tag:theconversation.com,2011:/us/topics/baby-nutrition-37067/articlesBaby nutrition – The Conversation2023-10-05T15:14:59Ztag:theconversation.com,2011:article/2143032023-10-05T15:14:59Z2023-10-05T15:14:59ZBaby formula preparation machines might not reach NHS recommended temperatures for killing bacteria – new research<figure><img src="https://images.theconversation.com/files/550876/original/file-20230928-21-25f2uo.jpg?ixlib=rb-1.1.0&rect=46%2C0%2C5184%2C3445&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The NHS recommends using water heated to at least 70C for mixing with formula powder.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/preparation-mixture-baby-feeding-on-white-556921537">279photo Studio/Shutterstock</a></span></figcaption></figure><p>When you have a new baby, it can feel as though there are suddenly thousands of things to worry about. One of the biggest concerns for parents in the early weeks is feeding.</p>
<p>Our <a href="https://doi.org/10.1111/mcn.13567">new study</a> has raised questions about one popular feeding device – the formula preparation machine. We found that only 15% of formula preparation machines tested dispensed water that appeared to be hot enough to meet NHS recommendations for preparing baby formula. In comparison, a majority of samples prepared using a kettle did meet the recommended temperature.<br>
Almost <a href="https://doc.ukdataservice.ac.uk/doc/7281/mrdoc/pdf/7281_ifs-uk-2010_report.pdf">three quarters</a> of babies in the UK receive some formula in the first six weeks after birth. This goes up to 88% within the first six months. Infant formula comes ready to drink in bottles and powdered, which parents need to mix with very hot water. Around <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/6053645514d0f3072adec94e/1616077909798/Marketing_of_infant_milk_in_the_UK-what_do_parents_see_and_believe_finala.pdf">80%</a> of parents who use formula use a powdered version at least half the time.</p>
<p>NHS guidance states that formula should be prepared using a kettle <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula/">to boil</a> 1 litre of water, leaving the water to cool for no more than 30 minutes before adding it to the formula. This is so that it remains at a temperature of at least 70C when it is mixed with the powder. This is needed to <a href="https://www.who.int/publications/i/item/9789241595414">kill any bacteria</a>. </p>
<h2>Formula preparation machines</h2>
<p>In recent years, a range of formula preparation machines have been sold in the UK. Some dispense a small amount of hot water to which powder should be added, the bottle shaken and then the bottle topped up with cold water. Other machines dispense prepared formula in to a bottle. Our past <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/6053645514d0f3072adec94e/1616077909798/Marketing_of_infant_milk_in_the_UK-what_do_parents_see_and_believe_finala.pdf">research</a> suggests that more than half of parents use a formula preparation machine. </p>
<p>Some <a href="https://www.southtees.nhs.uk/services/maternity/infant-feeding/formula-feeding/">NHS trusts</a> (as well as the <a href="https://www2.hse.ie/babies-children/bottle-feeding/preparing-baby-formula/#:%7E:text=The%20Food%20Safety%20Authority%20of,for%20preparing%20your%20baby's%20bottle.">Irish government</a>), have stated that parents should not use these machines to prepare formula, due to there being problems with these devices that could lead to babies becoming unwell. This may be based on concerns that the water may not remain at a <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5f58858c11457f399bae4a61/1599636878436/Bacterial_contamination_Aug20.pdf">hot enough temperature</a> to kill any bacteria in the powder. This matters because it increases the risk of gastrointestinal infection. </p>
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<img alt="A man feeds a baby with a bottle." src="https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/550878/original/file-20230928-27-d1ixap.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">shutterstock.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/family-parenthood-people-concept-close-father-1152717200">Ground Picture/Shutterstock</a></span>
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<p>Formula-fed babies are <a href="https://www.unicef.org.uk/wp-content/uploads/sites/2/2012/11/Preventing_disease_saving_resources.pdf">more likely</a> to get bacterial gastrointestinal infections than breastfed babies. There are two main ways that bacteria can get into formula. Firstly, powdered formula itself cannot be made sterile because of how it is manufactured, meaning it can get <a href="https://www.cdc.gov/cronobacter/infection-and-infants.html#:%7E:text=Powdered%20formula%20is%20not%20sterile,processing%20facilities%20that%20make%20it.">contaminated</a>. This means that a brand new, unopened tub of formula <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/624edeb6873c47686bd34825/1649335991943/Bacterial+contamination_April+22.pdf">can contain</a> harmful bacteria such as <em>Salmonella</em> and <em>Cronobacter</em>. </p>
<p>Secondly, bacteria can be introduced into the formula in the home <a href="https://www.nature.com/articles/s41598-019-46181-0">by parents</a> or carers if they do not wash their hands or adequately sterilise all feeding equipment before making a bottle.</p>
<p>Using water boiled in a kettle and cooled to above 70C <a href="https://iris.who.int/bitstream/handle/10665/43659/9789241595414_eng.pdf?isAllowed=y&sequence=1">kills</a> harmful bacteria that cause gastrointestinal infections. Because of this, it is the only method of preparing formula which is currently <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula/">recommended</a> by the NHS.</p>
<p>However, <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/6053645514d0f3072adec94e/1616077909798/Marketing_of_infant_milk_in_the_UK-what_do_parents_see_and_believe_finala.pdf">we found</a> that many parents do not feel confident about preparing bottles of formula safely.</p>
<h2>What we found</h2>
<p>We asked 143 parents to test the temperature of the water they used to prepare a bottle of formula at home. <a href="https://doi.org/10.1111/mcn.13567">We found</a> that only 15% of the 74 infant formula preparation machines tested appeared to produce water that reached NHS recommended temperatures for preparing bottles of formula.</p>
<p>But among the parents in our study who used a kettle to make up their formula, 78% of temperatures reported were above the recommended NHS level. </p>
<p>This is concerning, as temperatures below 70C can be harmful to babies’ health, and also given such a high number of parents use formula preparation machines. </p>
<h2>Advice</h2>
<p>If you are formula feeding, more information and support about preparing bottles is available on the <a href="https://www.nhs.uk/conditions/baby/breastfeeding-and-bottle-feeding/bottle-feeding/making-up-baby-formula/">NHS website</a>. The NHS guide recommends using a kettle to boil the water.</p>
<p>The Food Standards Agency (FSA) <a href="https://www.swansea.ac.uk/press-office/news-events/news/2023/10/study-raises-concerns-over-powdered-infant-formula-preparation-machines.php">recommend</a> that if you already have a formula preparation machine, you use a food thermometer to test the temperature of the water it produces. If you do this, do not put the thermometer into the bottle that you use to feed your baby, as the thermometer could introduce bacteria, so you will need to do this separately to making a bottle. </p>
<p>If your thermometer shows the water is below 70C, the machine should not be used to prepare bottles of formula and you should use a kettle instead. The FSA recommend that parents should notify both the manufacturer and their <a href="https://www.gov.uk/find-local-trading-standards-office">local trading standards</a> department or <a href="https://www.citizensadvice.org.uk/">Citizens Advice</a>. </p>
<p>We have shared our results with the <a href="https://www.gov.uk/government/organisations/office-for-product-safety-and-standards">Office for Product Safety and Standards</a>, the UK’s product safety regulator, who have purchased examples of formula preparation machines to assess compliance. We have also shared our findings with the <a href="https://www.food.gov.uk/">FSA</a>, who safeguard public health and protect consumers in relation to food across the UK.</p><img src="https://counter.theconversation.com/content/214303/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aimee Grant receives funding from UKRI and the Wellcome Trust. She has previously received funding from the NIHR, HEFCW, and public health charities. Aimee is affiliated with Disability Wales. The Finding the Formula study, which is reported on in this article, was funded by UKRI and the Food Standards Agency. We wish to thank Dr Vicky Sibson, Dr Rebecca Ellis, Abbie Dolling, Tara McNamara, Jonie Cooper, Susan Dvorak, Sharon Breward, Phyll Buchanan and Dr Emma Yhnell who were also part of the study team, and the parents who provided data for this study.
</span></em></p><p class="fine-print"><em><span>Amy Brown has received research funding from UKRI, HEFCW, Infant feeding charities, local councils, health trusts and Public Health Wales. </span></em></p><p class="fine-print"><em><span>Sara Jones was paid for her time as a study manager from the UKRI funding for this project. She has also received funding from MRC and infant feeding charities.</span></em></p>New research finds that 85% of formula preparation machines tested were dispensing water that did not appear to reach NHS recommended temperatures for preparing bottles of formula.Aimee Grant, Senior Lecturer in Public Health and Wellcome Trust Career Development Fellow, Swansea UniversityAmy Brown, Professor of Child Public Health, Swansea UniversitySara Jones, Senior lecturer at Lactation and Infant Feeding Translational research centre, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1176072019-07-17T10:26:12Z2019-07-17T10:26:12ZBreastfeeding support cuts are leaving unpaid volunteers to fill the role of public health<figure><img src="https://images.theconversation.com/files/284300/original/file-20190716-173347-1vj2u4g.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cheerful-young-beautiful-mother-works-freelancer-1343050196?src=R-jyCCcUoyPvHsHn3yX0BQ-1-13&studio=1">Anton Korobkov/Shutterstock</a></span></figcaption></figure><p>Support <a href="http://orca.cf.ac.uk/53914/1/Trickey%20Peer%20support%20for%20breastfeeding%20continuation%20an%20overview%20of%20research%20pp15-20.pdf">plays a vital role</a> in enabling women to breastfeed for longer. It helps solve many different challenges, stops physical and emotional pain, and helps women feel accepted as <a href="https://www.sciencedirect.com/science/article/pii/S0266613809001211">part of a community</a>. Yet across the UK, many breastfeeding support services <a href="https://www.theguardian.com/lifeandstyle/2018/jul/27/breastfeeding-support-services-failing-mothers-due-to-cuts">have been cut</a>. Austerity is usually cited, with policymakers failing to see that such support could save the NHS <a href="https://adc.bmj.com/content/100/4/334">many millions</a>, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/mcn.12366?casa_token=cSAFINz74UIAAAAA:fDPPPEnhBS8TnIIzuaVkuJNKYTNNckVTXmLai2zjhDBgeA4LlOfRi8ah7aK_iygklMtCyPlGyg92E24yNQ">even billions</a>, further down the line. </p>
<p>So who picks up the slack? Volunteers. Charities. Women who have breastfed their own babies (often through difficulties) who can’t bear to see women sold a dream of “breast is best” <a href="https://www.ncbi.nlm.nih.gov/pubmed/27052189">then failed with an absence of actual support</a>. Imagine that for any other area of health – sorry your hip is broken, can’t help with any medical treatment, but if you pop along to the association for broken hips, they’ll help you. </p>
<p>Breastfeeding might be “natural” but just like many physical skills, <a href="https://theconversation.com/breastfeeding-is-not-easy-stop-telling-new-mothers-that-it-is-98026">it can take time to learn</a>. In previous generations, when breastfeeding rates were much higher, we would have learnt about breastfeeding as we grew up. We would have seen it happening more often in our families and communities, <a href="https://www.taylorfrancis.com/books/e/9781315081984/chapters/10.4324/9781315081984-4">directly and indirectly learning how it worked</a>. There would have been little need for promotion of breastfeeding or organised support because the community would have picked up and supported any issues.</p>
<p>Fast forward to today and we just don’t see breastfeeding in the same way in our day to day lives – unsurprising given less than half of babies are receiving any breastmilk <a href="https://files.digital.nhs.uk/publicationimport/pub08xxx/pub08694/infant-feeding-survey-2010-consolidated-report.pdf">at all by six weeks</a>, and <a href="https://files.digital.nhs.uk/publicationimport/pub08xxx/pub08694/ifs-uk-2010-chap10-feed-outside-home.pdf">only half of women</a> who breastfeed ever do so in public.</p>
<p>In one study in Scotland, <a href="https://onlinelibrary.wiley.com/doi/pdf/10.1111/j.1740-8709.2009.00189.x?casa_token=aQkROYs0sfYAAAAA:O6nqxZ2NUmLHiuxI39By4V4JBSwQenvag8b5qDhALuig2SX8DcPdHzcPK9rBea5ThvhkzLUtWf9Cbw">less than half of pregnant women</a> reported having seen someone breastfed in the last 12 months. More astonishing than that, a <a href="https://journals.sagepub.com/doi/pdf/10.1177/0890334402239735?casa_token=9kpAmb2uaEEAAAAA:klDhjJVC0lG76omSS2dYGeS04KLaa-rtLRPOV47mgf3bdHZtxTA1vkw0zYXDVZrX6LOz485MsG4">study of teenagers in Ireland</a> found only half had ever seen a baby breastfed in their lives. </p>
<p>In the absence of this everyday learning, coupled with cuts to formal support, women are turning to a different type of community in the form of online support groups and social media pages. Typically run on a voluntary basis, these groups are designed to help women with breastfeeding challenges and provide a circle of support particularly for those in “real life” communities where breastfeeding rates are very low. </p>
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<img alt="" src="https://images.theconversation.com/files/284296/original/file-20190716-173325-1we3zl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/284296/original/file-20190716-173325-1we3zl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/284296/original/file-20190716-173325-1we3zl6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/284296/original/file-20190716-173325-1we3zl6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/284296/original/file-20190716-173325-1we3zl6.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/284296/original/file-20190716-173325-1we3zl6.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/284296/original/file-20190716-173325-1we3zl6.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">When mothers are struggling, the internet can be a vital lifeline.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-businesswoman-holding-newborn-crying-babe-472129582?src=SHmaspxjn2aZnz-aX2N75g-1-19&studio=1">fizkes/Shutterstock</a></span>
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<p><a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/mcn.12874">Our new research</a> shows just what a lifeline these online groups can be. In a series of interviews with mothers who had recently turned to online breastfeeding support, the findings highlighted just what a service gap these groups were plugging for new mothers.</p>
<p>When the local group closes down, and a mother can’t reach her overstretched health visitor fast enough to solve the pain she is experiencing, these groups are her answer. And given the global nature of some pages, and the regularity of babies waking at night, someone, somewhere, is always there, bleary-eyed or otherwise. </p>
<p>Online groups also provide a layer of support that face-to-face provision cannot bring. They don’t require you to be out of the door at a certain time, or even dressed. They don’t even require you to make actual conversation. You can listen to others’ stories when anything more than clicking “like” feels too much. This means that these groups play a vital role in supporting mothers who may be struggling with new motherhood, with local online groups helping mothers feel confident in building up to attending their face-to-face version (if they still exist). </p>
<p>The women we spoke to attributed the support they received in these groups to enabling them to continue breastfeeding. Which means that these groups are essentially propping up services that should be centrally funded. After all, although <a href="https://connect.springerpub.com/content/sgrcl/9/4/200">women value breastfeeding</a>, by doing so they are benefiting the government by <a href="https://academic.oup.com/heapol/advance-article/doi/10.1093/heapol/czz064/5531187?searchresult=1">reducing the need for GP appointments, hospital treatment and days off work</a>. So why, in an era where so much we do is now online, can the work of these groups not be recognised, valued and supported through funding?</p>
<p>The lack of funding can mean that some experience a dark side to online support. Groups that are led by those who are not trained to support breastfeeding, or do not have qualifications to manage complications, may be giving inconsistent, misleading or downright dangerous advice. The internet allows anyone to set themselves up as an expert, with no requirement that the advice that they give is accurate. </p>
<p>A lack of moderation by someone trained to do so can also mean that some online groups may do more harm that good. Women in our study reported online fights breaking out, polarised debates, and judgements being made (particularly against women who had decided for whatever reason that they needed to introduce formula milk).</p>
<p>Some level of regulation is needed to ensure women get the best possible information and support, yet many that do have these structures in place are still relying on volunteers, placing <a href="https://theconversation.com/we-need-to-talk-about-the-mental-health-of-content-moderators-103830">significant demands on their time and even well-being</a>. </p>
<p>When breastfeeding mothers need help, women and communities will come to support them. But this <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jhn.12496">major public health responsibility</a> should not be laid in the lap of unpaid volunteers.</p><img src="https://counter.theconversation.com/content/117607/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. She is author of three books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' and the 'The Positive Breastfeeding Book'.
With many thanks to Sian Regan who led the research as part of her MSc in Child Public Health at Swansea University. </span></em></p>Breastfeeding mothers are turning to online groups due to dwindling real-life support — but these volunteer-led platforms don’t always have the best advice.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1132192019-04-01T11:20:27Z2019-04-01T11:20:27ZBaby-led weaning or spoon feeding? The difference it makes to your child’s eating habits is actually very small<figure><img src="https://images.theconversation.com/files/266555/original/file-20190329-70996-s89be1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Dinner time - but who's leading the feeding?</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-early-stages-led-weaning-1072172030">R Gallianos/Shutterstock</a></span></figcaption></figure><p>When it comes to avoiding picky eating and meal time tantrums, parents are usually ready to try any method that promises their child will become a better and less fussy eater. This is in part why methods of giving solid food to infants have received a <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5934812/">lot of attention</a> in the last few years. Some think that the way babies are introduced to solids can change their attitudes to food into childhood or even for life.</p>
<p>The most <a href="https://www.nhs.uk/conditions/pregnancy-and-baby/solid-foods-weaning/">common method</a> used to give babies their first solids has long been to offer a puree or mash using a spoon. This helps parents make sure their babies receive adequate energy and nutrients for their development – something many are often anxious over.</p>
<p>More recently, however, <a href="https://www.bbcgoodfood.com/howto/guide/what-baby-led-weaning">baby-led weaning</a> has gained popularity – and divided parents. This method sees babies selecting finger foods – such as carrot sticks, broccoli trees or other pieces of whole, baby-fist size pieces of food – and feeding themselves. While there have been unsubstantiated claims that this method can improve a baby’s <a href="https://www.annabelkarmel.com/baby-led-weaning-pros-and-cons/">dexterity and confidence</a>, research has associated baby-led weaning with their ability to recognise <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.2047-6310.2013.00207.x">when they are full</a> and being less fussy with their food. This makes it an appealing choice for some parents.</p>
<p>However, as with most things baby-related, the reality is that many parents don’t use just one method of feeding. It changes depending on the time, day or situation they are in. Which is why, for our <a href="https://www.sciencedirect.com/science/article/pii/S0195666318316581?dgcid=author">recently published study</a>, we wanted to compare how different styles of feeding affects a baby’s eating habits and attitudes to food.</p>
<h2>Is baby-led weaning better?</h2>
<p>We looked at four different categories of toddlers, whose parents introduced them to solids using either: solely baby-led weaning, mostly baby-led weaning with occasional spoon feeding, mostly spoon feeding with occasional finger foods, or just spoon feeding. We asked the parents questions about their feeding strategies and eating behaviours of their toddlers, like fussiness and food enjoyment. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/266786/original/file-20190401-177171-173mif0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/266786/original/file-20190401-177171-173mif0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=402&fit=crop&dpr=1 600w, https://images.theconversation.com/files/266786/original/file-20190401-177171-173mif0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=402&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/266786/original/file-20190401-177171-173mif0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=402&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/266786/original/file-20190401-177171-173mif0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=505&fit=crop&dpr=1 754w, https://images.theconversation.com/files/266786/original/file-20190401-177171-173mif0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=505&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/266786/original/file-20190401-177171-173mif0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=505&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Here comes the aeroplane!</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/closeup-shot-baby-feeding-spoon-428585137">Petr Bonek/Shutterstock</a></span>
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<p>Usually, in a statistical analysis, we look at whether there is a difference between groups. But what this doesn’t tell us is how big the difference actually is. To solve this problem, we looked at the size of the difference between the groups (what we call the effect size). It helps us understand whether the difference actually matters. </p>
<p>We found that the magnitude of difference in a toddler’s fussiness and food enjoyment is minimal across the four groups. This means that baby-led weaning, spoon-feeding or anything in between might not actually be the solution to future mealtime battlegrounds some parents hope it will be. That may seem to be in contrast with what the research shows so far, but it doesn’t negate those findings. Babies will be less picky about their food if they are fed using baby-led weaning as opposed to any of the other types of feeding, it’s just not by that much.</p>
<h2>Socio-economics at play</h2>
<p>When looking at the strategies parents use to feed their children, our study did show that those who follow baby-led weaning are less likely to use food as a reward or encouragement, and have less control on eating overall. This helps their toddlers learn to make eating decisions for themselves based on whether they are hungry or full. These parents are also more likely to breastfeed for longer, introduce solids after six months and eat more frequently with their toddlers.</p>
<p>However, the key difference here is not that the children were fed using baby-led weaning but instead the type of families who usually follow it. Our findings show that these parents are usually of a higher socio-economic status and more educated, which makes them more likely to follow a distinctly different parenting style and be able to afford to spend more time and money doing so.</p>
<p>Overall, our results suggest that the way a baby is introduced to solids will make very little difference to how fussy they will become, or how much they will enjoy food. It is important to remember that how children eat depend on a lot of factors, including <a href="https://www.telegraph.co.uk/science/2016/10/13/fussy-eating-habits-of-children-are-down-to-genetics-not-bad-par/">their genetic background</a>, their past experiences with food and their <a href="https://www.livestrong.com/slideshow/13711836-12-ways-your-parents-messed-up-your-relationship-with-food/">interaction with their parents</a>.</p>
<p>Research findings are important when communicating complementary feeding advice to new parents, but headlines and quoted study results can often be misleading. So remember that when reports of research say there is a difference between one method over an other, it’s not the whole story. The size of this difference – something that is not often communicated – matters too. The most important thing that parents can do is to try their best and introduce solids in a way that is more appropriate for their family, rather than stressing about a specific method, as research suggests might make a only a very small difference.</p><img src="https://counter.theconversation.com/content/113219/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sophia Komninou does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Baby-led weaning won’t necessarily make your child a less fussy eater, new research finds.Sophia Komninou, Lecturer in Infant and Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1129012019-03-11T15:50:24Z2019-03-11T15:50:24ZBreastfeeding isn’t just about the baby – women’s bodies matter too<figure><img src="https://images.theconversation.com/files/262391/original/file-20190306-100778-mian18.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breastfeeding is not something women simply choose to do, it is an instinct, a biological imperative.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-mother-breastfeeding-her-newborn-709224187">Tomsickova Tatyana/Shutterstock</a></span></figcaption></figure><p>Women are increasingly opening up about their <a href="https://www.huffingtonpost.co.uk/entry/women-cant-breastfeed-let-baby-down_uk_5c4ee49ae4b06ba6d3beedec">breastfeeding struggles</a>. However, as individual as each story is, many have a core theme – it wasn’t working and <a href="https://www.thecut.com/2018/05/the-truth-about-not-being-able-to-breastfeed.html">no one could tell them why</a>. </p>
<p>Given the breadth and depth of medical knowledge, why do women <a href="https://www.huffingtonpost.com/jennifer-grayson/there-are-no-tests-the-st_b_11307426.html">still not have answers</a> if they can’t breastfeed? Why do GPs have <a href="https://gpifn.org.uk/gp-education/">such little training</a> on the breast, breastfeeding and human milk? Why are women who are struggling left to <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0581-5">hunt down their own support</a>, due to <a href="https://www.theguardian.com/lifeandstyle/2018/jul/27/breastfeeding-support-services-failing-mothers-due-to-cuts">cuts in breastfeeding support services</a>?</p>
<p>Why? Because for some reason breastfeeding is still seen as a lifestyle choice that women can give or take, rather than it being a primary physiological function of a bodily organ, which <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/apa.13102">helps to protect maternal physical and mental health</a>. If you ask a mother why she wanted to breastfeed, she will say how it helped her baby’s health. True, but there is another primary reason why breastfeeding is important – a woman’s right to have her body function as she expects. </p>
<p>Breastfeeding is a biologically normal function for women’s breasts. This is not to be confused with a biological or social imperative (something someone feels like they should do). It is not the breasts’ only function – <a href="https://www.independent.co.uk/news/science/lewis-wolpert-over-the-course-of-evolution-breasts-became-permanently-enlarged-to-signal-sexual-679871.html">far from it</a> – but we are mammals, <a href="https://www.ted.com/talks/katie_hinde_what_we_don_t_know_about_mother_s_milk">with mammary glands to feed babies</a>. “Biologically normal” <a href="https://theconversation.com/breastfeeding-is-not-easy-stop-telling-new-mothers-that-it-is-98026">doesn’t necessarily mean easy</a>, or that it will always work, however. But plenty of normal physiological functions – including walking and talking – are aided in their development by guidance and support, <a href="https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD001141.pub5/full">just like breastfeeding</a> should be. </p>
<p>So as with any other bodily function, the breast deserves a bank of research and knowledge to enable it to function well, and answers and treatment options if it does not. If you can’t smell anything you can usually visit a doctor who will perform tests on your nose, rather than telling you that your sense of smell doesn’t matter and that someone else can just smell your dinner for you. But many women experiencing breastfeeding difficulties <a href="https://milkandmotherhood.com/2017/03/interview-with-me-my-fight-with-low.html">are simply told</a> there are no tests, to stop persevering, and to <a href="https://www.ncbi.nlm.nih.gov/pubmed/27052189">give their baby a bottle of formula</a>. They should remember that the main thing is that their baby is fed. </p>
<p>Breastfeeding is not simply a logical choice based on some health benefit, <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2012.0008">but an urge, an instinct</a>. And breastfeeding is useful to women, not just as a milk delivery system <a href="https://www.sciencedirect.com/science/article/pii/S0277953607003590">but as a convenience and means of mothering</a>. Just as we quite enjoy having a sense of smell, women can enjoy breastfeeding. They can feel <a href="https://www.sciencedirect.com/science/article/pii/S0266613809001211">empowered</a>, <a href="https://www.sciencedirect.com/science/article/pii/S0277953605002716">healed</a>
and <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-2-6">calmed</a> by it. And wanting that – expecting that – is fine. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/262403/original/file-20190306-100796-ina0pe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/262403/original/file-20190306-100796-ina0pe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/262403/original/file-20190306-100796-ina0pe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/262403/original/file-20190306-100796-ina0pe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/262403/original/file-20190306-100796-ina0pe.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/262403/original/file-20190306-100796-ina0pe.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/262403/original/file-20190306-100796-ina0pe.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Breastfeeding can be just as important for mothers as well as babies.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-breastfeeds-her-baby-holding-712561063?src=N3e1YMQWlAwP3rBZo-3TQA-1-42">Tomsickova Tatyana/Shutterstock</a></span>
</figcaption>
</figure>
<p>Formula milk can be life saving and some women <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.1467-9566.2007.01020.x">may feel it works best for their family</a>, but for others it can never replace the experience they hoped to have as a mother. They don’t want to <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2010.0097">simply give a bottle</a> instead. Complications and stopping breastfeeding before a woman is ready can be a <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jan.12832">huge strain on maternal mental health</a>. Women will grieve their loss – <a href="http://connect.springerpub.com/content/sgrcl/9/4/200">and should be allowed to</a>. </p>
<h2>Reproductive health</h2>
<p>When men’s bodies don’t work, the impact on their physical and mental health is widely recognised. The <a href="https://www.auajournals.org/doi/abs/10.1016/S0022-5347%2805%2964302-9">effect of erectile dysfunction</a>, for example, is well recognised. There is even research into <a href="https://www.sciencedirect.com/science/article/pii/S0090429598005822">whether men are satisfied with treatment</a> of it. In fact, <a href="https://www.independent.co.uk/news/science/pms-erectile-dysfunction-studies-penis-problems-period-pre-menstrual-pains-science-disparity-a7198681.html">five times as much research</a> is conducted into erectile dysfunction than premenstrual syndrome and dysphoric disorder, despite the latter affecting five times as many women. </p>
<p>Looking deeper into the issue of reproductive health, a trial into the male contraceptive pill was halted because men were experiencing a few of the complications that <a href="https://www.newscientist.com/article/2110729-male-contraceptive-injection-works-but-side-effects-halt-trial/">many women put up with daily</a>. Research is even conducted into <a href="https://www.sciencedirect.com/science/article/pii/S1743609518302716">men’s satisfaction with their sex lives</a> when they have a partner with endometriosis – an excruciatingly painful condition which many women are left battling alone each month <a href="https://www.theguardian.com/society/2015/sep/28/endometriosis-hidden-suffering-millions-women">because it receives little funding</a>. </p>
<p>We don’t ask what the health benefits are to our bodies working as they should in other ways. We just accept people want their bodies to work. Yet the debate over whether investing in breastfeeding is worth it or not, based on whatever the latest <a href="https://www.huffingtonpost.co.uk/2015/10/29/breastfeeding-bottle-feeding-babies-obese-_n_8417592.html">confusing write up</a> of a research study shows, is battled frequently in the press.</p>
<p>Recognising breastfeeding as a bodily function rather than a lifestyle choice, and investing in the scientific field of human milk would benefit everyone, not just those who are able to breastfeed. We would have better answers for those who cannot breastfeed, and for those who are struggling to produce sufficient milk. We would have <a href="https://www.huffingtonpost.co.uk/entry/donor-human-milk_uk_5c0422d8e4b024223b60af12">greater investment in donor human milk facilities</a> so that more sick and premature babies could have the option. Rather than some women being <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-7-6">forced to choose</a> between breastfeeding or medication (despite <a href="https://journals.sagepub.com/doi/abs/10.1177/0890334415595513">evidence showing</a> that the majority of medications are safe), we would have a clear evidence bank that medical professionals could refer to. Those breastfeeding would be <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jhn.12496">part of a system that protected</a> their decision rather than simply promoting it with support. </p>
<p>Women’s bodies matter too. And that is the real reason why investing in breastfeeding matters.</p><img src="https://counter.theconversation.com/content/112901/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. </span></em></p>Breastfeeding is not a logical choice based on some health benefit but an urge, an instinct.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1037882018-10-05T12:27:45Z2018-10-05T12:27:45ZBreastfeeding is good for mothers’ mental health – but those who struggle need support<figure><img src="https://images.theconversation.com/files/238746/original/file-20181001-195282-1jyyaz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/frustrated-mother-suffering-post-natal-depression-238716724?src=-5g6AuMBP2JWkzsk9uZ1vA-1-16">SpeedKingz/Shutterstock</a></span></figcaption></figure><p>If you believed some newspapers you would think that breastfeeding was inherently bad for maternal mental health. Headlines regularly shout about “<a href="https://www.channel4.com/news/bressed-pressure-to-breastfeed-has-gone-to-far">pressure to breastfeed</a>” and “<a href="https://www.dailymail.co.uk/femail/article-3255275/Thought-breastfeeding-bullies-gone-away-nastier-ever.html">breastfeeding bullies</a>” making mums feel anxious and miserable. Calls are made for breastfeeding promotion <a href="https://www.theguardian.com/commentisfree/2017/mar/28/an-unrealistic-pressure-mothers-on-what-its-like-to-breastfeed">to stop</a> due to the perceived risk of ruining the motherhood experience. </p>
<p>But breastfeeding does not damage maternal mental health. In fact, a good breastfeeding experience can do marvellous things for women’s well-being. Alongside reducing risk of <a href="https://www.researchgate.net/profile/Np_Magula/publication/6076615_Breastfeeding_and_Maternal_Health_and_Infant_Health_Outcomes_in_Developed_Countries/links/557651a508aeacff1ffe62c2.pdf">reproductive cancers, heart disease and diabetes</a>, it can help mothers feel <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2010.0097">empowered, confident</a>, and <a href="https://www.sciencedirect.com/science/article/pii/S0277953605002716">heal birth trauma</a> too. Breastfeeding hormones are even thought to help <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-2-6">reduce the impact of stress and sleep deprivation</a> upon the body. It’s no wonder that <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1552-6909.2002.tb00063.x">numerous</a> <a href="https://internationalbreastfeedingjournal.biomedcentral.com/articles/10.1186/1746-4358-2-6">studies</a> have found that when breastfeeding is going well, a woman’s <a href="https://www.ingentaconnect.com/content/springer/clac/2011/00000002/00000002/art00007">risk of postnatal depression is lower</a>. </p>
<p>But when women are unable to breastfeed as they had expected their <a href="http://pediatrics.aappublications.org/content/123/4/e736.short">mental health can be badly affected</a>. Having a difficult breastfeeding experience and feeling forced to stop can leave women feeling <a href="http://journals.sagepub.com/doi/abs/10.1177/0890334407312002">devastated, grief stricken and very, very angry</a>.</p>
<p>But, I repeat, the problem is not breastfeeding itself. Instead it is the <a href="https://www.huffingtonpost.co.uk/entry/lack-of-support-for-breastfeeding-mothers-in-britain-is-inhumane_uk_5b5b0bb2e4b0b15aba9813f9">lack of support and investment</a> in infant feeding, new mothers and families more broadly. More than two-thirds of mothers who stop breastfeeding in the first few weeks do so because they <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">needed more support, had pain, or difficulty latching a baby on</a>. However, lack of investment in health services means that mothers are often forced to get on with it by themselves – often with the further blow of being told “the main thing is your baby is being fed” – rather than have the one-to-one support they actually need. </p>
<p>In fact, issues such as not getting enough <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1523-536X.2010.00446.x">professional help</a>, <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12219">exhaustion</a> and <a href="https://bmcpregnancychildbirth.biomedcentral.com/articles/10.1186/s12884-015-0581-5">misinformation</a> mean that more than half of UK babies have had formula by the <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">end of their first week</a>. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/238763/original/file-20181001-195269-mmml7s.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">A positive breastfeeding experience for both mother and child.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/horizontal-shot-happy-young-mixed-race-1104404429?src=y3YDVRuiHydKAhGA631m0Q-1-6">shurkin_son/Shutterstock</a></span>
</figcaption>
</figure>
<p>Difficult experiences also raise the risk of postnatal depression, over and above the hormonal implications of not breastfeeding. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jan.12832">Our research</a> – conducted with 217 mothers who stopped breastfeeding in the first few months – shows where women were ready to stop, or stopped for reasons that they perceived to be positive, their mental health was not affected. But when they stopped because of pain, physical difficulties, or because they couldn’t get the support they needed, their risk of depression was much higher. </p>
<p>This study expanded on a <a href="http://pediatrics.aappublications.org/content/123/4/e736.short">large body of research</a> showing a link between a short period of breastfeeding and postnatal depression. The findings are perhaps unsurprising. Experiencing <a href="https://www.sciencedirect.com/science/article/pii/S1526590011004871">pain and exhaustion</a> are both linked to increased risk of depression – before you add on <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1471-6712.2007.00572.x">shattered expectations</a> and often <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/j.1467-9566.2007.01020.x">a lack of advice about what to do next</a>.</p>
<p>What is confusing is that investment still isn’t being made to support women in reaction to this. We know that breastfeeding <a href="https://www.sciencedirect.com/science/article/pii/S0140673615010247">protects maternal and infant health</a>. We know it <a href="https://adc.bmj.com/content/early/2014/11/12/archdischild-2014-306701.short">saves money</a> for the healthcare system. We know the majority of women <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">want to do it</a> – and lots, once they get past the early weeks, find it <a href="https://www.sciencedirect.com/science/article/pii/S0266613809001211">simpler, more convenient and cost-effective</a>. And we know the potentially damaging effect on their mental health if they cannot breastfeed. </p>
<p>It’s not as if we don’t know <a href="http://www.pinterandmartin.com/breastfeeding-uncovered.html">why women are struggling</a>. There is an absence of professionals to support women, no community to take care of them, and lack of a culture that understands, values and protects breastfeeding and breastfeeding mothers whether they are at home, work or out in public. </p>
<p>But instead of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/jhn.12496">investing in the research, staffing, education and protection</a> that is needed, <a href="https://www.theguardian.com/lifeandstyle/2018/jul/27/breastfeeding-support-services-failing-mothers-due-to-cuts">cuts are being made to services</a>, and a bottle of formula is suddenly given as the solution to any <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2015.0175">breastfeeding challenge</a>. Although formula is sometimes needed when breastfeeding really does not go to plan, the <a href="https://www.nice.org.uk/guidance/ng75">National Institute of Clinical Excellence</a> states that women who want to breastfeed should be given intensive support to increase their milk supply if necessary, before formula is offered. </p>
<p>Moreover, formula doesn’t solve the perceived issues that it is often presented as solving. It <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2014.0153">won’t help a baby sleep</a> at night, does not create a more “settled baby” and does not stop babies wanting to be held. These are normal baby behaviours, <a href="https://www.sciencedirect.com/science/article/pii/S0022347679805405">to help a them feel safe</a> and comforted, and often nothing to do with hunger. And, most importantly, simply telling a mother who wants to breastfeed to give formula rather than helping her work through any challenges will not make her any happier – in fact, as shown, the opposite is often true. Mothers who are let down in this way – <a href="https://www.huffingtonpost.com/jennifer-grayson/there-are-no-tests-the-st_b_11307426.html">often without answers</a> as to why their breastfeeding experience went – wrong blame themselves, stating that they <a href="https://www.sciencedirect.com/science/article/pii/S0277953607003590">feel like failures</a>. </p>
<p>Mothers who cannot breastfeed are absolutely not failing, rather, they are being failed – by a government who is far too quick to promote breastfeeding without protecting it.</p><img src="https://counter.theconversation.com/content/103788/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. She is author of three books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' and the 'The Positive Breastfeeding Book'.</span></em></p>Mothers who cannot breastfeed are absolutely not failing, rather, they are being failed.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/996452018-07-10T10:46:03Z2018-07-10T10:46:03ZGiving your baby solid food early won’t help them sleep better<figure><img src="https://images.theconversation.com/files/226940/original/file-20180710-70042-wmwq4j.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Sleeping like a baby.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/3-months-old-baby-girl-sleeping-1102507679?src=oQVF0_4WEh552o-LfunUJw-1-75">Ekaterina Pokrovsky/Shutterstock</a></span></figcaption></figure><p><a href="https://www.theguardian.com/lifeandstyle/2018/jul/09/feeding-baby-solids-early-may-help-them-sleep-study">New research</a> claims that giving babies solid foods at just three months old will help them sleep. Though this may sound appealing to exhausted new parents, unfortunately there is a large gulf between the headlines and the data. </p>
<p>Much of the published evidence in this area actually shows the opposite, that what a baby eats has nothing to do with their sleep. In 2015 <a href="https://www.ncbi.nlm.nih.gov/pubmed/25973527">we found</a> that neither breast nor formula milk, timing of solids introduction, nor the amount of solids eaten affected how often babies woke up at six to 12 months. </p>
<p>Another study has found that the common practice of <a href="https://jamanetwork.com/journals/jamapediatrics/article-abstract/514762">adding rice cereal</a> to a bottle before bed (which should be avoided as it can cause choking) has no impact on sleep at four months old. While <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2866807/">a third</a> found that early introduction of solids was associated with <em>less</em> sleep at 12 months old. </p>
<p>The recent study is an excellent example of how statistically significant differences and real world differences can be miles apart. The <a href="https://jamanetwork.com/journals/jamapediatrics/fullarticle/2686726">authors themselves note</a> that no difference in waking was seen until five months old, despite one group having solids from three months. </p>
<p>From then, babies in the early introduction group may have technically slept more, but this amounted to an average of just seven minutes more a night. At its maximum (six months old) the difference was 16 minutes. Most babies in the study still woke up once or twice a night whatever they were fed. And given these figures are based on the self-reporting of sleep deprived parents – <a href="https://www.sciencedirect.com/science/article/pii/S1389945718303204">which often does not match up to sleep recordings</a> – this is not a basis for making major changes in infant feeding practices. </p>
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<p>There is no physiological reason why introducing solid foods early would help a baby sleep. First, babies (after the first few weeks) <a href="https://www.huffingtonpost.co.uk/amy-brown/does-anyone-really-sleep-_b_16971544.html">do not simply wake at night</a> because they are hungry. Just like adults, <a href="https://www.isisonline.org.uk/how_babies_sleep/">they wake because they are cold, uncomfortable or simply want comfort</a>. The difference being that they cannot always soothe themselves back to sleep. </p>
<p>Second, even if it were for hunger, the most sensible solution would be to offer additional milk, as it will give <a href="https://kellymom.com/nutrition/starting-solids/babyfoodcalories/">more energy, fat and protein than any other food</a> you can give a baby. The aim of the trial from which this data came was not to increase overall energy intake, but <a href="https://www.food.gov.uk/sites/default/files/media/document/eat-study-full-report.pdf">to test how introduction of allergenic foods</a> at three versus six months affects the development of allergies (which it did not). </p>
<p>The parents were advised to give very small amounts of allergenic foods (such as one egg, 25g fish and 100g yogurt spread over a week – just a few spoonfuls a day) alongside rice, cereals, fruit and vegetables. All of these foods are lower in calories than breast or formula milk but take up more room, meaning babies might even eat a little less as they get used to weaning – a potential explanation for the larger sleep gap at six months as the standard group got used to food. </p>
<h2>Solid sleep</h2>
<p>Less than half of the parents in the early introduction group stuck to the protocol. A variety of reasons were given but a major issue with introducing solids early is that <a href="https://kellymom.com/nutrition/starting-solids/solids-when/">babies are simply not physiologically ready</a>. At three months, many may only just have good head control. They won’t be able to sit up properly. They still have a gag reflex that pushes food out of their mouth. Earlier introduction of solids can be <a href="https://www.ncbi.nlm.nih.gov/pubmed/21143584">messy, time consuming and demoralising</a>, as babies simply aren’t equipped to be eating solids so soon.</p>
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<img alt="" src="https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=900&fit=crop&dpr=1 600w, https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=900&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=900&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1131&fit=crop&dpr=1 754w, https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1131&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/226915/original/file-20180710-70060-fe9jjo.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1131&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">At three months, most babies can’t sit up properly.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/biracial-mix-hispanic-black-african-american-39099073?src=PNXo7MeLuRpuMmASso4sCg-1-21">OLJ Studio/Shutterstock</a></span>
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<p>Research shows that the earlier a baby is weaned, the longer it takes them to eat anything other than a few tastes. <a href="https://onlinelibrary.wiley.com/doi/epdf/10.1111/j.1651-2227.2001.tb00785.x">One study found</a> if babies were given solids before four months it took them six weeks on average to eat just 100ml of food per day, but it was just 12 days for those weaned at the recommended six months.</p>
<p>The <a href="https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5a5a41479140b7e31a75ccbc/1515864404727/Eating_well_the_first_year_Sep_17_small.pdf">guidelines to introduce solid foods</a> at six months are there for good reason. There is <a href="https://www.ncbi.nlm.nih.gov/pubmed/22895934">no deficit to growth or nutrient status</a> in waiting until six months to introduce solid foods, but there is an increased risk of gastrointestinal and respiratory illnesses in infants given solid foods before then. </p>
<p>Introducing solids too early <a href="https://files.eric.ed.gov/fulltext/ED479275.pdf">can lead to</a> a reduction in breastmilk intake (and its associated antibodies), introduction of contaminants, and can cause digestive difficulties as babies do not develop all the enzymes needed to properly digest solid foods until between four and six months old. </p>
<p>It should also be noted that the babies in the study were a very specific group. Nearly all were <a href="https://www.nejm.org/doi/full/10.1056/NEJMoa1514210">breastfed until six months old</a> – 97%, compared to <a href="https://digital.nhs.uk/data-and-information/publications/statistical/infant-feeding-survey/infant-feeding-survey-uk-2010">just 34% in the UK population</a>. Research shows that <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/apt.12023">breastfeeding through introduction to solid foods</a> is important in reducing allergy development, but often early introduction of solids increases risk of <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/mcn.12166">stopping breastfeeding</a>. </p>
<p>Great care must be taken in generalising these findings. The research begs the question, does introducing solids early – with all its associated risks – really carry more weight if it comes with a few minutes of sleep every night? It seems to me that we should be asking why parents are struggling with sleep so much and <a href="https://www.ncbi.nlm.nih.gov/pubmed/28744924">seek better ways to support them</a> instead.</p><img src="https://counter.theconversation.com/content/99645/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. She is author of three books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' and the forthcoming 'The Positive Breastfeeding Book'.</span></em></p>A new study claims that an early start on solids can help babies sleep – but established research has proven the risks outweigh any benefit.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/980262018-06-19T10:44:23Z2018-06-19T10:44:23ZBreastfeeding is not ‘easy’ – stop telling new mothers that it is<figure><img src="https://images.theconversation.com/files/223669/original/file-20180618-85840-1saidut.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Not always simple, but worth it.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-beautiful-mother-breastfeeding-her-newborn-707981059?src=y3YDVRuiHydKAhGA631m0Q-2-6">Tomsickova Tatyana/Shutterstock</a></span></figcaption></figure><p>It’s difficult to talk about breastfeeding in a productive way right now. On the one hand, the UK’s breastfeeding rates are so low, that campaigns such as <a href="https://www.unicef.org.uk/babyfriendly/breastfeeding-celebration-and-awareness-weeks-2018/">National Breastfeeding week</a> have become really important in encouraging more people to support it. Unfortunately, at the same time, these events often stir up a lot of hurt, by reminding many women why we have such low rates in the first place. Whether they are breastfeeding, struggling to, or find they can’t, far too many women experience a <a href="https://theconversation.com/traumatic-breastfeeding-experiences-are-the-reason-we-must-continue-to-promote-it-63550">lack of support</a> in feeding their baby.</p>
<p>One of the traps public health promotion can fall into is being so keen to promote breastfeeding that any challenges get glossed over, through fear that it’ll put women off. Instead breastfeeding gets painted as some kind of idyllic, simple, miracle cure for all ills. Of course, many women hugely value breastfeeding, but any approach that takes this stance is doing both women and breastfeeding a huge injustice. </p>
<p>Breastfeeding is not easy. It requires women’s time and investment and can be a steep learning curve. However, that’s in no way to say the alternative is any easier. Many women find once they get through the early weeks of breastfeeding they actually find it much easier than bottle feeding. </p>
<p>But that still doesn’t make it easy. And that’s OK. </p>
<h2>Ignoring the truth</h2>
<p>What in life worth doing is easy? We put ourselves through challenges all the time. We work hard for exams. We train for races. We do it because we think it’s worth it, not because it’s easy. And we expect others to support us. Imagine our outrage if we were training for a race and everyone suggested it wasn’t worth it. </p>
<p>Calling breastfeeding easy is an injustice to the <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2016.0118">investment women make when they breastfeed</a>. They may want to breastfeed, enjoy it, believe it is worth it – but that doesn’t make it easy. Easy belittles the many hundreds of hours women will spend breastfeeding, the challenges they may have to overcome, the sacrifices they may make because they decide it’s worth it. </p>
<p>By thinking we need to call breastfeeding easy to persuade women to do it, we ignore their strength and resilience. In her groundbreaking book <a href="http://www.kimberlysealsallers.com/book/">The Big Letdown</a>, journalist Kimberly Seals Allers talks about how the pain and difficulty of breastfeeding is often skirted around, yet we admire women’s tattoos, or consider the pain of waxing to be completely normal.</p>
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<p>For a <a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2015.0175">2016 study</a> I asked more than 1,000 mothers how they wanted breastfeeding promotion messages to change. One of the key messages to come out of the study was a call for more realistic messages. As one woman appealed: </p>
<blockquote>
<p>Give us honest real information about how hard it can be to latch on, information about growth spurts, how often babies feed, so mums can make informed decisions on feeding.</p>
</blockquote>
<p>When we gloss over the realities of breastfeeding, women feel unprepared for what it’s really like. If we tell women to expect easy, and they hit a hurdle, they may think they’re doing something wrong. <a href="https://sarahockwell-smith.com/2012/11/04/the-fourth-trimester-aka-why-your-newborn-baby-is-only-happy-in-your-arms/">Normal (but not easy to handle) baby behaviour</a> such as frequent feeding, not wanting to be put down, or night waking, gets perceived as something has gone wrong, and that formula will solve it (<a href="https://www.liebertpub.com/doi/abs/10.1089/bfm.2014.0153">it won’t</a>). Women then end up <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jan.12832">depressed</a>, blaming themselves, thinking they didn’t try hard enough because after all, isn’t breastfeeding easy? </p>
<blockquote>
<p>It was all so positive. Breastfeeding will help you lose weight. Breastfeeding will make bonding easier. Breastfeeding is a wonderful experience. Perhaps true but when I then found it difficult I felt like a complete failure and embarrassed and guilty that I felt that way to boot. If I’d known the truth I could have worked through all of this rather than thinking it wrong.</p>
</blockquote>
<h2>Ease over easy</h2>
<p>Rather than calling breastfeeding easy, we need to think about how we as a society can make breastfeeding easier for mothers. In some cultures, the <a href="https://womenshealthtoday.blog/2017/07/30/how-cultures-protect-the-new-mother/">community comes around the new mother</a>, mothering and supporting her while she recovers from childbirth and gets to grips with breastfeeding. Instead, in many Western countries, our solution to any challenge is often to <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0133547">offer to feed the baby</a>. But the best way of caring for a breastfed baby is to care for their mother. Feed her, love her, support her by taking care of other stuff. Do housework, run errands, look after older children. The same goes for supporting women who are bottle feeding – don’t take the easy option of offering to feed the baby. </p>
<p>Alongside this the <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jhn.12496">government must step up</a> and make things easier for all new families. Better investment in the NHS is needed, so that women have <a href="http://cochranelibrary-wiley.com/doi/10.1002/14651858.CD001141.pub5/full">greater support</a> – however they feed their baby. Access to expert <a href="https://maternalmentalhealthalliance.org">mental health services</a> for all new parents needs to be widened too, to debrief birth, feeding and early parenting experiences. In addition, longer, better paid leave for both mothers and fathers, as per <a href="https://www.telegraph.co.uk/news/2017/12/19/take-five-months-parental-leave-swedish-fathers-told/">the Swedish model</a>, would do wonders for the well-being of the whole family. </p>
<p>Rather than sugar coating early motherhood as easy, we need to step up, tell the truth and actually support our new families.</p><img src="https://counter.theconversation.com/content/98026/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC, NIHR and Public Health Wales. She is author of three books published by Pinter and Martin Ltd - 'Breastfeeding Uncovered: who really decides how we feed our babies', 'Why starting solids matters' and the forthcoming 'The Positive Breastfeeding Book'. </span></em></p>Breastfeeding isn’t easy, and that’s ok – new parents can handle the truth.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/940552018-03-28T09:21:43Z2018-03-28T09:21:43ZBaby bottle propping isn’t just dangerous – it’s a sign of a broken society<figure><img src="https://images.theconversation.com/files/212264/original/file-20180327-109196-107wiec.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">
</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-bottle-on-white-background-97357565?src=msX-lxCttNRWbbzPNUEM1A-1-30">gresei/Shutterstock</a></span></figcaption></figure><p>Bottle propping is a dangerous practice that goes back years. But it is now receiving increased attention as society tries to sell a “solution” for everything. </p>
<p>Feeding a baby with a bottle resting upright against something allows the milk to flow without the need for parental hands. And over the last few years, numerous devices that essentially make feeding a baby a hands free (human free?) activity have flooded the market. Promoted as enabling parents to get a break from the proposed monotony of caring for a baby, they sell a solution to a deeply ingrained but skirted around societal issue – that we simply do not value or care for new mothers.</p>
<p>Tragically, <a href="http://www.bbc.co.uk/news/uk-england-lincolnshire-43016506">bottle propping can be fatal</a>. Young babies may not have the head control or strength to move away from the flow of the milk that is being aided by gravity. Quite simply they can choke to death as they cannot escape from the milk, or inhale it as the bottle becomes displaced.</p>
<p>There is also the very real risk that babies simply end up consuming too much milk if it keeps flowing. Research has shown how <a href="http://pediatrics.aappublications.org/content/87/6/829.short">babies take more milk from a bottle</a> than they do when they breastfeed (one reason why bottle fed babies can be at a <a href="http://pediatrics.aappublications.org/content/125/6/e1386">higher risk of being overweight</a>) and this increases if they are <a href="http://journals.plos.org/plosone/article?id=10.1371/journal.pone.0054229">encouraged to take more</a> – as a propped bottle would “encourage” them to do.</p>
<p>Yes, an older baby might be able to move their head away, but at what stage? When they’ve had enough? Or when they really can’t stand any more? Small extra amounts of milk every day matter. Those few extra calories can turn into extra kilos over the months. And encouraging a baby to keep feeding when they are full can also interfere with <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/j.2047-6310.2012.00071.x">their ability to control their appetite</a> later on. </p>
<p>Then there is the inescapable fact that having a bottle propped into your mouth when you can’t remove it can’t be the nicest feeding experience. Feeding is about so much more than nutrition. Holding a baby warm and close while being fed is a big part of them feeling secure and loved. It’s no coincidence that the <a href="https://www.parents.com/baby/development/physical/understanding-your-babys-developing-vision/">sight range of newborn babies</a> is pretty much perfect to reach their parents eyes at the angle that they would be held for a feed. <a href="http://cochranelibrary-wiley.com/store/10.1002/14651858.CD003519.pub3/asset/CD003519.pdf?v=1&t=jf9qiwvp&s=2120d7942331189a772e0aa07cb76d504cc06800">Skin to skin contact</a> is ideal when possible during feeds, but just the fact that the baby is being fed by a human being increases oxytocin, <a href="https://www.healthymummy.com/huge-benefits-cuddling-baby-often-reveals-new-study/">helping calm them</a> and create general all round lovely feelings.</p>
<p>And no, you don’t need to stare endlessly into a baby’s eyes at every feed, but there is a vast gulf between that and not even holding a baby.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/212268/original/file-20180327-109185-1jsbjbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/212268/original/file-20180327-109185-1jsbjbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/212268/original/file-20180327-109185-1jsbjbz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/212268/original/file-20180327-109185-1jsbjbz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/212268/original/file-20180327-109185-1jsbjbz.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/212268/original/file-20180327-109185-1jsbjbz.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/212268/original/file-20180327-109185-1jsbjbz.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Hungry but happy.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/young-mother-home-feeding-their-new-150594026?src=jUsCX2mVIhqDTJgB2IsoMQ-1-66">MJTH/Shutterstock</a></span>
</figcaption>
</figure>
<p>But my real question is: how did we get to a stage where these devices are needed? You can understand their appeal. We now have so many parents who are <a href="https://www.telegraph.co.uk/science/2017/11/06/parenthood-leaves-half-mother-fathers-feeling-lonely/">pretty much doing this on their own</a>. Yes, they might have a partner, but they’re often at work all day. Yes, they might have visitors, but how many are there just to coo over the baby rather than do anything useful such as cook a meal, do the washing up, or anything else that might actually help a new mother feel more relaxed? Rates of <a href="https://www.sciencenews.org/article/postpartum-depression-scientific-research-mothers">postnatal depression</a> are soaring. So many new mothers feel isolated and alone. The <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-2648.2004.02991.x/full">stress and sheer exhaustion</a> of trying to manage everything on your own, day after day, can be overwhelming.</p>
<p>How on earth have we got to the point where bottle propping is the solution? Why are we ignoring the needs of our new mothers? Why are new mothers literally the ones left holding the baby, day in, day out? Having a new baby is always going to be a huge change. But it doesn’t need to be like this.</p>
<p>There needs to be <a href="https://ihv.org.uk/wp-content/uploads/2015/08/iHV-Response-to-the-Shape-of-Caring-Review-October-2015.pdf">proper postnatal support</a> for new mothers. Professionals who are given the time and the training to identify issues and advise on options. We need partners to have <a href="https://www.theguardian.com/money/2011/jul/19/norway-dads-peternity-leave-chemin">extended, well-paid leave</a> (and indeed in places such as the US, even giving mothers this <a href="https://www.washingtonpost.com/news/wonk/wp/2018/02/05/the-worlds-richest-countries-guarantee-mothers-more-than-a-year-of-paid-maternity-leave-the-u-s-guarantees-them-nothing/">proper extended well-paid leave</a> would be a start).</p>
<p>There need to be support networks. No mother should be doing this alone. We should track down where the “village” – that extended network of family and friends which share responsibility for raising a child – went to and <a href="https://www.huffingtonpost.co.uk/katharine-hill/it-takes-a-village-to-rai_3_b_12261128.html">recreate it</a>. There must be a <a href="https://www.pbs.org/newshour/science/sleep-study-shows-new-moms-dangerously-exhausted-months">recognition of how isolating and exhausting</a> caring for a baby can be – and a system in place to catch mothers before they fall.</p>
<p>We need to <a href="https://www.huffingtonpost.co.uk/amy-brown/mothering-the-mother-the-_b_18317834.html">mother our new mothers</a>, so that mothering with your sanity intact isn’t an insurmountable challenge.</p>
<p>And finally, these devices should be recognised for what they represent – a breaking point, a plea for help. Governments must put their money where their mouths are and <a href="https://www.ncbi.nlm.nih.gov/pubmed/28744924">invest in repairing and supporting a future</a> that is balancing on the edge of being truly broken.</p><img src="https://counter.theconversation.com/content/94055/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC and NIHR. </span></em></p>A new baby feeding trend shows how desperate some mothers are getting for parenting help.Amy Brown, Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/826662017-08-22T12:26:09Z2017-08-22T12:26:09ZBreastfeeding: five ways it can be encouraged responsibly<figure><img src="https://images.theconversation.com/files/182950/original/file-20170822-14267-96yeq1.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Breastfeeding shouldn't face protest.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/can-breastfeed-my-child-wherever-want-470549681?src=3BCXKOLvtmrmRy5nYWstgQ-1-0">M-SUR/Shutterstock</a></span></figcaption></figure><p>Health promotion messages rarely work when they simply tell people what to do. We all know what a healthy diet looks like, yet that knowledge doesn’t prevent us from ordering another takeaway. Instead our behaviour is driven by the <a href="http://titleiii-ptlproject.wikispaces.umb.edu/file/view/35bronfebrenner94.pdf/455834098/35bronfebrenner94.pdf">environment in which we live</a>: public attitudes, financial constraints, and support from others all affect our confidence and ability to act. </p>
<p>The same is true for breastfeeding. Despite increasing breastfeeding rates being a <a href="http://www.who.int/nutrition/topics/globaltargets_breastfeeding_policybrief.pdf">strategic priority globally</a>, the involvement of many governments often only goes so far as unhelpful messages extolling women to breastfeed. These don’t work because <a href="http://online.liebertpub.com/doi/abs/10.1089/bfm.2015.0175">they don’t change the environment</a> in which women are trying to breastfeed. They might tell women breastfeeding is important but they don’t offer practical support, change negative public attitudes, or help women delay going back to work. All of this pushes many women to stop breastfeeding <a href="https://www.amazon.co.uk/Breastfeeding-Uncovered-Really-Decides-Babies/dp/1780662750">before they are ready</a>. </p>
<p>Rather than focusing on telling women to breastfeed, governments must recognise their wider <a href="http://onlinelibrary.wiley.com/doi/10.1111/jhn.12496/full">public health responsibility</a>, and work to create an environment that actually supports breastfeeding. It shouldn’t be left to <a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/breastfeeding-help-support.aspx">charities and volunteers</a> alone. Support should be part and parcel of society – and implementing a new strategy is not as difficult as you might think. </p>
<h2>1. Education and support</h2>
<p>Good quality education, rather than simply a list of reasons why women should breastfeed, is key to success here. Before the birth, mothers should be offered information on how breastfeeding works, <a href="https://www.theguardian.com/commentisfree/2017/aug/01/pregnant-women-breastfeeding-tough-british-attitudes">challenges that might arise</a> and who they can get support from. Peer supporter schemes are a highly valued source of practical and emotional help for new mothers, but in many places <a href="https://theconversation.com/mothers-are-subject-to-a-postcode-lottery-for-breastfeeding-support-77982">are absent</a> or <a href="http://www.blackpoolgazette.co.uk/news/mums-plea-to-save-breastfeeding-support-service-1-8540974">have had their funding cut</a>. </p>
<p>But this is not just about teaching mothers, <a href="https://www.ncbi.nlm.nih.gov/pubmed/28167998">ongoing breastfeeding education</a> is crucial for all who support them, including GPs and childcare staff, so that women get consistent, high quality advice. However, this education is not much use unless staff <a href="https://www.rcm.org.uk/content/if-breast-is-still-best-for-mothers-give-mothers-more-time-with-midwives-say-mothers">are also given the time</a> to work with mothers after birth. </p>
<h2>2. Public acceptance</h2>
<p>Breastfeeding promotion should not just target mothers, but <a href="https://www.unicef.org.uk/babyfriendly/baby-friendly-resources/advocacy/join-our-change-the-conversation-campaign/">the wider population</a>. A mother may want to breastfeed but if those close to her do not understand why, or how to help, her experience will <a href="https://www.ncbi.nlm.nih.gov/pubmed/27052189">be more challenging</a>. </p>
<figure class="align-right ">
<img alt="" src="https://images.theconversation.com/files/182949/original/file-20170822-30538-1kkc5tv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/182949/original/file-20170822-30538-1kkc5tv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/182949/original/file-20170822-30538-1kkc5tv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/182949/original/file-20170822-30538-1kkc5tv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/182949/original/file-20170822-30538-1kkc5tv.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/182949/original/file-20170822-30538-1kkc5tv.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/182949/original/file-20170822-30538-1kkc5tv.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
<figcaption>
<span class="caption">Support from day one.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mature-nurse-helping-woman-breast-feeding-163572821?src=Ebk7dknglz9o6krAPVIamw-3-36">Tyler Olson/Shutterstock</a></span>
</figcaption>
</figure>
<p>The public need to know why it is important to support breastfeeding, and that it has <a href="https://www.maternityaction.org.uk/advice-2/mums-dads-scenarios/6-breastfeeding-rights/breastfeeding-in-public-places/">legal protection</a> too. <a href="http://www.breastfeedingwelcomescheme.org.uk">Breastfeeding Welcome schemes</a> – participating organisations display signs saying they are supportive of breastfeeding – can play an important role here to reassure mothers, and also send a strong signal to potential critics. </p>
<p>Public acceptance is not just an issue for adults: children should <a href="http://www.huffingtonpost.co.uk/milli-hill/breastfeeding-schools-_b_1774235.html">also learn about the breast</a>, and its role in nutrition, health and reproduction, just as they would any other body part. Doing this would mean that the next generation would not even think to question breastfeeding. </p>
<h2>3. Maternal legal rights</h2>
<p>Countries, <a href="https://sweden.se/society/10-things-that-make-sweden-family-friendly/">like Sweden</a>, that have longer, well-paid maternity leave and flexible working rights also have the highest breastfeeding rates. However, in the UK for example, statutory maternity pay drops to <a href="https://www.gov.uk/employers-maternity-pay-leave/entitlement">just £140 a week after six weeks</a>, and in the US it <a href="http://www.independent.co.uk/news/world/americas/paid-maternity-leave-us-worst-countres-world-donald-trump-family-leave-plan-women-republican-social-a7606036.html">is non-existent</a> – meaning many mothers return to work weeks after the birth. </p>
<p>When they return, many struggle to continue breastfeeding due to poor facilities – despite research showing that when women have private, paid breaks to express, this leads to <a href="https://www.ncbi.nlm.nih.gov/pubmed/23087383">continued breastfeeding and happier staff</a>. Some simple changes here would not only enable women to breastfeed for longer, but show that society values mothering.</p>
<h2>4. Mental health</h2>
<p>Caring for a baby invariably leaves new mothers feeling exhausted. In many cultures, childcare is not down to one mother, but a whole village. However, in the West, <a href="http://www.telegraph.co.uk/women/womens-health/10665405/Do-you-feel-isolated-as-a-mum-in-modern-Britain-Youre-not-the-only-one.html">new mothers are often isolated</a>, lonely and exhausted, which can make breastfeeding <a href="https://www.laleche.org.uk/bf-postnatal-depression/">feel insurmountable</a>. </p>
<p>In the absence of a village, professional support is again vital. Research has shown that enabling health visitors to spend more time with new mothers, even just to simply <a href="http://www.magonlinelibrary.com/doi/abs/10.12968/johv.2016.4.5.264">talk about they are feeling</a>, can help mothers’ mental health immensely. <a href="https://www.ncbi.nlm.nih.gov/pubmed/17397975">Community support networks</a> are also vital, to reduce feelings of isolation, but these need encouragement to be set up and thrive. </p>
<h2>5. Formula control</h2>
<p>Formula milk is lifesaving for babies who cannot be breastfed but advertising these products is simply not necessary. Many of the claims made <a href="http://www.huffingtonpost.co.uk/amy-brown/dont-we-deserve-fairer-pr_b_15577536.html">have already been challenged</a> by health bodies as misleading or unnecessary – but numerous countries, including Britain, still need to stop companies from <a href="https://theconversation.com/26-years-ago-the-uk-signed-up-to-formula-milk-advertising-rules-so-why-isnt-it-law-yet-74794">putting promotions out altogether</a>.</p>
<p>In countries that have implemented these five elements, there have been clear increases in breastfeeding rates. <a href="https://www.theguardian.com/lifeandstyle/2005/may/11/familyandrelationships.health">In Norway</a>, for example, both mothers and fathers have extended, well-paid leave after the birth, while laws are upheld, and adverts for infant formula are regulated. Brazil has had success too, following similar changes and <a href="http://www.huffingtonpost.com/entry/amid-zika-crisis-brazil-leads-the-way-in-1-area-of-infant-health_us_579a3c5de4b02d5d5ed4c07e">investing in over 200 breast milk banks</a>. </p>
<p>We are happy to invest in other health interventions – such as laws around smoking in public places and banning lead paint – so why not extend this public health approach to supporting how babies are fed? If we want to give women the best possible chance of breastfeeding, governments – not mothers – must take responsibility for creating an environment that supports, protects and enables them to do so.</p><img src="https://counter.theconversation.com/content/82666/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC and NIHR. She is the author of 'Breastfeeding Uncovered: Who really decides how we feed our babies' and 'Why starting solids matters' both published by Pinter and Martin publishers.</span></em></p>It’s not that difficult to support breastfeeding mums - but governments need to take charge.Amy Brown, Associate Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/779822017-07-07T12:11:39Z2017-07-07T12:11:39ZMothers are subject to a postcode lottery for breastfeeding support<figure><img src="https://images.theconversation.com/files/177298/original/file-20170707-3005-131g4vj.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption"></span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/mother-breastfeeding-hugging-baby-young-mom-528384532?src=1JMEE0R1scNoohB-hLItqw-1-50">Uvarov Stanislav/Shutterstock</a></span></figcaption></figure><p>Though some mums choose not to breastfeed their children, it is still considered by most to be “an <a href="http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/">unequalled way</a> of providing ideal food for the healthy growth and development of infants”. </p>
<p>It is for that very reason that both the <a href="http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/">World Health Organization</a>and <a href="https://www.nhs.uk/start4life/breastfeeding">the NHS</a> specifically recommend breast milk as the only food for babies up to six months old, with infants benefiting from continued breast milk up until at least two years old. </p>
<p>But for both new and experienced mothers, starting to breastfeed a new baby can be difficult. For both parent and child to remain happy and healthy, <a href="http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/">they need support</a>. In the UK, <a href="https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=2&cad=rja&uact=8&ved=0ahUKEwj7uN-KiPXUAhXLb1AKHW-FBnoQFggtMAE&url=http%3A%2F%2Fcontent.digital.nhs.uk%2Fcatalogue%2FPUB08694%2Fifs-uk-2010-sum.pdf&usg=AFQjCNGCK637nNzh1KfyiCHzNdF-jqBsWg">more than 80% of mothers</a> breastfeed their baby at least once, but rates drop off quickly. </p>
<p><a href="https://www.nice.org.uk/guidance/ph11/chapter/4-recommendations#breastfeeding-3">According to NICE</a> – the body which suggests the treatments patients should receive as part of NHS England care – the health service should have “a multifaceted approach or a coordinated programme of interventions across different settings to increase breastfeeding rates”. In other words, all mothers should be getting help to breastfeed their babies – but we’ve found that this is not the case. </p>
<p>One specific <a href="https://www.nice.org.uk/guidance/ph11">NICE recommendation</a> is that mothers should be guided and encouraged through breastfeeding peer support programmes. The peer supporters are women who have received training in breastfeeding and have personal experience. However, NICE does not provide guidance about what this peer support should be like. In the US, there is a standardised training programme for peer supporters, trainers and service managers, which has helped to <a href="https://www.fns.usda.gov/sites/default/files/ops/WICPeerCounseling-PhaseII-Summary.pdf">work towards a standard</a> service across the country. But in the UK, each NHS trust or health board has its own strategy for the care of breastfeeding mothers, and these training programmes vary greatly.</p>
<h2>Service success</h2>
<p>To date, breastfeeding peer support services have <a href="http://www.bmj.com/content/344/bmj.d8287">not been successful</a> in the UK. For this reason, the National Institute for Health Research commissioned us to undertake <a href="http://www.cardiff.ac.uk/centre-for-trials-research/research/studies-and-trials/view/mamkind">a programme of research</a> to find out how mothers were being supported to breastfeed across the country, outside of midwifery and health visiting services.</p>
<p>We asked NHS and local authority staff who had responsibility for infant feeding if breastfeeding peer supporters were available in their area – defined as either a NHS health board, NHS trust or local authority (in England). Where we did not get a reply from the member of staff, we searched NHS/local authority websites.</p>
<figure class="align-left zoomable">
<a href="https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=237&fit=clip" srcset="https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=849&fit=crop&dpr=1 600w, https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=849&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=849&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=1067&fit=crop&dpr=1 754w, https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=1067&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/177296/original/file-20170707-3035-xnyvfg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=1067&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
<figcaption>
<span class="caption">Breastfeeding support availability in the UK.</span>
<span class="attribution"><span class="license">Author provided</span></span>
</figcaption>
</figure>
<p><a href="http://orca.cf.ac.uk/100555/">What we found</a> was that breastfeeding peer support is not available uniformly across the country – despite NICE’s recommendation. In fact, peer support is only available in 56% of NHS trust areas. This postcode lottery means that some mothers are not able to access peer supporters, which might make it harder for them to breastfeed their children. </p>
<p>Alongside this, participants also told us that services were not even available uniformly under the NHS trusts and health boards they worked with or for – while some towns had access to peer support services, others did not. They attributed this lack of service to the money available, rather than the support needs of new mothers. Indeed, some services reported there had been budget cuts which meant services such as training new peer supporters could not be provided. </p>
<p>Among the areas which had peer supporters, the roles that they did – such as providing support in hospital wards or visiting new mums at home – varied. Participants in our study advised that peer support services were most complimentary to NHS midwifery care when the peer supporters had clear roles and responsibilities. It was also important that peer supporters were visible to midwives and health visitors, for example by working on postnatal wards.</p>
<p>The health professionals also told us that it was difficult to attract mothers from poorer backgrounds to seek support from breastfeeding peer support programmes.</p>
<p>We also looked into the availability of support groups for breastfeeding mothers across the country. These are groups based in the community which aim to help mothers breastfeed. Though they are sometimes run or attended by peer supporters, they are also run by midwives, health visitors and voluntary groups, such as the <a href="https://www.nct.org.uk/">National Childbirth Trust</a>. Most areas in the study (89%) had at least one breastfeeding support group, but the number of groups was not related to the number of births or the perceived level of need. </p>
<h2>Proving benefit</h2>
<p>One reason for the low prevalence and lack of funding for breastfeeding support may be the <a href="http://www.bmj.com/content/344/bmj.d8287">insufficient amount of evidence</a> of its clinical benefit in the UK. Globally, it has been proven that these support services <a href="http://www.bmj.com/content/344/bmj.d8287">increase breastfeeding rates</a>, but without specific evidence from UK mothers, trusts would be reluctant to fund it.</p>
<p>For so many mothers, peer support feels absolutely vital to continuing their breastfeeding. At what can be a <a href="https://theconversation.com/traumatic-breastfeeding-experiences-are-the-reason-we-must-continue-to-promote-it-63550">lonely, frustrating and upsetting time</a>, it is absolutely vital that mothers have someone to turn to.</p>
<p>Our team is now working to test a new model of breastfeeding peer support, <a href="http://www.cardiff.ac.uk/centre-for-trials-research/research/studies-and-trials/view/mamkind">Mam-Kind</a>, which aims to <a href="https://www.facebook.com/mibfps.study">provide mothers with regular support</a> to help them identify and meet their own breastfeeding goals.</p><img src="https://counter.theconversation.com/content/77982/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aimee Grant receives funding from the National Institute for Health Research, the Wellcome Trust ISSF Public Health Scheme and the Welsh Crucible Small Grant Scheme. She has also undertaken paid consultancy for Public Health Wales NHS Trust, where she previously held the role of Senior Health Promotion Practitioner. She is affiliated with the Action on Smoking and Health (ASH) Wales Cymru research committee, where she previously held the role of Research and Policy Officer.</span></em></p>The UK isn’t doing enough to help mums breastfeed successfullyAimee Grant, Research Associate, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/780862017-06-05T14:48:47Z2017-06-05T14:48:47ZDoes spoon-feeding really make babies overweight?<figure><img src="https://images.theconversation.com/files/172263/original/file-20170605-16877-9yftvs.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Assessing a tasty treat.</span> <span class="attribution"><a class="source" href="https://www.flickr.com/photos/simonwheatley/10765669526/">Simon Wheatley/Flickr</a>, <a class="license" href="http://creativecommons.org/licenses/by-sa/4.0/">CC BY-SA</a></span></figcaption></figure><p>Deciding when and how to introduce babies to solid foods can be overwhelming for parents. But aside from timing and amount, could how babies are introduced to solid foods also make a difference to their health? </p>
<p>Until the early 20th century, babies were simply given foods that the rest of the family ate, <a href="http://www.magonlinelibrary.com/doi/abs/10.12968/johv.2016.4.10.524">towards the end of their first year</a>. This was before the <a href="http://www.ucpress.edu/book.php?isbn=9780520283459">dawn of the baby food industry</a> led to the majority of babies in Western countries being weaned onto solid foods using specially prepared, pureed infant foods that are spoon-fed. </p>
<p>However, since government recommendations in 2003 changed to <a href="https://www.nhs.uk/start4life/first-foods">introduce solid foods at six months</a>, increasing numbers of parents have been returning to letting their baby eat the same food as the rest of the family, by following <a href="http://www.rapleyweaning.com">baby-led weaning</a>. Evidence suggests that delaying introduction of solids until six months <a href="https://link.springer.com/article/10.1007/s13668-017-0201-2">may protect against</a> babies becoming overweight. So spoons and purees are being forgone to let infants eat at their own pace – which they are typically developmentally <a href="https://eric.ed.gov/?id=ED479275">able to do at six-months-old</a>. </p>
<p>Research has found that parents are choosing baby-led weaning because they feel it makes for <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1740-8709.2011.00360.x/full">less stressful and easier</a> (albeit messier) mealtimes. But growing numbers of parents also choose to follow the method because of <a href="https://www.theguardian.com/lifeandstyle/wordofmouth/2011/oct/05/baby-led-weaning">suggestions</a> that it may help their baby develop better eating habits and a healthier weight – but is this true?</p>
<h2>The evidence so far</h2>
<p>Limited research on baby-led weaning suggests that, to some extent, yes, it can help children develop better eating habits. Preschool children who followed baby-led weaning are <a href="http://bmjopen.bmj.com/content/2/1/e000298.short">less likely to be overweight</a> than those who were spoon-fed. Similarly, <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.2047-6310.2013.00207.x/full">toddlers who had followed the approach</a> were less likely to be fussy eaters, less likely to overeat and were less likely to be overweight. </p>
<p>But is it really as simple as saying that spoons and purees are potentially putting babies at greater risk of being overweight and developing picky eating habits? In a nutshell, no. </p>
<p>A more balanced explanation is that baby-led weaning promotes a number of behaviours that <a href="https://link.springer.com/article/10.1007/s13668-017-0201-2">positively shape</a> an infant’s appetite and weight development. The baby-led approach naturally encourages parents to let their baby <a href="https://link.springer.com/article/10.1007/s10995-010-0678-4">go at their own pace</a> when eating. Research with older children shows that when parents <a href="https://ijbnpa.biomedcentral.com/articles/10.1186/1479-5868-5-15">are too controlling</a> over what and how much their child eats, the child is more likely to go on to develop weight problems and be a fussy eater. Babies and young children are <a href="http://www.nature.com/ijo/journal/v28/n7/abs/0802532a.html">good at regulating their intake of food</a> according to energy needs but parents encouraging them to finish all the food on their plate, or withdrawing certain foods so they crave them, can break this down. </p>
<p>The baby-led approach, on the other hand, allows infants to be in control, rather than parents. Although spoon-feeding parents may be responsive, the baby may accept more food than it would eat when self feeding.</p>
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<p>We also know that <a href="http://www.sciencedirect.com/science/article/pii/S0002822311005840">adults who eat slowly</a> are less likely to be overweight. The same could very well apply with infants: naturally, it takes more time for an infant to self-feed and chew whole foods than it does to be spoon-fed purees. </p>
<p>Potentially, the way food is presented to infants who are following baby-led weaning may promote a wider variety of intake too. Food in its whole form may not only be more appealing than puree, but self-feeding also allows infants to explore how foods feel. We know that this is an important part of how children learn: when older children are allowed to play with food they are <a href="http://www.fasebj.org/content/31/1_Supplement/958.7.short">more likely to eat it</a>. </p>
<h2>The importance of context</h2>
<p>It could be that the healthy food attitudes gained through baby-led weaning are due to factors unrelated to the experience, however. Baby-led weaning has often been <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1740-8709.2010.00243.x/full">linked with breastfeeding</a> as a natural follow on. Breastfeeding mothers are <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-277X.2010.01145.x/full">more used to their baby being in control</a> of feeding – although bottle fed babies do follow baby-led weaning too. On average, breastfed babies are <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.2047-6310.2012.00071.x/full">less likely to be overweight or fussy eaters</a> and this might explain the difference, rather than weaning approach. </p>
<p>Healthy attitudes might also be developed because of the type of parent who chooses to baby-led wean. Babies who have a more <a href="http://pediatrics.aappublications.org/content/127/2/229.short">difficult temperament</a> are typically weaned earlier, before the recommend six months point, meaning they are likely to be spoon-fed. Mothers who are <a href="http://europepmc.org/abstract/med/25623385">more anxious</a> about their baby are also more likely to spoon feed too. This anxiety is linked to <a href="http://jn.nutrition.org/content/138/4/799.short">non-responsive feeding</a>, which can increase the risk of the child being overweight. </p>
<p>Overall, it’s not a clear answer but current research does suggest that infants who follow a baby-led weaning approach may go on to be better eaters and have a healthier weight – but more studies are needed to confirm this. </p>
<p>However, this doesn’t mean that parents who choose to spoon-feed should worry.
Babies’ food attitudes are unlikely to be anything specifically to do with spoons, but rather positive feeding interactions. Giving purees within a mixed diet is unlikely to have a negative impact; <a href="http://www.pinterandmartin.com/why-starting-solids-matters.html">what is important</a> is variation, chance to explore and, most importantly, a laid-back parenting approach.</p><img src="https://counter.theconversation.com/content/78086/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding for research exploring infant feeding from the ESRC and NIHR.
She is author of the book 'Why Starting Solids Matters' published by Pinter and Martin. </span></em></p><p class="fine-print"><em><span>Hannah Rowan and Sara Wyn Jones do not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and have disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Three academics analyse the evidence for and against baby-led weaning.Amy Brown, Associate Professor of Child Public Health, Swansea UniversityHannah Rowan, PhD researcher, Swansea UniversitySara Wyn Jones, PhD researcher, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/783992017-06-02T02:40:30Z2017-06-02T02:40:30ZHealth Check: is it safe to express milk before giving birth?<figure><img src="https://images.theconversation.com/files/171590/original/file-20170531-25664-1awgx8t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Some women, especially with diabetes, are recommended to express milk while still pregnant and to save it for their newborn. But it's not for everyone.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/480007972?size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>Late in their pregnancies, some women notice <a href="https://www.sciencedaily.com/terms/colostrum.htm">colostrum</a> (early milk) leaking from their nipples.</p>
<p><a href="http://brochures.mater.org.au/brochures/mater-mothers-hospital/breastfeeding%E2%80%94antenatal-expression-of-colostrum">Some hospitals</a> are advising women to collect this milk in the last weeks of pregnancy, ready to give to their newborn baby, if needed. Midwives, doctors and lactation consultants may suggest this in particular to women with diabetes in pregnancy.</p>
<p>Although collecting colostrum before giving birth is not new, it is now <a href="http://thehealthyhoneys.com/why-i-chose-to-express-my-colostrum-before-giving-birth/">more widely promoted</a>. Yet there has been little research on the practice. And some people are concerned that collecting it when pregnant could bring on labour early, potentially <a href="https://www.breastfeeding.asn.au/bfinfo/antenatal-expression-colostrum">increasing the risk</a> to mother and baby.</p>
<p>So is it safe for women to collect their own colostrum while pregnant? And are there some situations that are more risky than others?</p>
<h2>What is colostrum and how do women collect it?</h2>
<p>Colostrum contains high levels of antibodies, the proteins that not only fight infections but <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3257684/">program a baby’s immune system for life</a>. We don’t know why some women’s breasts start producing colostrum in pregnancy; many women won’t have any until after they give birth.</p>
<p>If women are advised to collect colostrum while still pregnant, they usually “express” these early drops of fluid <a href="http://brochures.mater.org.au/home/brochures/mater-mothers-hospital/breastfeeding-antenatal-expression-of-colostrum">by stimulating their nipples by hand</a> rather than using a breast pump. </p>
<p>The amount women collect varies from nothing, to a few drops, to a teaspoonful or more. They collect it in a syringe or small sterile jar, which they <a href="https://abm.me.uk/expressing-milk-baby-arrives-antenatal-expression-colostrum/">store in the freezer</a> at home. They then bring it (still frozen) to the hospital when they give birth, where it is thawed if needed to give to the newborn baby while he or she is one or two days old.</p>
<h2>Why do women collect it?</h2>
<p>The most common reason why women consider expressing colostrum early is if they have diabetes in pregnancy, whether that’s existing diabetes or diabetes that only came on while pregnant (pregnancy-onset or gestational diabetes).</p>
<p>Before birth, all babies receive a continuous supply of food in the form of glucose from their mother. This stops suddenly at birth and as babies transition to life outside the womb they have a period of low blood sugar (hypoglycaemia).</p>
<p>However, this adaptation to outside life <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1786710/">takes longer</a> for babies of mothers with diabetes. About one in four or five of these babies <a href="https://www.ncbi.nlm.nih.gov/pubmed/24292970">develop hypoglycaemia</a> soon after birth. If untreated, this could <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4659381/">cause seizures or brain damage</a>.</p>
<p>To treat hypoglycaemia these babies are often supplemented with infant formula since mothers’ milk does not “come in” for a <a href="https://www.ncbi.nlm.nih.gov/pubmed/26113051">couple of days after birth</a>.</p>
<p>While breast milk is <a href="https://www.ncbi.nlm.nih.gov/pubmed/19226355">much better</a> than formula at bringing blood sugar to normal levels, there may not be enough milk in the breast to boost the newborn baby’s blood sugar levels. So babies of women with diabetes are more likely to be admitted to a <a href="https://www.ncbi.nlm.nih.gov/pubmed/15790322">special care nursery</a> for treatment. </p>
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<img alt="" src="https://images.theconversation.com/files/171579/original/file-20170531-25697-1fzw1b8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/171579/original/file-20170531-25697-1fzw1b8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/171579/original/file-20170531-25697-1fzw1b8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/171579/original/file-20170531-25697-1fzw1b8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/171579/original/file-20170531-25697-1fzw1b8.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/171579/original/file-20170531-25697-1fzw1b8.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/171579/original/file-20170531-25697-1fzw1b8.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=503&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">The most common reason for women considering expressing milk while pregnant is if they have diabetes.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/272961047?src=97kC_V7OjcDyj6J-Is7YGQ-1-15&size=medium_jpg">from www.shutterstock.com</a></span>
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<p>But if the mother has a small supply of breast milk ready to feed the baby – a few millilitres in a syringe or spoon – they could avoid this.</p>
<p>If the mother has collected colostrum before birth, the newborn baby may also be less likely to need infant formula, which has a number of <a href="https://www.ncbi.nlm.nih.gov/pubmed/8583288?dopt=Abstract&holding=npg">risks to the immature gut</a>. Giving formula based on cow’s milk to newborns may also increase their <a href="https://www.ncbi.nlm.nih.gov/pubmed/26192405">risk of allergies</a> and <a href="https://academic.oup.com/nutritionreviews/article/70/9/509/1835283/Current-evidence-on-the-associations-of">developing diabetes</a> themselves.</p>
<p>Other women may want to <a href="https://www.breastfeeding.asn.au/bfinfo/antenatal-expression-colostrum">express milk before giving birth</a> because they had a low milk supply with a previous baby or they know their baby has a medical condition that might make it hard to breastfeed well, like a heart condition.</p>
<p>While there can be short-term benefits to newborn babies from being fed colostrum expressed before birth, no one has studied if there are any longer-term benefits.</p>
<p>There also doesn’t seem to be <a href="http://joe.endocrinology-journals.org/content/74/3/509.extract">much difference</a> between the quality of the colostrum expressed before birth and colostrum expressed 24 hours afterwards.</p>
<h2>Risks to mother and baby</h2>
<p>By stimulating their nipples and expressing milk while pregnancy, women could bring on <a href="https://www.ncbi.nlm.nih.gov/pubmed/26444882">regular contractions</a> of the womb and <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3538605/">give birth early</a>. </p>
<p>This is because nipple stimulation leads to an <a href="https://www.ncbi.nlm.nih.gov/pubmed/2618602">increase in the hormone oxytocin</a>, which plays a role in both milk <a href="https://www.breastfeeding.asn.au/bf-info/early-days/let-down-reflex">let-down</a> and contraction of the womb.</p>
<p>For this reason, women who need a caesarean (for instance if their baby is not “head down” or if they have had previous caesareans), have been advised <a href="http://bmjopen.bmj.com/content/4/10/e006571.long">not to express while pregnant</a>.</p>
<p>Another concern is that stimulating the nipple and the increased contractions could reduce blood flow to the womb. So, expressing while pregnant <a href="http://bmjopen.bmj.com/content/4/10/e006571.long">is not recommended</a> when the foetus is not growing well, or has other medical conditions such as macrosomia (excessive weight), or there is too much fluid in the womb.</p>
<h2>Is it right for me?</h2>
<p>Our <a href="http://www.latrobe.edu.au/jlc/research/breastfeeding/dame">study</a> results, published <a href="http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(17)31373-9/abstract">today</a> in The Lancet, found that expressing while pregnant is safe for women with diabetes in low-risk pregnancies in late pregnancy (from around 36 weeks). After studying over 600 women, we found no increase in early births or admissions to neonatal intensive care. However, one in four women couldn’t collect any colostrum.</p>
<p>Before our trial, researchers had only run <a href="http://www.sciencedirect.com/science/article/pii/S0266613812000174">three small studies</a> of expressing colostrum while pregnant, and no randomised trials for women without diabetes.</p>
<p>So, our advice to women with questions about expressing while pregnant is to ask their health care professional about their individual situation. They are best placed to discuss the risks and benefits.</p><img src="https://counter.theconversation.com/content/78399/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Lisa Amir receives funding from National Health and Medical Research Council. She is the Editor-in-Chief of the International Breastfeeding Journal.</span></em></p><p class="fine-print"><em><span>Della Forster receives funding from National Health and Medical Research Council</span></em></p><p class="fine-print"><em><span>Susan Walker is also affiliated with Mercy Perinatal.</span></em></p><p class="fine-print"><em><span>Anita Moorhead does not work for, consult, own shares in or receive funding from any company or organisation that would benefit from this article, and has disclosed no relevant affiliations beyond their academic appointment.</span></em></p>Hospitals sometimes recommend women express milk towards the end of their pregnancies. But it’s not suitable for all.Lisa Amir, Associate Professor in Breastfeeding Research, La Trobe UniversityAnita Moorhead, Trial Co-ordinator, La Trobe UniversityDella Forster, Professor of Midwifery and Maternity Services Research, La Trobe UniversitySusan Walker, Professor of Obstetrics and Gynaecology, The University of MelbourneLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/747942017-03-22T14:02:23Z2017-03-22T14:02:23Z26 years ago the UK signed up to formula milk advertising rules – so why isn’t it law yet?<figure><img src="https://images.theconversation.com/files/162007/original/image-20170322-31219-f4re2l.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Protecting children's health starts with curbing formula adverts.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-bottle-boxes-infant-milk-381680932?src=Uvjq01ckbdCdF9iK97Gd8A-1-3">Kacenki/Shutterstock</a></span></figcaption></figure><p>Like the <a href="https://theconversation.com/mothers-are-made-to-feel-guilty-whether-they-breastfeed-or-formula-feed-their-baby-66101">topic of infant feeding</a> itself, public health bills can be a minefield. For each issue, there can be numerous pros, cons and opinions. And much like the debates that follow them, it is quite often that some go undiscussed by the mainstream media.</p>
<p>Ask any mum or dad and they will tell you that parenting media in the UK is <a href="http://www.telegraph.co.uk/women/mother-tongue/11697178/Breastfeeding-Formula-industry-has-hijacked-breastfeeding-for-profit.html">flooded with</a> potentially <a href="http://www.dailymail.co.uk/health/article-1201307/Formula-milk-ad-banned-misleading-parents-immunity-boosting-claims.html">misleading</a> advertising for <a href="https://hansard.parliament.uk/commons/2016-11-16/debates/552A05C8-5D1C-4BDB-BB2A-03C37A034DD4/FeedingProductsForBabiesAndChildren(AdvertisingAndPromotion)">certain formula products</a>. </p>
<p>Many global health organisations state that babies should be breastfed <a href="http://www.who.int/nutrition/topics/global_strategy_iycf/en/">exclusively for the first six months</a> of their lives. But for some mums that is not possible, either for their own health or other personal reasons. These mothers instead turn to “first infant formula” – for babies up to six months old – to feed their children.</p>
<p>The problem is that though the NHS tells mothers that babies who are fed first infant formula need <a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/types-of-infant-formula.aspx">nothing more than that</a>, there is still a wide range of “follow on” formulas available for babies over six months old. The health service has a clear stance that this <a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/types-of-infant-formula.aspx">variety is unnecessary</a>, saying outright that there is “<a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/Pages/types-of-infant-formula.aspx">no evidence</a>” that formulas marketed for “hungrier babies” make them sleep longer, for example.</p>
<p>So why do manufacturers make these products, and advertise their “health benefits” if children don’t need them? The current UK rules are that though follow-on formula milk can be promoted, manufacturers and sellers are <a href="http://www.legislation.gov.uk/uksi/2007/3521/contents/made">banned from advertising</a> “first infant formula”. <a href="http://www.babymilkaction.org/">Baby Milk Action</a>, the UK member of the <a href="http://www.ibfan.org/">Intentional Baby Food Action Network (IBFAN)</a>, has <a href="http://www.babymilkaction.org/ukrules-pt2a">highlighted</a> that these adverts encourage brand recognition and cross-promote products, including infant formula intended for use by newborns.</p>
<p>The UK government does not proactively monitor formula advertising for breaches, so infant formula companies, who profit when women do not breastfeed, regularly undermine breastfeeding by <a href="http://www.babymilkaction.org/monitoringuk17">breaching the code</a>. Price promotions and prominent displays have been placed at the point of sale, and advertisements and promotions suggest that infant formula <a href="http://www.which.co.uk/reviews/formula-milk/article/choosing-the-right-formula-milk/breastfeeding-vs-formula-milk">is comparable to breast milk</a> in terms of health and development. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=382&fit=crop&dpr=1 600w, https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=382&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=382&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=480&fit=crop&dpr=1 754w, https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=480&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/162008/original/image-20170322-31176-1rdmano.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=480&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px">
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<span class="caption">Supermarket aisles are stocked with formula options.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/toronto-canada-november-22-2014-baby-233666974?src=hu8qAJf1-RvRrOM0ZROsXw-1-6">ValeStock/Shutterstock</a></span>
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<p>There are now moves to change this, however. The <a href="http://services.parliament.uk/bills/2016-17/feedingproductsforbabiesandchildrenadvertisingandpromotion.html">Feeding Products for Babies and Children (Advertising and Promotion) Bill</a> passed through parliament <a href="http://www.bbc.co.uk/news/uk-scotland-scotland-politics-38000569">on its first reading</a> with unanimous support in November 2016 – though as yet it has not attracted the public attention that it should have. </p>
<p>If enacted, the bill would provide important provisions to protect the health of babies and children from corporate advertising, which the World Health Organisation <a href="http://www.who.int/nutrition/topics/global_strategy_iycf/en/">identifies as a priority</a> for improving child health. It would bring into UK law <a href="http://www.who.int/nutrition/publications/code_english.pdf">WHO provisions</a> on the marketing of infant formula which have been in place since 1981. Though the country is signed up to the code, until this bill arrived the government had not <a href="http://apps.who.int/iris/bitstream/10665/206008/1/9789241565325_eng.pdf">fully legislated to implement it</a>.</p>
<p>The WHO code includes a ban on the promotion of formula, including through advertising, gifts directed towards mothers and health professionals, and at the point of sale. It also provides detailed guidance on appropriate packaging, for example restricting nutritional and health claims and images which idealise formula use. </p>
<h2>The follow-on fallacy</h2>
<p>The Formula Marketing Bill has long been needed, and is of vital importance to ensuring the health of both babies and mothers. However, 26 years after the WHO code was signed by the UK, it has taken a <a href="https://hansard.parliament.uk/commons/2016-11-16/debates/552A05C8-5D1C-4BDB-BB2A-03C37A034DD4/FeedingProductsForBabiesAndChildren(AdvertisingAndPromotion)">private members’ bill</a> to put this issue on parliament’s agenda – and even then its second reading has been delayed by a month already.</p>
<p>The provisions of the bill seek to establish a new infant and young child nutrition agency which would ensure that infant formula and packaging was regulated to optimise child health. This includes licensing feeding products suitable for children aged under 36 months, to prevent unnecessary ingredients being added, and to ensure that packaging does not undermine breastfeeding. Those who breach the law by selling unlicensed products could be fined or imprisoned for up to six months.</p>
<p>Other important clauses include one that would allow plain packaging of infant formula, and ban terms that <a href="http://www.babymilkaction.org/monitoringuk17">can confuse parents</a>, such as “follow-on milk”. These steps will help parents understand that the legally required recipe for infant formula results in minimal variation between brands, saving them money, and protecting them from unverifiable claims. Alongside this, the bill also seeks to comprehensively restrict other types of advertising and promotion of feeding products for babies and infants – for example, by restricting formula industry social media, parenting clubs and classes, and helplines.</p>
<p>We need to stop wasting time and make this bill law.</p><img src="https://counter.theconversation.com/content/74794/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Aimee Grant receives funding from the National Institute for Health Research, the Wellcome Trust ISSF Public Health Scheme and the Welsh Crucible Small Grant Scheme. She has also undertaken paid consultancy for Public Health Wales NHS Trust, where she previously held the role of Senior Health Promotion Practitioner. She is affiliated with the Action on Smoking and Health (ASH) Wales Cymru research committee, where she previously held the role of Research and Policy Officer.</span></em></p>Parents need to know the truth about formula milk.Aimee Grant, Research Associate - infant feeding, smoking, stigma, class, identity, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.