Why Parents Are Confused About Vaccinations...

I have always been confused about vaccines, to be honest attempts to pick fact from fiction turn my brain to mush.  I frequently feel like I'm reading propaganda from both sides, and whilst for some there is no debate to be had, and that's fine either way (I envy parents who are so certain about these things), many more tell me they are utterly confused.

Many falsely believe people are reluctant to vaccinate solely because of Dr Andrew Wakefield and the whole MMR affair,  but I think that's really quite untrue.

 Today we are in the position of being able to draw information from across the globe; the internet connects people worldwide and parents are no longer solely influenced by their pediatrician, health visitor or doctor.  Instead debate rages on social media, links are pulled from a vast array of medical journals and websites as the discussion ping pongs back and forth.

My mum often comments that things were simpler in her day, "when we didn't know so much", and in a way I understand what she means. On the one hand having access to medical texts, studies and cross cultural opinion to allow choice is enlightening. On the other there is a strange comfort in just doing what an "expert" says and the blame sitting squarely with them should anything not pan out as expected.  But the more people know, the more they question - and this is where vaccination is running into problems.

Profit/Trust.

Firstly we have the problem of profit, and the fact many more parents are now aware what some will do for it; manufacturing and selling vaccines has to be extremely profitable.  The number given has sky rocketed since the 1980's and before reaching a year old children in the UK will have had at least 20 vaccinations if the full schedule is followed. For those who appreciate companies can and do take risks with the health of our children, it's hard to blindly trust what we are told.

As an example, baby food manufacturers wont increase the age on their jars of food from 4-6 months (despite contradicting The World Health Organisation and UK guidance), despite the health implications, because of profit. Formula companies employ insidious marketing techniques, whilst producing a product often loaded with aluminium and dubious iron levels.

The Politics of Breastfeeding (when breasts are bad for business), perfectly highlights how when something makes that much money, it's incredible influential.

But where things get really confusing is when one starts comparing the information from countries that don't vaccine against a specific disease, to those that do.  For example Chickenpox (Varicella)

The US vaccinates against Chickenpox

The CDC say (quotes from various pages in no particular order):

"Chickenpox Can Be Serious. Protect Yourself and Your Child."

"The best way to prevent chickenpox is to get the chickenpox vaccine. Before the vaccine, about 4 million people would get chickenpox each year in the United States. Also, about 10,600 people were hospitalized and 100 to 150 died each year as a result of chickenpox." 

"Chickenpox is a very contagious disease caused by the varicella-zoster virus (VZV). It causes a blister-like rash, itching, tiredness, and fever. Chickenpox can be serious, especially in babies, adults, and people with weakened immune systems. It spreads easily from infected people to others who have never had chickenpox or received the chickenpox vaccine."

"Once it gets going, chickenpox is very contagious and can catch up with anyone in its path who’s not received chickenpox vaccine. Before the vaccine was available, about 100 people in the U.S. died each year from chickenpox. Fortunately, you can make yourself nearly invincible against chickenpox if you get the vaccine." 

"Chickenpox is a very contagious disease. You or your child may be at risk if you have never had chickenpox or gotten the vaccine."

"Varicella (chickenpox) is a highly contagious disease that is very uncomfortable and sometimes serious. The chickenpox vaccine is the best protection against chickenpox."

WebMD tells us:

Vaccine Refusal Raises Chickenpox Risk

Kids Are 9 Times More Likely to Get Chickenpox if They Don't Get Vaccinated

""Many parents refuse the varicella vaccine because they think of chickenpox as a mild illness, but this is not necessarily true," study investigator Jason M. Glanz, PhD, of Kaiser Permanente tells WebMD.

"Before the vaccine there were 100 deaths and 10,000 hospitalizations a year due to varicella. It can cause very severe illness in newborns and adults and in children with compromised immune systems."

Shit right! I've had chicken pox, so have my kids, so have 99% of people I know, I don't know anyone who has had severe complications, nor died - yet I'm nearly queuing up for a vaccine after reading that!

Now in contrast lets examine guidance from the UK, a country that doesn't vaccinate against Chickenpox

"Chickenpox is a mild and common childhood illness that most children catch at some point."

"Chickenpox is most common in children under 10. In fact, chickenpox is so common in childhood that 90% of adults are immune to the condition because they've had it before." 

"Chickenpox in children is considered a mild illness, but expect your child to feel pretty miserable and irritable while they have it." 

"Complications of chickenpox are rare in healthy children. The most common complication is where the blisters become infected with bacteria.  A sign that the blisters have become infected is when the surrounding skin becomes red and sore.  If you think that your child's blisters have become infected, contact your GP as the child may need a course of antibiotics."

It's hard to believe we are talking about the same illness.

UK media reports:

"During the first half of the 20th-century it made sense to be introducing vaccines against whooping cough, diphtheria and tuberculosis, all of which were killing thousands of children every year. But nowadays, the vogue is to recommend immunisation for diseases that are either relatively harmless, or serious but rare."

"Chickenpox falls firmly into the former category; most children suffer only a few uncomfortable days. Yet we are being told that it is a serious disease against which we need to vaccinate. These recommendations are based on research that actively looked for serious complications of chickenpox in all children admitted to hospitals in the UK and Ireland over a 13-month period. The researchers found 112 children who had serious complications of chickenpox, most often a secondary infection treatable with antibiotics. Six deaths were reported. Excluding one baby that died in the womb, four had a chronic health problem, such as HIV or cerebral palsy. Only one previously healthy child died, out of a total population of over 10 million. Chickenpox causes serious complications in less than 1 in 10,000 children.  Telegraph.co.uk "

Image used in newspaper article

"Children might soon be vaccinated against chicken pox, according to recent reports. But some experts question the need for a vaccine against an infection that's so mild - especially when it could put thousands of elderly people at greater risk of shingles."

"Chicken pox causes up to 50 deaths a year, 40 of them children, and it seems the Government's Joint Committee on Vaccination and Immunisation is considering adding a vaccine against it to the MMR jab."

"But there is widespread concern about this. First because a similar MMR super jab now used in America has been found to double the risk of fits in some children."

"Also the jab has raised the rate of shingles among the old - according to one U.S. study, cases have risen by 90 per cent. Here even the Government health watchdog, the Health Protection Agency, has predicted that a vaccine could cause a 20 per cent rise in shingles cases." Daily Mail.

More here

You can see why parents are confused? 

Notice the different language used to describe the same disease and statistics when trying to promote vaccine use, compared to that where it isn't available.  The US make no reference to any potential links with shingles whatsoever, the UK highlights this as reason the vaccine isn't given to all.

Who should parents believe?

The other big problem I find with those promoting vaccine use, is the distinct lack of acknowledgement of risks.  

Now I'm not a doctor, but even a paracetamol tablet carries potential side effects, I look at what those are, weigh up the pros and cons and decide whether to take the tablet - I struggle to believe something injected to alter the immune system doesn't carry any.  Yet how many parents are given these details or perhaps vaccine pack insert beforehand so they can be informed?

How many debates go along the lines of yes there is a X% risk of ABC, but the reduction in illness is XYZ?

No, instead we get told how people die without vaccines, that we should be grateful as some countries would love them, that how could someone forgive themselves if their child caught a disease they weren't vaccinated against?

We are told herd immunity is vital to protect the vulnerable, and as one article recently discussing the flu vaccine how selfish the non vaccinating were.  At the same time the author (without a hint of irony) tells us that the vaccine is only 60% effective, (and even that figure varied depending on one’s age group and other factors), but apparently we should all rush out and get it anyway because of herd immunity, and because the protection isn't 100% the non vaccinated are putting those who have had the shot at risk.  The fact everyone vaccinated could merrily pass it among themselves without needing an unvaccinated person if it's only 60% reliable doesn't seem to matter.

A quick Google on the subject of herd immunity turns up this and this, which means pretty soon parents need  a medical degree to pick apart the facts.

If we are assuming vaccine is risk free, 60% protection is a bonus, but this again is where we hit a bump in the road. As highlighted above parents are connecting at a level unseen before - they hear stories from others who have a vaccine injured child, they see that the UK Government offers a "vaccine damage payment".

"1. Overview If you’re severely disabled as a result of a vaccination against certain diseases, you could get a one-off tax-free payment of £120,000. This is called a Vaccine Damage Payment."

In fact by 2005 the vaccine damage scheme had paid out 3.5 million for injuries that had occured in just the previous 8 years.

But hang on where did anyone mention becoming severely disabled was a risk of vaccinating?   So now along with imagine how bad you would feel if your child caught the disease, we have to throw in imagine how bad you would feel if you gave your child a vaccine that resulted in disability.  Google vaccine injury and there are pages of results - a point which of course is not even touched upon by the author above beyond "there is proof vaccines don't cause autism", yawn, next.

In the UK there is no such debate to be had about flu as only the vulnerable and now children are offered the vaccine, the NHS instead tells us:

"If you are otherwise fit and healthy, there is usually no need to see a doctor if you have flu-like symptoms.
The best remedy is to rest at home, keep warm and drink plenty of water to avoid dehydration.
You can take paracetamol or ibuprofen, to lower a high temperature and relieve aches."

Of course, no vaccine piece would be complete without at least a mention of Wakefield and autism.  An outbreak of measles in Wales prompted "The Independent" to provide a platform here where he published a full statement..

Take Wakefield out of the equation and Google autism and measles, and this piece that lists "22 medical studies that show possible connections to vaccines and autism" soon appears.

A letter from your GP saying Andrew Wakefield has been disproven and so here is your appointment for the MMR, just isn't going to cut it for many.

I personally think we need to be exploring what impact vaccine have on gut flora, just like scientists have done with antibiotics.  We know disturbed gut flora is linked to not only autism but a whole host of problems, see here and here.  New studies also suggest gut flora plays a key role in vaccination - could it be there are people with a certain genetic makeup that have a gut bacterial profile that may be at increased risk of vaccine damage?   We simply don't know because it seems you have to sit in the "pro" or "against" camp and take the hard line either way.

Surely we should be trying to understand all and any possible implications of vaccines, both good and bad?

No it hasn't been proven it's dangerous for certain subgroups to be vaccinated, but nor has evidence proved they're safe for everyone either.  In fact a total of 917 payments from the UK vaccine injury scheme since it started in 1979 (with no doubt thousands more who couldn't provide a compelling enough case for a payout) would suggest otherwise.

If there is a case to be had for vaccinating, health care professionals need to recognise the shift that has taken place in obtaining advice - and realise that "because we recommend so", is no longer good enough.

13 Baby Led Weaning Myths

"Baby-led weaning (often also referred to as BLW) is a method of adding complementary foods to a baby's diet of formula or breastmilk. 

Baby-led weaning allows babies to control their solid food consumption by "self-feeding" from the very beginning of their experiences with food. The term weaning should not be taken to imply giving up formula or breastmilk, but simply the introduction of foods other than formula or breastmilk." (wikipedia)

I love BLW for lots of reasons;   it allows baby to regulate their own intake, offers oodles of sensory opportunities and the chewing and processing promotes good oral development.

Seven years ago when I used it to introduce solids to my baby, my health visitors had never heard of it (although one did come round to learn more) and as he was born at 34 weeks gestation a few people thought I was rather mad, he would surely choke or starve! Yet it worked brilliantly.

As more people recognise the benefits of letting babies feed themselves, I've noticed when working with parents (in person and online) the same myths and questions arise.  So I thought I would share my thoughts here to save repeating :-)

1. Baby must be able to sit unaided to start solids.

A mum the other day online asked whether that meant when baby was placed in the seated position, or when they could actually get themselves there from laying down?

Some babies are 8/9 months before they can sit unsupported, why can they not eat before then even if showing other signs of readiness?  Once babies can sit unsupported you wouldn't feed them without support until truly stable, as they will still randomly tip over after a bit which is hardly safe when consuming food.

So what's the relevance?

The key is that baby is upright and has a clear passage from mouth to stomach....

This baby is reclined, eating solids in this position is not recommended.

Both these babies are supported, yet have good head control, are not slumped to one side and food can move easily from mouth, to throat to stomach.  They may or may not be able to sit unsupported but as we can see that's really irrelevant, they are maintaining a safe eating position.

In fact lets compare it to a baby in a high chair:

Again we have no idea whether this baby can sit unsupported or not, because she's supported by the seat behind and the tray in front.  It really doesn't matter as she has a clear passage from mouth to gut.  She would be sat in this chair exactly the same way whether she could sit by herself or not.

Gill Rapley says:

"Sit the baby up to the table with everyone else. He can be either in a high chair or on an adult's lap – supported, if necessary, so that he can use his hands and arms freely. Make sure he is sitting upright to handle food, not lying back or slumped."

I confess it's a long time since I read Gill's book, but I don't recall anything about baby sitting unaided there either.  Anyway as I say, personally I don't see a rationale for it.

2. Vegetables & fruit are the best first solids.

I think it takes a lot for people to make the mental shift from the old fashioned weaning schedule, when solids were introduced before gut closure.  Babies of three and four months (particularly before 17 weeks) are at increased risk of allergies from exposure to solids - therefore vegetables were considered "safer", particularly those considered easier to tolerate, and with low allergenic potential such as carrots, pears and butternut squash!

Pre six months nutritional needs are met by breastmilk, and so babies don't need vitamins and minerals from foods.  From around the middle of the first year, requirements for additional protein, iron, zinc, B Vitamins and vitamin D increase  - but the best sources of these aren't fruit and vegetables!  We know some infants are more at risk of low mineral stores than others, for example those born early, at low birthweight or to mums of poorly controlled diabetes.

We also know babies have small tummies, so they need nutrient dense foods - ie foods which provide good amounts of vitamins, minerals and calories even when consumed in small amounts.  Breastmilk has around 70 Kcal per 100g, in comparison carrots for example have 27 Kcal, less if there if they're not drained well.  

Judy Hopkinson, Ph.D., Associate Professor of Pediatrics at Baylor College of Medicine says:

"It is important to remember, that when solid foods are introduced, the amount of breast milk a baby consumes decreases."

If a baby has an underlying feeding problem or isn't taking enough milk, baby may then I believe take food in addition to solids (which is why Dr Newman recommends earlier solids rather than formula if extra nutrition is required from around 17+ weeks), for typical babies though a reduction in milk feeds occurs.

This means that although vegetables are healthy, the vast majority don't offer anything that breastmilk doesn't ie milk is also abundant in these same nutrients too - but they do have less calories and less easy to assimilate iron and zinc.  Vegetables gradually become more significant the more baby transitions to solids, and important when baby is no longer drinking breastmilk or formula.

Therefore whilst parents think they're giving gentle, harmless foods by not offering their 8 month old anything more than plums and pears, to ensure optimum growth and protect against deficiencies, food should contain nutrients babies begins to need first.  

In Canada meat and eggs are now recommended as ideal first foods, the La Leche League have suggested this for years - in fact there are not many cultures who wean on to refined grains, vegetables and fruit.  This makes sense as baby has all the enzymes to easily digest meat  at 6 months, and it's also high in protein, iron, B vitamins and zinc - the foods we know infants need first.  Egg yolks are extremely easy to digest and if organic are also an excellent source of vitamin D.  Obviously vegans and vegetarians can meet requirements via their normal sources of these nutrients, although as less bioavailable clever food pairing is also required (which I'm assuming those choosing either diet are already familiar with).

3. Closely followed by grains: bread, pasta, cereal.

Let's start with bread as a product.

Made at home contains: Wheat Flour, Yeast, Water, and Salt (with a very small amount of sugar if any).

Wharburtons meduim sliced contains: Wheat Flour,Water ,Yeast, Salt,Vegetable Oil, Soya Flour, Emulsifiers E481, E472e, Preservative Calcium Propionate, Flour Treatment Agents Ascorbic Acid (Vitamin C), E920 (Vegetarian)

The sodium amount in one slice of bread is 0.4g yet according to the NHS:

"The maximum recommended amount of salt for babies and children is:up to 12 months – less than 1g salt a day (less than 0.4g sodium)"

Which means one slice equals more than baby's total daily maximum allowance - yet breastmilk and infant formula also contain sodium..

Wheat gets even more complicated as: 

"Today's wheat is a far cry from what it was 50 years ago.  Back in the 1950s, scientists began cross-breeding wheat to make it hardier, shorter, and better-growing.

Today's hybridized wheat contains novel proteins that aren't typically found in either the parent or the plant — some of which are difficult for us to properly digest. Consequently, some scientists now suspect that the gluten and other compounds found in today's modern wheat is what's responsible for the rising prevalence of celiac disease, "gluten sensitivity," and other problems."

Read more here, here, here and here.

Lastly grains also contain phytic acid, a substance present in grains in relatively large amounts. Phytic acid is often referred to as an “anti-nutrient,” as it blocks absorption of minerals, like iron, magnesium, zinc, and calcium, in the body; the very things baby needs to absorb.  Other cultures who eat grains early, typically either prechew, sprout or ferment.  You can read more here and here.

As part of a balanced diet for an adult, quality grains may not be a huge issue for some; but when we're looking at nutritionally significant foods for babies who don't consume much, it seems to me there are far more valuable solids to explore, particularly in the first year or two.

The bigger picture is also that we are eating more wheat than ever before, hidden in products you wouldn't necessarily expect to find it. Hit the supermarket and check out how many ice creams, salad dressings and processed meats contain wheat.  Then consider some get cereal for breakfast, bread for lunch and pasta for dinner!

4. And only one type.

Just carrots, peaches or whatever else parents have selected. To me baby led weaning isn't just in the sense they feed themselves, but also that they lead what they choose to eat from a balanced meal.

Gill discusses in her book how some theorise the baby will choose foods with the nutrients he might need, guided by taste (2, 3) - but how if you only have a single food offered?

For those with severe food allergies in the family or where reactions may be serious, it of course makes sense to present things as individual foods before mixing in say a curry or casserole where it may be more difficult for baby to avoid potential allergens.

Similarly higher risk foods such as egg, dairy, peanuts etc should be given at different times so it's easy to identify if there is a problem, which item caused it.

For the most part however there is no evidence supporting the concept of introducing one food every few days and watching for a reaction, particularly once the gut is closed; people can develop a food intolerance at a later date too.

5.  Babies need bland.

Baby rice being the king of!  Breastfed babies are exposed to tastes and flavours via breastmilk and so often parents report their baby is far more interested in tasty meals.  Herbs, spices, garlic and pepper are all suitable.

Cultural norms vary widely so if we look at Indian cuisine and first foods, one example is a "cereal" made from rice (not processed, stripped of any goodness and then refined with synthetic vitamins baby kind!), toor dal (split peas), cumin seeds (bitter, spicy), ajwain seed (strong, spicy thyme like flavor), asafetida (tastes a bit like strong onions with a touch of earthy truffles) and dried ginger - bit of a far cry from a rusk!  Google the nutritional qualities of each ingredient and you will also see it's a good source in magnesium, zinc and iron with a low GI and is considered easy to digest.

6. Baby has to be exactly 182.6 days old (6 months).

Why? Does the magic gut fairy wave a wand on the eve of night 181 thus rendering the baby ready for solids? No.

It's a guideline not a rule.  I hear people say I'm going to start BLW at 6 or 7 months and wonder, if it's baby led, how do you know when you will start unless actually you're picking the date and it's not baby led at all?

I don't want to cover again the ins and outs as I covered everything here  but from a biological perspective it makes no sense babies would be able to pick up food, get it to their mouth, chew and swallow before they're ready to eat, because how would cave woman have known about the 6 month rule?  How would our ancestors have known to withhold food even after the baby was helping themselves?

Furthermore if you're going to buy into the concept of self feeding and that being able to do this indicates solid readiness, then surely it also follows that if babies aren't ready, you can present them with all the solid food in the world yet they won't be capable of eating it?

Indeed Gill Rapley conducted some small scale research and found:

“The babies who participated in the research were allowed to begin at four months. But they were not able to feed themselves before six months. Some of the younger babies picked food up and took it to their mouths; some even chewed it, but none swallowed it. Their own development decided for them when the time was right."

Just like I think baby led is more than self feeding and should encompass self selection of foods, I also think that should extend to when they do so.

7.  Tongue tie doesn't impact on starting solids.

This really confuses me.  The tongue is pretty key to eating (ask anyone who has ever suffered Bell's Palsy ), it needs to move the food laterally to the gums/teeth for mashing, it needs to retrieve bits that get stuck in the cheeks or roof of mouth, it needs to undulate to move the food to the back of the mouth for swallowing - how can that always happen if the tongue is anchored to the floor of the mouth in a way that significantly hinders these actions?

I'm not suggesting for a second all babies slow with solids have tongue tie, nor am I saying a restricted frenum always causes eating problems; but it's equally wrong to say that it never can, as this mum's diary clearly highlights.  If baby is still struggling with excessive gagging, pouching food (getting it stuck in cheeks or roof of mouth) or doesn't really seem to have progressed two or three months into the eating journey and parents have concerns, it's worth ruling out.

8.  Babies need water with their meal as soon as they start solids.

The general consensus seems to be formula fed babies should be offered water when solids are introduced; breastmilk however is around 88% water and so if you are feeding on cue there is no rush to introduce extra fluids with meals.  Playing with cups and water outside of mealtimes (some find in the bath allows for spillage!) can give baby time to enjoy that experience in itself.

9.  Puree on spoons is still BLW - if not you're a purist.

Of course some foods are easier to spoon - yoghurt or soup for example; and preloading spoons for odd foods is I think pretty instinctive.  However recently I've heard of people blending or mashing all meals, before loading up spoons and calling it BLW.  Yet I'm not convinced appetite regulation is that easy when things aren't solid.

Take a punnet of strawberries, you're average 6-9 month old might eat anywhere from a bite to a few. Puree the punnet however and you get a surprisingly small amount of mush.  Think how much fruit you need to make a smoothie, it's much easier to consume larger amounts of blended food than you would consume  in their solid state.

Having to pick up and bring food to the mouth and then process, rather than just swallowing, slows down the eating process allowing the baby more time to recognise they are full.  Babies pushing a preloaded spoon a few inches to their mouth eat much faster than those feeding themselves.

It also removes a lot of the sensory experience - visual identification and textures of foods, learning how to pick up a particular item and manipulate using fine motor skills, not squishing too hard or letting it fall.  I think Gill in one of her presentations has said previously, how can a child build a relationship with foods if green mush is sometimes apple, sometimes avocado, sometimes cabbage?

10.  Everything has to be in its whole untouched state, no mashing or it's not BLW.

I know this seems rather a contradiction to the above statement but some things are shades of grey, not black and white.  Whilst there is the extreme of pureeing everything to a soup and calling it self feeding, there is also the other end of the spectrum - some foods  that are nutritionally valuable are much more difficult for babies to process.  Previously premastication would be used in hunter gatherer societies, plus perhaps bashing something with a rock or squishing it between fingers eg nuts or meat (no mincers then!).

Surely instinct also plays a part?  

If baby enjoyed a meal, yet at a later date the same items are presented cooked/chopped differently, say in a casserole with a slippery sauce baby may struggle to pick it up as well as before - how can they be less ready for the food than they were before?

Helping baby by say roughly squishing to make more "graspable", is hardly comparable to spooning down jars at 4 months.

To some degree processing is often done - we don't present baby with a whole chicken and say he's can only eat it if he can carve himself a leg.  Nor offer eggs but declare baby only ready if he can get through the shell.  When offering a piece of chicken the parent is already subconsciously deciding the size and shape of what baby receives; whether that is one piece baby can hold, shredded which baby can practice picking up skills, made into minced balls or a mixture depending upon what the parent feels baby handles best, is to me personal preference rather than "weaning rules".

11.  Food is just for fun until they're one!

Agh this is up there with my pet hate sayings along with "happy mum = happy baby"!

A blogger who makes some great points (although also some I don't agree with!) sums it up well:

"I think the phrase “Food before one is just for fun” needs to go die a merciful death, to be honest. In all likelihood, the phrase itself was invented by some well-meaning person who wanted to encourage a more relaxed approach to solids among anxious mothers who were engaging in weird little mompetitions with other mothers about who could cram the most “jars” inside their child--and in the process, harmfully crowding breastmilk/formula out of the baby's diet.

But it’s looking increasingly as though this phrase has begun to be interpreted as meaning that solid foods play no nutritional role at all before one year of age—and that therefore, it’s completely fine and not an issue if months and months go by while your older baby eats basically no foods at all and does not receive any micronutrient supplementation either. And the evidence suggests strongly that this is just not true."

WHO say:

"At 9-11 months of age, for example, the proportion of the Recommended Nutrient Intake that needs to be supplied by complementary foods is 97% for iron, 86% for zinc, 81% for phosphorus, 76% for magnesium, 73% for sodium and 72% for calcium (Dewey, 2001)."

Nobody is suggesting babies need vast quantities of foods, to be on 3 meals per day ASAP, if baby is enjoying picking from a balanced diet, normal amounts can vary hugely.  Milk should absolutely be babies main form of nutrition, fueling bone and brain growth and only starting to tip in the favour of solids towards the end of the first year.

What's more nobody is suggesting food isn't fun!  Of course it is, it's an amazing learning experience.  But it isn't just for fun.

I think it's this belief that in part leads to some parents choosing less nutrient rich foods believing they're not actually needed at this age.

12.  Babies have the same tastes we do.

How can I sweeten yoghurt or porridge is a question I frequently hear.  Adding pureed fruit seems to be a common suggestion, but I always have to wonder why?  Whilst many adults are used to eating foods packed full of hidden sugars and so to them things taste bland or sour without,  why encourage sweetening for baby?

It's also normal for them to pull a funny face or shudder if something is bitter, tart or sour - but this doesn't necessarily mean they don't like it or it isn't worth offering again.  It can take ten tastes of something for baby to get used to it. Bitter foods are considered important to our health, despite the fact many now eat very little - these taste buds are typically underdeveloped, whilst sweet are over enhanced.

Recommendations are to eat more vegetables than fruit, and where possible choose traditional varieties; some new types of fruit are being bred for their intense sweet taste to suit ever sweetening palates.  For example grapes should be prominently sweet with a hint of sourness and a deep flavour, yet many now are designed to taste like balls of sugar with thin skins and extra water (juiciness sells) to compete with the every growing confectionery industry.

13.  BLW are slow to start solids compared to puree led and may go hungry.

Many say BLW babies consume less foods than those puree fed, but we could also flip that to say puree weaned babies eat more than those BLW.  Some worry BLW infants will go hungry as they can't consume enough.

A small study published last year found:

"BMI scores differed significantly between groups lower BMI were associated with baby-led weaning in the whole sample. The mean BMI percentile rank for the baby-led group was close to the expected average."

"In contrast, the mean percentile rank for the spoon-fed group was above the average level, indicating that more children in this group were likely to be classed as overweight."

"BMI z-scores were also found to differ significantly between the weaning groups. We found there to be an increased incidence of obese children in the spoon-fed group (n=8) as compared to the baby-led group (n=1)" (6)

and

In contrast, more children in the baby-led group were classified as significantly underweight (n=3)

The baby-led group was close to the expected average, furthermore 9 children were obese, 8 spoon fed and 1 baby led.  3 children were underweight, all baby led.    Therefore the risk of overweight when spoon feeding was statistically much greater than the risk of being underweight was if baby led.  They concluded:

"Our results suggest that baby-led weaning promotes healthy food preferences in early childhood that could protect against obesity. This finding is of note given the serious problems with childhood obesity facing many modern societies."

References

1. The Role of Zinc in the Growth and Development of Children Nutrition 2002;18:510–519

2. Davis, Clara M. Results of the self-selection of diets by young children. Can Med Assoc J1939 41: 257-6

3. Strauss, Stephen. Clara M. Davis and the wisdom of letting children choose their own diets.Can Med Assoc J 2006 175: 1199

4. Institute of Medicine, Food and Nutrition Board. Dietary Reference Intakes for Vitamin A, Vitamin K, Arsenic, Boron, Chromium, Copper, Iodine, Iron, Manganese, Molybdenum, Nickel, Silicon, Vanadium, and Zinc. Washington, DC: National Academy Press, 2001.

5. Hambidge KM, Krebs NF. Zinc deficiency: a special challenge. J Nutr 2007;137:1101-5.

6.  1.I. Blossfeld, A. Collins, M. Kiely, C. Delahunty, Texture preferences of 12-month-old infants and the role of early experiences, Food Quality and Preference, Volume 18, Issue 2, March 2007, Pages 396-404, ISSN 0950-3293, 10.1016/j.foodqual.2006.03.022.

Stop giving my kids junk food!

When my children were pre school age, we received a lot of information about the governments "Change 4  Life" scheme.  For those who haven't heard of it it's designed to promote increased exercise, reduced consumption of junk food, eating five + fruit and veg per day and so on.

The risks of cancers, diabetes, obesity and heart disease increase as a result of eating too much of the wrong foods we are told. we received cloth bags, leaflets and were invited to various events locally promoting the scheme that is still actively running in the area.

Once they hit school age, dodging junk food (and I use the term "food" loosely!) becomes a skilled art form.

I first noticed it when we visited our local leisure centre, which is after all somewhere purpose built for fitness.  I therefore did a double take when the first thing I was greeted with upon walking through the door, was a row of vending machines.  Not a single healthy choice is available; just rows of crisps, poor quality chocolate and fizzy drinks.

Why?  People are going into the building 99% of the time purely to do something positive for their health, yet the glowing beacons of temptation have to be negotiated before you're even through the door.  What message does this send children, who are being taught about great and not so great food choices as part of the school curriculum?  Why aren't they using one of the many healthy vends that are available such as this or this.

Negotiating for one class isn't too difficult, signing up for a week long activity course however is a whole different ball game.  Friends from the group hit the vends at lunch time, as do the leisure centre staff running the course joining them (you know, the guys promoting a healthy active lifestyle) - but you have to tell your child that whilst you know lots of other people are getting it, that stuff isn't good as part of a daily diet?

"Why does the leisure centre sell it then" my daughter asks?

The cynic in me wants to say it's because there is a huge confectionery factory next door, and profiting from children by supplying addictive unhealthy foods is how this country seems to roll;  but I resist and say that sometimes people make different food choices.  Even I can't understand how the government can promote Change 4 Life as a supposed healthy living scheme with one hand, whilst filling their centres with junk.

(Update:  I contacted the leisure centre who stated healthy food didn't sell as well and they had "vending targets to meet".  So basically they get targets to sell foods known to be harmful to health to generate profit, and then the NHS uses that money to mop up the resulting diseases?  I'm clearly missing an integral piece of the puzzle here....)

Next up was a social group run by a charity within school grounds (but independent from them) one evening per week. As my daughter was waiting for a place at the local school, and as they had always been educated out of the area, we thought this would be a good way for her to meet other children before starting.

We walked in and paid, before being advised we could leave money for "tuck" if we wanted.  I turned around to see a woman unveiling rows of sweets and chocolate and my heart sank.  Seriously?  They're there for an hour and a half straight after dinner.

Please don't misunderstand, my children get chocolate and "treats", but like many I suspect they're also sensitive to the chemicals and additives in many commercial brands.  From as young as 2 years old I knew instantly if someone had given her "treats" when out, as she would be one big emotional mess for hours.  OK so not too out there for a 2 year old, but try that on for size with a 10 year old and see how fun it is.

It seems to me it's all a bit of a gamble, as there hasn't been a generation previously raised eating half the additives there are now.

Toffee which is just sugar would be a million times more preferable than:
"Sugar, Glucose Syrup, Cornstarch, Invert Sugar Syrup, Wheat Starch, Vegetable Fat, Wheat Flour, Humectant, Glycerol , Malic Acid, Potato Starch, Citric Acid, Tartaric Acid, Gelling Agent ( Gelatine) Emulsifier( Glycerol Mono Stearate) Acidity Regulator( Potassium Citrate) Salt . Colours: E100, E120, E133, E171, Flavours: Blackcurrant Concentrate, Carrot," found in these "rainbow pencils".

We eat 70%+ dark chocolate, we make our own raw chocolate (that the kids love doing and takes literally minutes), make "bounty bars" and other bits and pieces.  If they go to parties or special occasions, we go with the flow on cakes, crisps etc as much as possible (although my daughter knows she can't eat anything coloured red!)  but these are odd events not a daily occurrence.

So, the next week before attending I decided to be one step ahead on the planning front.  We arranged for her to have dinner, not buy "tuck", then have some strawberries with chocolate sauce when she got home.   She eagerly agreed and off she went.

When she got back I was preparing her dessert.  "I'm not really hungry now "she said, "because I won a race I was given a Caramac bar, and then they gave us a cola flavoured drink and biscuits before we left...."

Last week my daughter started her place at the new school, within the first week we had received a letter home inviting parents and pupils to a talk about nutrition, and learn about a fitness programme they were launching.  Great I thought (although I noticed it was run by Juice +, don't even get me started on them!) healthy eating is part of the curriculum.

We take a lot of time, trouble and expense to send our daughter to school with a healthy lunch, so I was a bit confused this morning when I found money in her school bag.  She explained she was taking money for school tuck?  Scuise me what?

Apparently the school sell crisps and biscuits at break time, and she wanted to get some.  Confused I called the school and was advised they only sell healthier crisps that are baked not fried like Space Raiders or Mini Cheddars, and the biscuits are just plain rich tea or digestives.

Head meet desk.

These products contain among other things Maltodextrin, Flavour Enhancers, Monosodium Glutamate, Glucose Syrup, Glucose-Fructose Syrup and Partially Inverted Sugar Syrup. Blood sugars must be all over the place when the children return to class.

And what happens if blood sugars spike?  "interesting" and "lively" behaviour follows (to be diplomatic). Check out the different behaviours that followed different foods during this experiment.  There were 720 incidents of mean, physically aggressive or hyperactive behaviour in the group that consumed biscuits, crisps, and fizzy pop.  In comparison there were 120 in the healthy food group.

Google "child behaviour carbs" and you will find page after page highlighting how sugar and refined carbs cause problems for many children, even if as minor as reduced concentration/brain fog.

Why I asked, didn't they sell fruit, cheese or something that would at least provide some nutrition? I was told they had tried that but the children wouldn't buy it, and that there was no obligation for them to buy anything.

If the children don't want something vaguely healthy, why sell anything at all? Is it about profiting from our children? We all know how easy it is to snack on crisps and junk, even when you're not hungry.

No the children don't have to buy it, however children that are sensitive are often even more driven to consume these foods that give them a "buzz".  Their friends are eating it and who wants to be the odd one out? I don't want to create a big deal around these sorts of foods, I shouldn't have to negotiate this when going to school.

Also consider the children are at school for only just over 6 hours, with lunch in the middle.

I asked on the Facebook group what their school's "tuck shop" offered and it seems there are big variations, I suspect depending upon the demographic (mums in a nearby area would freak out if the raisins weren't organic, let alone allow crisps and biscuits!). One mum replied:

"It sold junk pure junk, my protests went unheeded and they "lent " her money so she didn't feel left out. I watched my child stagger home high on sugar and colourings".

Lots replied saying only healthy choices are available such as fruit, vegetables, cheese, cherry tomatoes or dried fruit such as raisins; others that their children took a snack from home.

Since then my daughter has joined another school social club and been invited to a school disco, both of which are advertising sweets/pop and the latter includes a free hot dog!  It appears the lure of crap is marketing material, rather like enticing a junkie to your party with the offer of free crack cocaine.

Then there's "birthday sweets" and with 30 odd kids in a class that's not infrequent, plus on several occasions the teachers have given them out as rewards.

So it seems to me we have a situation where the demographic that would most benefit from a nutritious break time snack, don't get them as they wont buy them. In an area where for some children 5 per day is more likely to be of confectionery, the school takes the view of give em what they want?

The trouble is even taking food sensitivities out of the equation, if you consume lots of junk food you get addicted - and when you are healthy choices just don't cut it, hence why people don't buy it.

This is probably to be expected.

A 2010 study exploring food preference in rats (which aren't humans but we do share many of the neurobiological and hormonal mechanisms of flavour learning and appetite regulation), found as you might expect - those who had access to "junk" ate more and gained more weight than those who didn't.
What researchers didn't expect was that these foods triggered a "dopamine high", but that with regular consumption the "hit" became less; causing the rats to actively consume more food to repeat the high.

After the rats had gorged themselves to a ridiculous weight, the junk food was taken away and replaced with healthy food. Rather than eat the healthy food, the rats chose to starve themselves for two weeks. The rats would even intentionally subject themselves to electric shocks to get to the junk food, even though the healthy food could have been eaten without enduring a painful burst of electrocution. 

You may recognize this as the textbook definition of addiction.

A 2014 study found after just 2 weeks on a diet that included daily access to cafeteria foods, including pie, dumplings, cookies, and cake -- with 150% more calories -- the rats' weight increased by 10% and their behaviour changed dramatically. They also reduced their appetite for novel foods, a preference that normally drives them to seek a balanced diet.

The concluded:

We observed that rats fed a cafeteria diet for 2 weeks showed impaired sensory-specific satiety following consumption of a high calorie solution. The deficit in expression of sensory-specific satiety was also present 1 week following the withdrawal of cafeteria foods. Thus, exposure to obesogenic diets may impact upon neurocircuitry involved in motivated control of behavior.

Basically after 2 weeks, a high cal solution couldn't trigger the sated response in rats, and this was still the case even a week after they had stopped eating cafeteria food.  They theorise diets that cause obesity may impact on neurological pathways that drive behaviour.

We know junk food is deliberately manufactured to be addictive.  In 2001 a study of 120,877 people found:

"The largest weight-inducing food was the potato chip (or crisps to us Brits). The coating of salt, the fat content that rewards the brain with instant feelings of pleasure, the sugar that exists not only as an additive but also in the starch of the potato itself — all of this combines to make it the perfect addictive food.

"The starch is readily absorbed,” Eric Rimm, an associate professor of epidemiology and nutrition at the Harvard School of Public Health and one of the study’s authors says. “More quickly even than a similar amount of sugar. The starch, in turn, causes the glucose levels in the blood to spike” — which can result in a craving for more."

Regardless of whether they're baked or fried!

A few eye opening facts from Jamie Oliver as part of his campaign to protect the health of our youngsters:

• FACT: The UK has one of the highest child obesity rates in Europe.
• FACT: By the age of five, one-fifth of children in the UK are already overweight or obese.
• FACT: By the age of 11, this figure increases to one-third.
• FACT: 78.5% of children, aged 5 to 15, fail to consume the recommended five portions of fruit and veg per day.

Perhaps they could disseminate this information to all schools and leisure centres?  Because as it stands, it seems society in some areas at least, is unconcerned about the health of our children.  Are they only interested the money to be made from them, whatever the long term cost?  I don't want to be one of those parents, but similarly I don't want my children to become just another statistic.

Update:  I have received an email stating the school have withdrawn Space Raiders from the school tuck shop and are asking the children what healthier snacks they would be prepared to eat (fruit apparently didn't sell and made a loss for the school).  Unfortunately this feels like a drop in a very large ocean!

Cafeteria diet impairs expression of sensory-specific satiety and stimulus-outcome learning

Dopamine D2 receptors in addiction-like reward dysfunction and compulsive eating in obese rats

Breastfeeding In Swimming Pools

In the last few months the hot topic seems to have been asking mums to stop breastfeeding in the public swimming baths.

Imajica Gilroy was told she couldn't breastfeed at Parkside Pool in Cambridge as it was "unhygenic".  For anyone in the area, there is a breastfeeding flash mob planned there Sat 17th August @ 1pm. 

Manchester Aquatics Centre allegedly told Stephanie Wilby it was "indecent exposure", and Stephanie claims the staff likened it to someone urinating in the pool. Breastfeeding flash mob there planned Friday 16th @ 10am.  Stephanie also claims staff shouted at her to stop immediately, causing a scene - but I don't want to dwell on that as I think it detracts from the real issue.

What's interesting about swimming pools is that unlike other venues, even pro breastfeeding mums often say if the rule is no eating this should apply to all.

So I wanted to reply to a few common comments :)

1.  Breastmilk could get in the water.
If we're concerned about breastmilk getting in the water, all lactating mums should be stopped from swimming in case they leak.  I'm also wondering why when breastfeeding we would expect milk to be pooling around the mother in the water, er no it's going into baby!

b)  Even if breastmilk gets into the water, it is antibacterial, antimicrobial and doesn't pose a health hazard.

Lots of things that do pose a health hazard end up in the water.  It's rather ironic that Manchester Aquatics Centre allegedly likened it to someone urinating in the pool - because I'm sure plenty of toddlers have a sneaky pee in there, and have they ever tested for "leakage" in those without great pelvic floor muscles when doing the breaststroke?  Perhaps they should ban them too! Sweat, urine, mucous, saliva, hair, dead skin and faecal matter - not to mention sun cream, perfume and cosmetics - are among the pollutants introduced by bathers into pools.  Lordy a breastmilk bath is looking more desirable by the minute.

2.  Baby could vomit after feeding.
This is kind of a futile argument with babies though given a) they can puke anytime, even an hour or two after a feed.  b)  If the mum is leaving the area to feed as expected and then returning with baby, he may still vomit.  Some babies just don't posset, my first only ever did twice, both times after we had tried colief.

Those who have babies who are prone to refluxing copious amounts are hardly unlikely to breastfeed in the pool anyway, mums don't lose their brains when they get a baby - often the person most aware and conscious is the mum.

Important point to note:
Swimming pools are chlorinated.  

Swimming pools are chlorinated.  

Swimming pools are chlorinated.

I feel a need to repeat this as any argument over "water contamination" is wiped out with this point.

Chlorine is known to kill almost all kinds of bacteria, as well as viruses and protozoa - hence why it's used in pools. When chlorine isn't used, the bacteria in pools is comparable to that of a toilet - without anyone breastfeeding.

6.  It's indecent. 

Sorry but I'm frequently glad my eyes have an avert function when at the public baths, budgie smugglers anyone?  Aside from this it breaks the law to ask a mother to stop breastfeeding on the grounds of decency.

7.   If the rule is no eating, that means everyone.
This rule is clearly to avoid Big Mac and chips finding their way into the water, imagine if everyone took snacks!  Babies sometimes need feeding several times in an hour, whereas adults can consider the fact they are going swimming and eat more in advance.  They can also wait when hungry because they don't survive solely on a substance digested quickly and have bigger stomachs.

Furthermore the breast isn't just food,  I think a lot of people still struggle to grasp that babies don't just seek the breast when hungry.  They can do so for comfort, reassurance at a new situation (like swimming), or because they want to warm up if feeling chilly.  Furthermore we know babies don't always transfer milk - so they may not in fact be "eating" in the pool at all, they could be sucking for comfort. Are pacifiers, a nipple replica also banned?  What if they suck their own fingers?  Is sucking mum's finger OK but not her nipple?

8.  I think the mum should have got out and done it in the changing rooms.
Why?  It's not always convenient for mum to hot foot it off to the changing room, she may have an older child to supervise who cannot be left.

9.  It's unhygienic for baby.
How?  When attached to the breast the baby forms a seal, there is less likelihood of them ingesting water than when they're swimming in it. Mothers are also hardly likely to have their baby's face half in the water, don't believe me, you can see a great example here.  Some baby swimming classes involve submerging both mouth and nose under water, yet I've never heard anyone express concern that is unhygienic.

If you think pool water is that gross despite the chlorine, perhaps better off not taking your baby at all. Ultimately it's the mother's choice whether she feels it's a hygiene risk to her baby or not?

10. Other babies have to wait so why should breastfed babies be any different!
Oh no, I would be quite happy for a mum to bottle feed her baby or use a pacifier in the pool too! Not suggesting certain babies get special treatment, all have the same needs whether met by breast or bottle; our society has been intolerant of babies and children for long enough.

Unlike no petting, bombing or ducking - I can't think of a single plausible, logical reason why a baby cannot feed in a pool.  Nor has anyone else been able to offer one other than the rules say so.

Which tells me the rules need changing :)

With regard to Stephanie's case above, a spokeswoman for Serco said:

"We are fully supportive of mothers breastfeeding their child whilst in our centres.  Serco’s operating practices are to encourage breastfeeding in a safe and comfortable environment for both the mother and child rather than it taking place in the swimming pool."

Serco are you seriously suggesting breastfeeding in the pool is more dangerous than a baby swimming in it?  If so why?  I also trust we can let mums choose to decide where they are most "comfortable"?

There is a petition here to ask Manchester Aquatics to review their policies

Councillor Rosa Battle, executive member for culture and leisure at Manchester council, said: 

"We have asked the Manchester Sport and Leisure Trust and Serco to investigate this incident thoroughly and to take action immediately if it is established that any members of staff behaved inappropriately towards Stephanie.  We have also asked that the Trust and Serco review their existing policies, to make sure that they reflect the law.".

Update:

"Lifeguards at Manchester Aquatics Centre told they CAN’T stop mums breastfeeding"

"Now the M.E.N. has seen an internal memo sent to staff warning them not to discriminate against breastfeeding mums and warning ‘we must comply with the law’." - read more here

When To Introduce a Bottle To a Breastfed Baby?

A few months ago I received a call from a confused mum; her baby was 3 months old, breastfed, and that night he had refused his daily bottle.  Mum couldn't understand why, after all they had given a bottle once per day since week 2 as advised to "get him used to it".  He had always taken it without a problem why now should he refuse?

I get asked when should parents introduce a bottle a lot, and like the mum above many are told early introduction equals success, and conversely if the bottle isn't introduced early then baby is likely to refuse or struggle with technique.

What's the deal?

Firstly expressing:

In the early days of breastfeeding (once milk has "come in") your body is trying to establish how much milk your baby needs and thus how much to produce.  It does this based on what is removed, so if you feed baby and then express, your breasts will replace a feed plus more to replace the amount expressed.

Mums often plan to express so dad can give a feed and allow a longer stretch of sleep, but in the early days this often proves rather impractical as missing a feed results in overfull, painful breasts - meaning mum ends up pumping again whilst dad gives the bottle.

Some mums deliberately choose to cultivate an oversupply early on, usually if they want to build a stockpile for some reason ie they want to feed baby now, plus add a regular amount to the freezer.  Otherwise an oversupply can be problematic, leading to engorged painful breasts between feeds, faster flowing milk and increased leaking (as an example at the extreme end of the scale, one mum I worked with had to sleep with a super absorbent nappy taped over each breast at night).

Bottles:

I've spoken to so many mums over the years who have diligently given a bottle every day, or every week from a young age to ensure baby would be used to taking it.

This doesn't however account for the fact babies have personalities. 

Some will take that daily/weekly bottle fine until one day they decide out of the blue that they don't want it thanks; others will continue to take a bottle just fine.  Some will refuse a bottle in the early days, then one day decide actually OK they will drink from it.  Others that aren't offered a bottle when young will take it just fine when offered at any age.   The same can also happen to a baby fed exclusively from the bottle.  I've worked with mums struggling to get the necessary amount of formula or expressed milk into baby because they fuss or refuse the bottle, take hours to consume small amounts or leak, splutter and gulp.

Introducing a bottle and finding baby takes it, really only tells you they will do so at that point in time.  It is no indicator of how baby will respond at any point in the future.

It seems a standard expectation (particularly with first babies) that mum will of course express and bottle feed at some point, imagine not being able to leave baby!  Some mums have no alternative but to do so if they need to work or be separated.  On the flipside if you don't need to, it's also OK if you don't want to, mums often tell us that the expectation she will want time away, is greater than her desire to actually do so.

Babies naturally settle into a more predictable pattern of feeding, and so some mums find it's easier to work things in and around this rather than expressing.  From around 4 months some soft spouted cups are suitable if you don't need bottles on a regular basis, and things like a doidy cup can be used even earlier.

Nipple confusion, real or not?

This really depends on who you ask!  In my experience the biggest risk in terms of bottles is if a baby hasn't completely mastered the breast and/or has reduced milk transfer, the flow from a bottle can cause some to quickly show preference to the easiest milk source, causing them to fuss earlier and earlier into breastfeeds (although as the breast isn't just food, they will often be happy to return to it afterwards).  Others in this situation will refuse a bottle outright too, but ultimately the key is resolving the initial problem, the bottle is a symptom.

Although more and more bottles are claiming to be "like the breast", realistically to baby they are still poles apart.  No bottle can deliver the smell, sounds and scents of mum (think Heston Blumenthal style dining). None are made of the same substance as nipples or let down in milk ejections as the breast does.

This can cause some to become impatient waiting for the breast to "letdown", which is why mums are often advised to use the slowest flow teat and encourage sucking without milk beforehand, with regular pauses during the feed.

For an infant refining his breastfeeding technique, I like an analogy Lisa at Everyday Miracle uses.  Imagine you are just learning to use a knife and fork, but at some feeds these are swapped for chopsticks - something that requires a totally different action and technique.

The added difference however is that the bottle requires far less effort than the breast, and the baby may try out techniques that work on the bottle when at the breast:

"When bottle feeding occurs, only the buccinator muscles and the orbicular muscle(s) of the mouth are exerted without stimulating other muscles. They concluded sucking only during breastfeeding promotes correct muscle activity, and thus proper development of the oral motor structures" (1) 

It's important to note however....

That giving a bottle doesn't mean baby wont be able to breastfeed effectively again.  I get asked quite frequently whether its worth persisting with breastfeeding if baby has had a bottle, could learning this incorrect action permanently hinder skills at the breast and be the cause of their problems?

Dig a little deeper however and a lot of mums experiencing problems now, who introduced a bottle in the early weeks when trying to establish feeding, did so because they were experiencing a problem; pain, baby that wouldn't leave the breast and settle, slow weight gain - whatever.  So we always have to question what came first, the chicken or the egg?

Even after a bottle baby can still refine, improve and develop their technique at the breast. Conversely some mums never need or want to use one and that's fine too :) 

1) The relationship of bottle feeding and other sucking behaviors with speech disorder in Patagonian preschoolers BMC Pediatrics 2009, 9:66 doi:10.1186/1471-2431-9-66

The Breastfeeding Support Pyramid

After seeing a few "food pyramids" floating around online recently, it reminded me that I wanted to blog about how I think a breastfeeding support system should work.  Not an obvious link and perhaps a tad narcissistic you might think, probably but hey ho what's the point of a blog anyway if not a personal soap box?

Firstly I should quickly cover "breastfeeding titles" again, for those not familiar with the basics there is an outline here.  It needs editing as it's rather long (which I'm sure I will get around to doing at some point in the next decade), but scroll down to "Titles and what they mean" for a quick summary.

For ease in this post I use the terms peer supporter, breastfeeding counsellor and lactation consultants to differentiate between different types of support, but in practise as the above post discusses there are lots of different titles and lots of grey areas.  But let's keep it simple.

OK so technically it's a triangle, not a pyramid - but you get the idea.

Just like a food pyramid, all three parts are equally as important as each other - they key being that everything (or in this case everyone) is present in the right amounts...

Peer supporters (PS): make up the biggest chunk of the triangle.  We need loads of them, because lots of people don't have a friend, sister or aunt who breastfed and who can help with what is and isn't typical. Perhaps suggest different positions (help with biological nurturing ;)) share tips and tricks that worked for them, explain cluster feeding and why the breast is a whole lot more than food - on a truly peer level, a friend and equal mum can relate to.

The peer supporter should also be able to identify when there is a problem beyond the basic normal new baby stuff and help mum access support to help to resolve it.

This is where it sometimes gets tricky as if we want to help, often the instinct is to dive on in, try to problem solve and "fix".  I feel it's really important peer supporters don't head in to this territory, because it completely shifts the whole dynamic of the relationship from peer to problem solver.  Plus of course the risk that without further training, a mistake is made.  As just one example, I meet mums who are told to block feed because the green nappies must mean too much lactose.  However this is a technique to reduce supply and so if this isn't the reason, problems can quickly become more significant, even if intentions were good.  Mum then gets conflicting advice from different people, which can serve to demoralise her further and soon she is unsure who to trust.

I work with several doulas who are peer supporters and the best feedback always comes from those who are the cheerleaders.  When mums feel truly supported this is absolutely as important as getting the right "technical help", if not more so at times.  Those who are encouraging, supportive "you can do this!", "lots of mums experience this but we'll get you hooked up with someone that can help and then I will stick around to help you implement stuff, bounce any concerns off, tell you how fab you're doing!" are truly valued.

Breastfeeding Counsellor (BFC):  A peer supporter with a problem should have people trained to breastfeeding counsellor level that she can refer to.  A BFC can handle a large percentage of the concerns that will arise daily in the community.  Training includes the counselling skills to allow a mum to explore problems in a safe non judgemental space, so that together they can find a path forward that works for both mum and baby.  All breastfeeding counsellors should have in my opinion, basic training to spot the signs of tongue tie.  This doesn't mean lots of people rooting about in baby's mouth, but it does mean recognising key symptoms,  visual indicators and so on.

Lactation Consultant (IBCLC)/Infant Feeding Advisor:  If the pyramid below this point is functioning well with appropriately trained staff, we shouldn't actually need lots of IBCLC's for things to work well.  It also means IBCLC's are being best utilised dealing with more complex cases, and not doing things PS's or BFC's can do perfectly well.   These are typically what I would call clinical or more complex cases like weight gain issues, tongue ties, babies who are very disorganised or unable to latch at all, perhaps under consultant care for reflux or suchlike, premature babies and so on.  An IBCLC can help make a care plan to move forward and communicate with other health professionals involved in care.  All should be capable of identifying both obvious and posterior tongue ties and furthermore whether the tie is the cause of the problem.

Referring up the pyramid does not mean care ceases from lower down - on the contrary continued collaborative working is key.  An example might be tongue tie referred to IBCLC, an appropriately trained/experienced BFC might take over aftercare alongside support from PS once everyone is sure the procedure has been successful and symptoms are improving.  The BFC can go back to the IBCLC at any point, or if all is well the PS can take over entirely.

Of course in a funded care system it can be tempting to be short sighted; to perhaps think that money can be saved by having half the IBCLC's and double the amount of peer supporters, perhaps chopping the middle rung altogether. Some run purely on the first tier, with the only referral options being a GP or health visitor. If everyone works a bit outside of their remit, surely we can fill the gaps...

But what my eyes and brain tell me in practise is that it's not only false economy, but also not truly supportive or at times even adequate. Infant feeding is the cornerstone of health, yet we have voluntary organisations propping up the entire system!  If all were to close tomorrow and all volunteers were to leave - what do we think would happen to breastfeeding rates in the UK?  The thousands of calls per year to the those organisation paints a clear picture - parents not only need appropriately qualified help, but they need it at the right time to have a chance to succeed.

Image & Tshirt from .lactivist.co.uk (currenly reduced from £13 to £6 - 26.7.13) 

8 Questions I've Pondered This Week...

1.  Why do so many GP's still have no idea what an IBCLC certified Lactation Consultant is?  Why are some telling mothers that if someone isn't a doctor, their services aren't valuable?  Do these same people also want to scrap physiotherapists, occupational therapists, midwives, nurses and sonographers who aren't doctors too?

2.  Why are some baby clinics telling mothers their child should be weaned from the breast by a year?  Directly contradicting guidelines from the World Health Organisation and ironically using a poster featuring a child using a sippy cup!  An item which in itself may be linked to poor oral formation...

3.  Why are some health professionals telling mums that posterior tongue ties don't exist when this simply isn't true?

b) How can these same people then tell mothers that a posterior tie doesn't hinder breastfeeding anyway and as such isn't worth treating.  As one mum questioned, how could one treat what you just claimed didn't exist?

4)  Why are some midwives advising parents of newborns that it is normal for their breastfed baby not to stool for up to 2 weeks.  No as a newborn this IS NOT normal, regardless of how the baby is fed!  Output is a key sign of intake, particularly in the first few weeks.

5)  Why are the NHS allowing Bounty to profit from parents?  Ok so I actually wondered this in March 2012 when I wrote the afore linked blog piece; however it's up for discussion again this week as Mumsnet have launched a campaign and the BBC are even Tweeting about it too!

6)  Why does anyone say that cracked/damaged/agonising nipples are a normal part of establishing breastfeeding?  No, no, no, no, no, no, no!

7)  Why don't some health professionals not listen to mums?  If their gut instinct is something isn't quite right, listen, parents have those instincts for a reason.

8) Why are some babies readmitted to hospital for slow weight gain/weight loss, supplemented with additional formula/breastmilk in hospital and then sent home without any plan other than "just breastfeed"?  If the initial problem wasn't resolved and/or feeding hasn't been assessed, why would anyone assume cutting the supplements out again won't result in the same problem?  Furthermore, if mum isn't told how to cut out the top ups AND ensure baby is still getting enough by monitoring output, isn't this rather irresponsible?

What have you pondered this week?