in the percentage of preterm births was seen.

When analysing the data while adjusting for the potential confounding factors, the researchers found that the risk of preterm delivery was reduced after each of the smoking ban introductions, with the drop being largest after the second and third phase of the bans.

After the second phase was introduced (banning smoking in restaurants), there was a 3.13% drop in the annual rate of spontaneous preterm delivery (95% confidence interval (CI) -4.37 to -1.87%). Following the third phase (no smoking in bars serving food) this drop in rate was -2.65% each year after January 2010 (95% CI -5.11% to -0.13%).

The researchers report that this is equivalent to a reduction in six preterm births per 1,000 deliveries over the five years following the second phase of the ban.

How did the researchers interpret the results?

The researchers concluded that there were “significant reductions in the rate of preterm births after the implementation of different types of smoking bans, whereas no such decrease was evident in the years or months before these bans” and that this has important public health implications, given the association between preterm birth and the baby’s health.

Conclusion

This study suggests that the rate of preterm births dropped in the years immediately after a public smoking ban was introduced in Belgium. This is not to say that the ban was the sole factor contributing to a change in the risk of preterm birth.

The study authors suggest that their research is best viewed and interpreted as: “an investigation into the possible impact of a ‘population intervention’ rather than an investigation of changes in individual behaviour”. They suggest that the trend in preterm births that they observed could possibly be due to the impact of unmeasured confounding variables, and not to the smoking ban.

They note that other outcomes were measured, including birth weight and size for gestational age. No trend over time was observed in these outcomes, despite the fact that they have been previously found to be associated with secondhand smoke exposure.

Given the limitations of a single time-trend study, it is not possible to state conclusively that population-wide smoking bans are associated with reduced risk of preterm birth.

The researchers also note that similar studies in different countries could be useful in determining whether this trend is consistently seen after smoking bans are introduced, and whether reverse trends are seen in countries in which such bans have been introduced but later relaxed. Of course, we would like to see the results for similar research in this country.

Despite these inherent limitations in interpreting the results of this study, it is still the case that smokers should avoid smoking near pregnant women and that pregnant women should avoid smoking and smoky environments.

Analysis by Bazian. Edited by NHS Choices. Follow Behind the Headlines on Twitter.

Summary

“Smoking ban ‘cuts premature births’,” BBC News has reported. Despite the BBC News headline, this research only showed an association between the smoking ban and a reduction in premature births. It didn’t show direct cause and effect.

Links to Headlines

Links to Science

Editor’s Note: * Clarification provided for our U.S. audience

January 8, 2015 | Filed Under Awareness | Leave a Comment 

When Having an Only Child Is The Only Choice

In reading Dr Borba’s post from last week (July 25, 2011) on raising only children, it brought back my own experience. I have an only child, but not by choice. I was caught by the trend in delaying childbearing – due to an earlier focus on education and career, and marrying later.

Why Have Another?

When my husband and I first got married we weren’t entirely sure we wanted any children, let alone more than one. But we did finally decide to start a family and were really happy with our little guy. When it came time to consider whether to have more, what Dr Borba highlighted as the benefits of an only child did figure in our thinking. We both had hectic full-time careers, so dividing our attention amongst multiple children seemed like a disservice to our son – and we enjoyed the close parenting relationship we had with him. Plus, having more kids might have meant not working so much, so finances were a concern.

However, there were powerful arguments in favor of having more children. We fell so much in love with our first baby that we really liked the idea of having a second. Plus I am an only child and I always wanted siblings when growing up. In fact, even now I would like to have a brother or sister – for my own benefit – but also for my son’s.

At the end though, one of the most powerful drivers was that he was always asking for a sibling – just like I did.

Our Sibling Odyssey

Getting pregnant the first time was fairly straightforward, even though I had already reached “advanced maternal age”. We decided to try for a second when Elliott was three and I was nearing 40. Since it was so easy the first time, we thought it would be fairly easy the second time – and it more or less was – until we discovered it was an ectopic pregnancy, resulting in emergency surgery and the loss of one tube. So, with my chances of getting pregnant halved – and now informed of the significantly reduced fertility at my age – we embarked on a series of IVF procedures. Clearly we had no idea of the journey yet to come.

Mistake #1: Despite my age and the statistics, we were over-optimistic about our chances of conceiving through IVF. Since I’d gotten pregnant twice, and carried a baby to term, it seemed like just a matter of time. Which might explain our second mistake.

Mistake #2: We were much too open and optimistic with our son about trying to have another baby, especially at the beginning of the process. Eventually, we had to start managing expectations since several months of IVF procedures went by without success. Finally one succeeded…but this resulted in ANOTHER ectopic pregnancy (very rare with IVF). And it was a huge saga as it was discovered on an overseas trip and involved emergency surgery in a foreign city, 3 days in hospital, a week in a hotel waiting for the all-clear to fly home, wheelchair transport through airports on the way back, and 2 months recovery off work. We managed one more unsuccessful attempt a few months later, and finally gave up – leading to our final mistake….

Mistake #3: We avoided telling our son we had stopped trying to have another baby. It was just too painful. I couldn’t talk about it – or even see a little baby on the street – without crying, and I think the idea of telling him made the decision feel so irrevocable. Unfortunately one evening on the way home from friends with a house full of kids, we accidentally let it slip out in conversation. But he picked up on it right away – and what an UPSET!! There was so much crying going on in the car that we had to pull over for a while. That night is still very clear to me.

Helping Our Son (and Us) Adjust

After making the decision not to keep trying for another child, and despite our mistakes, we did take some steps that helped everyone adjust to this new and initially painful reality:

Talked about the benefits – Once everyone had a chance to calm down, we sat with our son and talked about why we wouldn’t be having another baby, and about the benefits of being an only child, in a way he might understand: having his own room, getting to spend more time with Mom and Dad, and no one to steal or break his toys.

Got a surrogate sibling – Yes, we got a puppy. And for the next few years, Nelson (the dog) was his brother – four legs and fur notwithstanding. This worked very well, until Elliott’s school class learned about family roles and he insisted his dog was a brother…while his teacher insisted this wasn’t possible.

Found social opportunities – Due to our dual-career life Elliott had always been involved in external social settings with other kids. But now we had even more reason to sign him up for sports, clubs, summer camp and Cub Scouts.

Created a “flexible” family concept – Soon after our painful odyssey we had the opportunity to become god-parents to the daughter of a dear friend. We embraced this new responsibility and more or less “adopted” my friend and her family. This gave me some consolation – both for my loss and my son’s. Elliott became a “god-brother” and Nelson, a “god-dog!” While it’s not exactly the same – and he really only started enjoying her once she turned three – he is experiencing many aspects of being a brother: her adoration, looking out for her safety, playing with and performing for her, and protecting his possessions from her. And on a recent shopping trip he picked out a pair of pajamas for himself that proclaimed “big brother” on the front. There’s definitely more than one way to “make” a family.

August 5, 2011 | Filed Under Community | 2 Comments 

WOW…I’m a Parent! I’m Completely Responsible for this Little Life

I didn’t know much about looking after a baby or raising a child when I was lucky enough to become pregnant with my son. As an only child with extended family spread far across the West, I didn’t come in contact with these little creatures previously. But once on the baby path there were many experiences that helped build the feeling that I’d soon be a parent – and all that entails: the first heartbeat and ultrasound picture, the first overwhelming visit to the local baby superstore (yikes!), prenatal baby-care classes, the first time seeing newborn clothes….so small!! Not to mention the joy when I finally held my son – or the panicky feeling when they let us take him home.

And of course I read the books. I knew what he would need daily or hourly – how to feed, care for and protect him. But nothing really brought home the full weight of parental responsibility until a couple of weeks back at work when I got THE CALL. Daycare. A staff member had fed my son someone else’s breast milk. I can still picture where I was, holding the phone – even though it was now over 8 years ago. My first thoughts: “Hmmm…this one isn’t in the book. What do I say? What do I do? Can’t HIV be transmitted through breast milk? But how likely is that?” There are some concerns about transmission – HIV, illicit or prescription drugs, etc. But the risk was probably very low based on the limited amount of milk (one bottle) that he got. Nevertheless, my husband and I quickly ended up in the daycare centre director’s office, discussing an issue that had already been elevated to the lawyers and risk management staff at the centre’s corporate head office.

We were informed that there had already been implications for the staff member, although thankfully she had not been fired. She was actually great with the babies and I wasn’t going to call for her head, though I was glad she had been moved to work with older kids. We couldn’t learn much about the other mother, due to reasons of privacy, but we were told that she had struggled for years to have her baby, undergoing multiple rounds of IVF – which gave some comfort that she probably hadn’t been doing anything that would put her child (or mine) at risk.

We walked away that day thinking…“We really need to think this through”…to look at the long-term possibilities. We were responsible for him – not just his current reality – but the unknown future ahead of him. He couldn’t make the decisions here, but he’s the one who would be affected in the long-term if the unlikely occurred. WOW…we’re parents! This little creature depends on us – not just for basic daily needs, but for his safety, growth, development, and happiness. So we had to determine a course of action, for his sake.

I contacted our pediatrician and a baby doctor in the neighborhood. I also got the perspective of another daycare center. Everyone reassured me of the low risk of any negative effects, which helped me and my husband sleep better and probably would have been sufficient if it were only our interests at stake, but it wasn’t….this was for our child. In the end, we decided to ask the other mother to undergo testing for the major concerns – facilitated and paid for by the daycare – just to be sure. We got the results quickly and reviewed them with our pediatrician: everything was fine and we were now satisfied. There was probably more we could have done, but the thing was we did more than we normally would have if we were just looking out for ourselves.

There’ve been a few more challenging experiences since then: injuries requiring trips to the ER and issues that caused us to change schools. None were life threatening or altering, though all of them tested me as a parent and made me feel the weight of that responsibility…but, still, none sticks with me like that first one.

What about you?? What was your “wow – I really am a parent” moment?

March 25, 2011 | Filed Under Community | 2 Comments 

To Breastfeed for 6 Months or Not To Breastfeed for 6 Months…

…that is the question…

This week a small group of pediatric health experts from the UK published a report in the British Medical Journal questioning the 2001 World Health Organization’s recommendation to provide 6 months of exclusive breast feeding. The WHO and UNICEF recommend:

  • Initiation of breastfeeding within the first hour of life
  • Exclusive breastfeeding – that is the infant only receives breastmilk without any additional food or drink, not even water
  • Breastfeeding on demand – that is as often as the child wants, day and night
  • No use of bottles, teats or pacifiers

This is based on significant evidence that breast milk reduces the rate of pneumonia, ear infections, gastroenteritis and other infections.

Given however the much lower incidence rate of these illnesses in “developed countries” some medical professionals have voiced their concern about applying the 6 month restriction universally. They argue that while “exclusive breastfeeding for 6 months is readily defendable in resource-poor countries with high morbidity and mortality from infections, in developed countries, other concerns can take precedence”.

This aligns with the new report which suggests that babies who are breastfed exclusively for six months are at a higher risk for iron deficiency and food allergies including celiac disease, and may also lead to a delay in developing a taste for food products which could have a long term impact on diet. Among the questions asked – “will babies who aren’t introduced to bitter-tasting foods in the first 6 months continue to have an aversion to them for the rest of their lives??” If this does in fact occur, will it make it even more difficult to win the battle against obesity?

All of that being said, the current debate is not one which attempts to answer the question of whether or not a mother should breastfeed. That is a separate conversation with its own proponents for and against. But even for those moms who make the decision to breastfeed, many still struggle to continue for the recommended 6 months – especially if they return to work. (According to the CDC , although 75% of new moms in the U.S. start breastfeeding, only 13% are still breastfeeding exclusively at 6 months).

So what is the right answer? Can solid foods be introduced as early as 4 months? The WHO and UNICEF are continuing to support a 6 month guideline while a number of experts are now recommending the alternative. One area they both seem to agree is that each child is different, and watching for baby’s cues will be the best guideline of all.

So what about you?? How did you know when your little one was ready for solids?

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References:

January 17, 2011 | Filed Under Awareness, zFeatured | 10 Comments 

Twins – Celebrating One of Life’s Great Miracles

There can be no more joyous time than the moment of birth for an eager set of parents. The long awaited event has changed this couple during the short 9 months of conception, of which some of the changes are immediately reversible and some will endure. It has brought out the best (and sometimes the worst ) in people who naively thought that this was an easy accomplishment.

Imagine, if you will, the double enjoyment (or shock) of seeing two babies delivered at the same time and in the same place, and they are both yours. Yes folks, TWINS! Sometimes this blessed occurrence can be foreseen but many times it is a total surprise. Even without a family history of twins we all have heard of many couples delivering them without warning. Of course in this day and age the use of prenatal sonograms is very popular and therefore a true surprise at the time of delivery seldom happens.

A family history of twinning or using aids to conception (IVF, etc) raises the possibility of multiple births which is then incorporated into the pregnant psyche after a day or two of mild shock.

Such a blessed event happened to my daughter and her husband; all her babies were conceived through IVF. She already had a 2 year old boy when she found out about the twins. The delivery was smooth (easy for me to say!) and she had a beautiful boy and girl to add to the lineage.

Whether twins are fraternal, occurring from the fertilization of two separate eggs by two separate sperm, or identical, occurring from the fertilization of a single egg by a single sperm that then splits into two during very early conception, they will always maintain a bond that at times can border on the metaphysical. These identical twins really do share the same genetic structure, but even then there are significant differences easily seen by their parents. They develop their own language and means of communication, they easily comfort one and other, and at times can “feel” a similar sensation originating from the other twin who may be miles away. Don’t ask me how!

While there is such a close bond there is an immediate need to separate them in the parent’s minds… to think of each as individuals. They are not “they”; they are not “the twins”, they are very individual and unique persons with distinct and separate needs and feelings and should be seen as such and addressed as such. At times each one can act as a “control” in an observed occurrence as parents struggle to define what is normal and what is not, while direct and specific comparisons are not a good idea. In fact, scientific studies are done in twins because of similar genetic matter (more in identical), in which the age old question of nature versus nurture is approached.

Either way, these are very special children, born with an immediate friend to spend the early part of their life with and share experiences. When else does that happen except in marriage?

December 20, 2010 | Filed Under Community | 1 Comment 

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