tag:theconversation.com,2011:/africa/topics/baby-health-30005/articlesBaby health – The Conversation2022-05-12T13:09:02Ztag:theconversation.com,2011:article/1829292022-05-12T13:09:02Z2022-05-12T13:09:02ZWhat’s causing the US baby formula shortage – and how to make sure it doesn’t happen again<figure><img src="https://images.theconversation.com/files/462578/original/file-20220511-18-x6ls08.jpg?ixlib=rb-1.1.0&rect=53%2C341%2C6000%2C3646&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">No easy formula.</span> <span class="attribution"><a class="source" href="https://www.gettyimages.com/detail/news-photo/grocery-store-shelves-where-baby-formula-is-typically-news-photo/1240603860?adppopup=true">Stefani Reynolds/AFP via Getty Images</a></span></figcaption></figure><p><em>A <a href="https://www.nytimes.com/2022/05/10/us/baby-formula-shortage.html">baby formula shortage</a> has added to the woes of American parents already confronted with the pressures of <a href="https://www.theatlantic.com/culture/archive/2021/03/isolation-becoming-new-parent-during-pandemic/618244/">raising an infant during a pandemic</a> in a country <a href="https://www.forbes.com/sites/marybethferrante/2019/06/21/unicef-study-confirms-the-u-s-ranks-last-for-family-friendly-policies/?sh=176ff24133ba">ranked low for family-friendly policies</a>.</em></p>
<p><em>Media reports have highlighted the plight of mothers, fathers and caregivers across the U.S. who have <a href="https://www.seattletimes.com/seattle-news/baby-formula-shortage-in-washington-has-caregivers-parents/">scrambled to find scarce supplies</a>, or <a href="https://www.wfaa.com/article/news/local/texas/lake-jackson-texas-mom-drives-hour-baby-formula-amid-shortage/287-d1638ecb-4153-415d-ab63-58e342ec764f">driven long distances</a> to buy formula.</em></p>
<p><em>But what is behind the shortage? And how can it be prevented from happening again? The Conversation asked Dr. Steven Abrams, a leading <a href="https://dellmed.utexas.edu/directory/steven-a-abrams">expert on pediatric health</a> at the University of Texas who has advised both the formula industry and government on infant nutrition, these questions along with what advice he could give parents facing problems getting adequate supplies of infant formula.</em> </p>
<h2>1. Why there is a shortage of formula now?</h2>
<p>There are really two factors that have driven the current shortage. First, we have the <a href="https://theconversation.com/4-reasons-americans-are-still-seeing-empty-shelves-and-long-waits-with-christmas-just-around-the-corner-168635">supply chain problem</a>, which has affected all manner of goods since the onset of the pandemic. It eased off a little, but then at the beginning of 2022 it <a href="https://www.wired.com/story/supply-chain-crisis-data/">became worse</a>.</p>
<p>Then in February a <a href="https://wwmt.com/news/local/baby-formula-shortage-crisis-intensifies-as-sturgis-plant-remains-shut-down">major baby formula manufacturing plant in U.S. went down</a>. The FDA <a href="https://www.nbcboston.com/news/national-international/fda-to-allow-closed-abbott-plant-to-release-baby-formula-supply-amid-shortage/2717440/">shut down Abbott Nutrition’s factory</a> in Michigan. The closure came after Abbott’s nationwide <a href="https://www.similacrecall.com/us/en/home.html">recall of multiple brands of formula</a>, including routine Similac cow milk-based formulas such as Similac Advance and several specialty formulas for allergic babies, including Similac Alimentum and and Similac EleCare.</p>
<p>Closing the factory had to be done amid an <a href="https://www.fda.gov/food/outbreaks-foodborne-illness/fda-investigation-cronobacter-infections-powdered-infant-formula-february-2022">investigation into bacterial infections</a> in connection to powdered formula produced at the plant, and the deaths of at least two babies. The problem is there just isn’t much redundancy in U.S. infant formula production. In other words, there aren’t enough other factories to pick up the slack when one goes down. The Michigan plant is the largest producer in the country, so when it goes down, it put added strain on the entire U.S. formula distribution system, especially for certain formulas for babies with high-risk allergic diseases and metabolic disorders.</p>
<p>Over the last couple of weeks the shortage has gotten worse. I can’t say for sure why this has happened. But I suspect there has been some hoarding going on as parents get anxious. Stores can limit the amount of formula that people can buy, but that doesn’t stop people going online to buy more.</p>
<p>On top of that, the shortage has gained wide publicity in newspapers, on TV and in political speeches. All that publicity feeds into public sense that the system is failing, prompting more panic buying and hoarding.</p>
<h2>2. Who is the shortage affecting?</h2>
<p>A majority of parents will feed babies with formula at some point to meet their nutritional needs, especially older infants. At birth and in days immediately after, around 80% of babies receive <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">all their nutrition through breast milk</a>. But by the age of 6 months, the <a href="https://www.cdc.gov/breastfeeding/data/reportcard.htm">majority of babies get at least some formula</a>. The proportion of year-old babies receiving formula is even higher. This is largely the result of social dynamics and pressures - mothers going back to work after giving birth, but not receiving sufficient support to produce and store sufficient amounts of breast milk.</p>
<p>But the shortage will affect some parents more than others. Not surprisingly, the most affected parents are those on the lowest income. The federal food program for poorer women, infants and children, <a href="https://www.fns.usda.gov/wic">called WIC</a>, provides formula for a majority of babies in low-income families. But costs have gone up and formula has become scarcer.</p>
<p>I’m hearing of some families driving two hours to find stores selling formula. Obviously that will be harder to do for poorer families as there are costs involved. Likewise, more affluent parents may be able to buy more expensive, so-called elite brand formulas.</p>
<p>The other thing to note is that the shortage is affecting both regular infant formula, and <a href="https://www.fda.gov/news-events/press-announcements/fda-takes-important-steps-improve-supply-infant-and-specialty-formula-products">specialized versions</a>. Regular or standard formula is the type most families are familiar with, and around 95% of formula-fed babies get the standard type. Specialized formula is for babies with unusual requirements, due to allergies, damaged intestines or special nutritional needs. Before the Michigan factory closed, it made most of the specialized infant formula used in the U.S. So it is an absolute crisis for families needing that type of formula.</p>
<h2>3. What are the potential consequences of the shortage?</h2>
<p>In the first six months, babies should <a href="https://www.cdc.gov/breastfeeding/faq/index.htm">only have breast milk or formula</a> – anything else fed to them will be nutritionally incomplete. So there is a risk that a shortage will mean that babies will not be getting the nutrition they need to develop. That could lead to a range of health problems affecting their physical growth and brain development.</p>
<p>Then there are concerns that parents may be using unsafe alternatives, like watering down their baby’s formula. People have been known to try and make their own by mixing powdered milk or vegan milk with vitamins. Not only are these alternatives <a href="https://www.cdc.gov/mmwr/volumes/70/wr/mm7033a4.htm">not nutritionally complete</a>, they may not be entirely sterile.</p>
<p>After the age of six months, things get a little better once the infant is able to start eating solid food. But even then, formula or breast milk remains the primary source of nutrition. So there may still be a risk of nutritional deficiencies, such as iron deficiencies.</p>
<h2>4. Are there any viable alternatives?</h2>
<p>Over the age of six months of age, for only reasonably short periods of time, <a href="https://healthychildren.org/English/tips-tools/ask-the-pediatrician/Pages/Are-there-shortages-of-infant-formula-due-to-COVID-19.aspx#.Ynr6sYw9zEQ.twitter">parents can feed infants whole cow milk</a> and look into iron supplements.</p>
<p>It isn’t ideal, and only applies for older babies. For those under six months old, cow milk is a real problem. It doesn’t have the right protein blend for babies and has next to no iron – risking anemia in very young babies. Cow milk also has a misbalance of minerals, especially for younger babies.</p>
<h2>5. So what guidance is there for low-income parents?</h2>
<p>It is challenging and I can’t provide a magic answer. But food banks and the WIC program have been a crucial lifeline. The WIC program in particular has proved itself to be very flexible during this shortage. When Abbott had to recall products and then couldn’t provide enough non-recalled formulas in states in which they were the WIC provider, WIC was able to change providers and reprogram EBT cards to allow low-income parents to buy different brands.</p>
<h2>6. What can be done to prevent this situation happening again in the U.S.?</h2>
<p>First we need to help families regain confidence in the formula production and supply system. This will prevent problems such as hoarding or making home brew formulas.</p>
<p>Then we need to look at how to make sure one plant going down doesn’t affect the whole system. The federal government can’t stockpile formula in the same way it might stockpile oil, as formula has a shelf life. But diversifying infant formula production is a possibility. This would involve making sure multiple factories and companies are making the formulas that this country needs. This doesn’t necessarily mean increased costs – competition could potentially drive down prices.</p>
<p>I believe America also needs to look at the country’s breast feeding support system. Don’t get me wrong, some parents will always need formula. But those who want to breast feed need everything possible done to support them. That includes better family leave policies, and help for low-income mothers who want to pump and store milk while they work.</p><img src="https://counter.theconversation.com/content/182929/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Steven A. Abrams received funding from Perrigo Nutrition for research related to food insecurity in Austin during the COVID-19 pandemic and has given paid presentations on nutritional physiology to Abbott Nutrition's educational unit, ANHI.</span></em></p>An infant nutrition expert explains what is behind the current formula shortage and what can be done to support hard-pressed parents.Steven A. Abrams, Professor of Pediatrics, The University of Texas at AustinLicensed 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/1176062019-07-04T11:00:04Z2019-07-04T11:00:04ZSome baby care books are giving advice that goes against safe infant care guidelines<figure><img src="https://images.theconversation.com/files/282654/original/file-20190704-51312-ud8rr.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Parenting and baby care books may be unintentionally putting babies in danger.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/close-young-mom-reading-fairy-tales-716928106?src=JP9IIXRdI2lvHzDfJX2J6A-1-3&studio=1">Cookie Studio/Shutterstock</a></span></figcaption></figure><p>Becoming a new parent can be one of the most stressful things you ever do. It’s normal to feel blindsided between what you thought it would be like, and the reality. But it can lead to all sorts of emotions from <a href="http://oro.open.ac.uk/22943/">panic and anxiety</a>, through to <a href="https://www.theguardian.com/books/2001/sep/09/biography.features">grief</a> for your former existence, and even (often hidden) <a href="https://www.journals.uchicago.edu/doi/abs/10.1086/678145?mobileUi=0&journalCode=signs">regret at what you’ve got yourself into</a>. </p>
<p>This isn’t helped by how <a href="https://www.ncbi.nlm.nih.gov/pubmed/28795604">isolated many new parents now are</a>. Just a few decades ago, family, friendships and networks were far more localised, but now, many new mothers have babies many miles away from family, and may not know a single person close by who is going through the same thing. These connections are <a href="https://www.huffingtonpost.co.uk/entry/mums-feel-lonely-after-birth_uk_58bec088e4b09ab537d6bdf9">important socially</a>, but also in terms of <a href="https://www.rcog.org.uk/globalassets/documents/patients/information/maternalmental-healthwomens-voices.pdf">learning from others and sharing information</a>. </p>
<p>Without the advice of family and friends to hand, many new parents turn to baby books for advice. Parenting guides that suggest certain styles of caring have been around for many years. But recently there has been an explosion of these books, fuelled by the <a href="https://www.theguardian.com/news/2018/jan/16/baby-advice-books-industry-attachment-parenting">willing and waiting market of confused and isolated new parents</a>. Although a whole range of parenting books are available, books that promote getting babies into parent-led sleep and feeding routines, along with the idea of them being settled and more “independent” in between, have become particularly popular. </p>
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<p>We have previously shown that the more of this type of book that new mothers read, the higher their symptoms of depression and parenting stress, and <a href="https://theconversation.com/are-baby-advice-books-making-mothers-depressed-and-anxious-83992">lower their confidence in their own parenting abilities</a>. Although it could be that mothers who are feeling stressed and depressed choose to try and follow the advice in these books, for this study we also asked mothers directly how the books made them feel. A minority (15–20%) did like them and felt more confident, but far more said that they felt more stressed because they didn’t work for them. Some mothers reported that they were even left feeling “like a failure”.</p>
<p>More recently, we have been exploring <a href="https://onlinelibrary.wiley.com/doi/10.1111/mcn.12858">how these books are actually used</a> and the impact they have on baby care. Speaking to 354 mothers with a baby aged 0–12 months old, we found that several pieces of advice in these books are associated with a number of behaviours that go against the UK government’s recommendations for safe infant care, and research findings too. </p>
<p>For example, when mothers read these books, we found that 39% of babies were placed in their own room to sleep, <a href="https://www.lullabytrust.org.uk/safer-sleep-advice/">going against guidance</a> that the safest place is to share a room with their mother. Although thankfully rare, babies who sleep in a different room are <a href="https://www.sciencedirect.com/science/article/pii/S0140673603153238">at a higher risk</a> of Sudden Infant Death Syndrome (SIDS). This is <a href="https://www.sciencedirect.com/science/article/abs/pii/S0277953612002924">possibly because</a> parents are unaware of the temperature in that room, or that the baby has become unwell. While sleeping close to their baby can help parents regulate <a href="https://www.sciencedirect.com/science/article/abs/pii/S1526054205000230">the child’s breathing, temperature and heart rate</a>. </p>
<p>We also found that just 28% of mothers responded immediately if their baby cried at night, with 25.5% leaving a baby to cry themselves to sleep in the evening. Although occasionally leaving a baby to cry briefly is not going to cause harm, consistently leaving a baby to cry <a href="https://www.sciencedirect.com/science/article/abs/pii/S1087079210001322">can increase the level of stress hormones</a> circulating in a baby’s body, which could potentially programme their system to be overstimulated. </p>
<p>Breastfeeding rates were also lower, both in terms of starting and continuing breastfeeding. Breastfeeding <a href="https://www.sciencedirect.com/science/article/pii/S0140673615010247">protects maternal and infant health</a> and stopping breastfeeding before mothers are ready is associated with an <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/jan.12832">increased risk of depression</a>. The guidance in these books sets women up to not be able to breastfeed.</p>
<p>Breastfeeding works best when <a href="https://kellymom.com/ages/newborn/bf-basics/importance-responsive-feeding/">babies are kept close and fed responsively</a> whenever they want to. However, we found that mothers following the book guidance were more likely to try to feed to a mother-led routine, and as noted their babies were sleeping separately at night. </p>
<p>Of course, all this this might just be correlation – mothers who want to parent in this way may be more drawn to the books in the first place, rather than the books affecting their decisions. But we also asked mothers whether the books directly affected their behaviour in any way. Our findings showed that reading the books persuaded mothers to use a sleep and feeding routine (45%), sleep separately to their baby (23%), delay how quickly they responded to their baby’s cry (24%) and cuddle their baby less (15%).</p>
<p>Some advice books can promise a utopia to new parents desperate for a solution to a baby with frequent needs but such strict routines and separation behaviour often do not work and can place babies at <a href="https://www.lullabytrust.org.uk/safer-sleep-advice/">increased risk of SIDS</a>. We also know the importance of <a href="https://www.sciencedirect.com/science/article/pii/S0163638308001215">loving, responsive parenting interactions</a> in the early years for longer term social, emotional and health outcomes – which some books appear to promote the antithesis of. </p>
<p>Although some parents may make an informed decision to follow such advice, for many this guidance doesn’t work, leaving mothers feeling even more stressed. Rather than selling new parents a promise that they can “control” their baby, we need to focus on helping fewer new families <a href="https://www.huffingtonpost.co.uk/amy-brown/mothering-the-mother-the-_b_18317834.html">feel under such stress and anxiety</a> in the first place.</p><img src="https://counter.theconversation.com/content/117606/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><p class="fine-print"><em><span>Victoria Harries 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>When there is no “village” to help raise a child, parents often turn to baby books for guidance — but they don’t always hold the best advice.Amy Brown, Professor of Child Public Health, Swansea UniversityVictoria Harries, PhD Researcher in Biological Anthropology, Yale 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">
<figcaption>
<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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</figure>
<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/1094772019-02-13T11:40:19Z2019-02-13T11:40:19ZBabies with healthier diets are more active and sleep better - new findings<figure><img src="https://images.theconversation.com/files/257988/original/file-20190208-174894-bci5wx.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Learning to climb.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-baby-bad-room-213820711?src=1GdJUWXWdazRjY5dIRS5MQ-1-18">Zsolt Biczo/Shutterstock</a></span></figcaption></figure><p>Physical activity is important at all stages of life. It prevents obesity, improves well-being and reduces the risk of many chronic conditions, such as heart disease, arthritis and diabetes. Evidence shows that being active at a young age tracks into adulthood, and that physical activity behaviours adopted when young are likely to <a href="https://www.ncbi.nlm.nih.gov/pubmed/25074589">carry through life</a>. And now our <a href="https://onlinelibrary.wiley.com/doi/full/10.1111/ijpo.12512">study</a> of babies’ activity levels has shown how different factors, including sleep and diet, link together to improve baby health from the day they are born.</p>
<p>For our research project, we tracked the physical activity of 141 12-month-old infants (77 boys and 64 girls) using accelerometers, which they wore on their ankles for a week. We looked at how active the children were during the day and at night. Then we compared the different characteristics of the most and least active children. This involved using the accelerometer data, information that we collected from measuring the infants at home – things like weight and diet diaries were included in this – and medical records from the mothers’ pregnancy, as well as the the infants’ own birth and GP records. </p>
<p>Overall, the research showed that getting the right start means that other healthy behaviours fall in to place more easily. Across the board we found that active babies are healthy, are of good weight and are born full term. In addition, the larger babies who had been born full term were more active. </p>
<p>We found that diet is an important factor when it comes to being an active child. The children who were breastfed (breastfeeding has been associated with <a href="https://www.ncbi.nlm.nih.gov/pubmed/22237059">higher fitness levels in childhood</a>) and those who ate more vegetables were more active. Infants who were less active had a more adult style diet, with juice rather than milk and adult crisps. </p>
<p>As well as improving their activity levels, healthy eating behaviours, such as having a higher vegetable intake, adopted at this age are <a href="https://www.bmj.com/content/348/bmj.g3256">likely to be carried through life</a> too. This, when combined with another finding that infants born prematurely, and who do not put on weight well after birth, move less, also suggests that preterm and low birthweight infants should be breastfed for longer, and that a healthy diet of milk and vegetables is even more important for them.</p>
<p>We also found that active babies sleep better than less active babies. Those infants who were active during the day woke up less at night, so they tended to sleep better – although they did move about in their sleep more. This suggests that encouraging activity could have a knock-on effect on improving other behaviours like good sleep practices. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/257989/original/file-20190208-174873-resqgg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/257989/original/file-20190208-174873-resqgg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/257989/original/file-20190208-174873-resqgg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/257989/original/file-20190208-174873-resqgg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/257989/original/file-20190208-174873-resqgg.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/257989/original/file-20190208-174873-resqgg.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/257989/original/file-20190208-174873-resqgg.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&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">Nap time.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/one-year-old-baby-girl-sleeping-664478614?src=y_W4EoDSKqKRJXhvCYGwpg-1-5">Stephan Schlachter/Shutterstock</a></span>
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</figure>
<h2>Boys are more active</h2>
<p>The data showed that boys are more active than girls in general, even at 12 months old. Although we are not sure if this is because boys are inherently more active than girls, or if parental behaviours encourage boys to be active, and that parents accept boisterous physical behaviours from boys but not from girls. </p>
<p>Given the link between early movement and physical activity later in life, this finding raises questions about how we address girls’ physical activity. Are girls inherently less active or are they taught to be less physical? Is a boy climbing the curtains just acceptable behaviour while we worry that a girl climbing will get hurt? Is it nature or nurture that makes girls less active than boys? </p>
<p>Though we can’t answer these questions solely based on this study, another recent project of ours has <a href="https://bmcpublichealth.biomedcentral.com/articles/10.1186/s12889-018-5274-3">highlighted the frustrations</a> girls feel towards activity through to their teenage years. Girls report there are many activities for boys but few for girls. But if girls are inherently different from boys in their activity rates, perhaps we should be tailoring activity for girls rather than assuming the want to do the same as boys. The finding from our study of infants gives more weight to the argument that we need to rethink our gendered perceptions of activity. </p>
<p>Risks for poor health cluster together in this study, but by tackling one, it could create a ripple effect of change. Improving infant diet means that they will be more active which has a knock-on effect for their sleep patterns too. And ultimately it can improve the infant’s physical fitness throughout life. Helping families with poor health behaviours from pregnancy could really improve overall health for the future infant.</p><img src="https://counter.theconversation.com/content/109477/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Sinead Brophy works in Swansea University and through the university receives funding from Heath and Care Research Wales, MRC and ESRC</span></em></p><p class="fine-print"><em><span>Michaela James receives funding from the National Centre for Population Health and Wellbeing Research. </span></em></p><p class="fine-print"><em><span>Shang-Ming Zhou works with Swansea University. He receives funding from MRC, Health and Care Research Wales, China Social Science Foundation.</span></em></p>Encouraging your baby to be active can improve their health in other areas too.Sinead Brophy, Professor in Public Health Data Science, Swansea UniversityMichaela James, Research Assistant in Childhood Physical Activity, Swansea UniversityShang-Ming Zhou, Senior Lecturer in Health Data, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/1084662018-12-14T12:31:49Z2018-12-14T12:31:49ZWhy vegan diets for babies come with significant risks<figure><img src="https://images.theconversation.com/files/250640/original/file-20181214-185252-1qh551t.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/feeding-adorable-baby-child-eating-spoon-382796395?src=rrXOFS-8ON9Z09hG8fSb_w-1-50">Natalia Deriabina/Shutterstock</a></span></figcaption></figure><p>There are now more than <a href="https://www.bbc.co.uk/news/business-44488051">1m vegetarians and 500,000 vegans</a> in the UK – and numbers are thought to be growing. While these people, identified through research commissioned by the Vegan Society, are over 15 years of age, the growing numbers make it likely an increasing number of infants are also being brought up on vegetarian or vegan diets.</p>
<p>But making sure babies get the right amount and balance of nutrients can be a tricky job even without restrictions on what they can eat. Even in developed countries, a large proportion of children don’t get enough vitamins and minerals, and there is <a href="https://theconversation.com/vegan-diets-are-adding-to-malnutrition-in-wealthy-countries-107555">some evidence</a> that vegan diets might be adding to this. So how hard is it for vegetarian or vegan parents to get this right while passing on their food preferences?</p>
<p>Babies need a lot of nutrients. They may triple their birth weight in the <a href="https://www.rcpch.ac.uk/resources/growth-charts">first 12 months</a>, indicating just how much skin, bone, blood and organ tissue they need to lay down. They also have particular needs when it comes to the type and balance of nutrients they need. Adult <a href="https://www.nhs.uk/live-well/eat-well/">healthy eating recommendations</a>, encouraging people to eat less fat and more fibre, are totally inappropriate for children under two.</p>
<p>For the first six months, babies can get all the nutrients they need from breast milk or a reputable infant formula, with the World Health Organisation recommending they be exclusively <a href="https://www.who.int/mediacentre/news/statements/2011/breastfeeding_20110115/en/">breastfed where possible</a>. But after this period, babies need to be started on high-quality <a href="https://www.bda.uk.com/foodfacts/complementary_feeding_weaning">complementary foods</a> alongside breast milk or formula for at least the first year of life.</p>
<p>Their diet should comprise good sources of protein and fat, mixed with vegetables, fruits and cereals – although not too much fibre because it can be too filling without providing enough nutrients. They should have as little highly processed food as possible and no added salt. Sugar can be useful to help meet energy needs but should come as a component of foods that have lots of other nutrients. The more variety of foods a baby eats, the less likely they are to be lacking any nutrients.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/250647/original/file-20181214-185246-f9kfe0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/250647/original/file-20181214-185246-f9kfe0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=520&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250647/original/file-20181214-185246-f9kfe0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=520&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250647/original/file-20181214-185246-f9kfe0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=520&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250647/original/file-20181214-185246-f9kfe0.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=653&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250647/original/file-20181214-185246-f9kfe0.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=653&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250647/original/file-20181214-185246-f9kfe0.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=653&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">Meals need to be carefully planned.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-chef-healthy-food-vegetables-pan-641696383?src=rrXOFS-8ON9Z09hG8fSb_w-1-37">Oksana Kuzmina/Shutterstock</a></span>
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<p>It’s a common myth that it’s hard for vegans and vegetarians to get enough protein. <a href="https://onlinelibrary.wiley.com/doi/abs/10.1111/1747-0080.12001">Approximately half</a> of the protein that people in developed countries eat comes from plants. It’s true that plants (except seeds) are predominantly made up of carbohydrates and (except soya) contain lower amounts of the essential amino acids that make up proteins. Whereas animal products (and soya) contain good amounts of these amino acids in a small portion of food.</p>
<p>But all this just means a plant-based diet should contain a mix of protein sources. For example, meals of baked beans on toast, peas and rice, and pasta and lentil “bolognase” would provide the variety babies need.</p>
<h2>Vitamins and minerals</h2>
<p>What’s more of an issue with a plant-based diet is getting enough of certain vitamins and minerals, such as iron, calcium, iodine, zinc and vitamins B12 and D. In plants, these minerals are not only restricted to certain sources but are also harder for the body to absorb because they can bind to the fibre in plants.</p>
<p>But because these vitamins and minerals are found in dairy and eggs, a varied vegetarian diet that includes these foods is unlikely to cause concerns, providing the baby has a good appetite. </p>
<p>Getting enough iron is a particular concern for babies once they start eating solid foods because they need <a href="https://academic.oup.com/nutritionreviews/article-abstract/50/3/90/1939999?redirectedFrom=PDF">proportionately more</a> than older children and adults. Anaemia from a lack of iron is the most common nutrient deficiency around the world, and under-fives are <a href="https://www.who.int/nutrition/publications/micronutrients/global_prevalence_anaemia_2011/en/">most vulnerable</a> to it. But babies can get iron from eggs, pulses such as lentils, nut butters (providing they aren’t allergic), dark green vegetables such as broccoli, fortified cereals, fortified white flour and breast or formula milk.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/250649/original/file-20181214-185258-14srv5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/250649/original/file-20181214-185258-14srv5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/250649/original/file-20181214-185258-14srv5a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/250649/original/file-20181214-185258-14srv5a.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/250649/original/file-20181214-185258-14srv5a.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/250649/original/file-20181214-185258-14srv5a.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/250649/original/file-20181214-185258-14srv5a.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">Babies need more than just vegetables.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-rabbit-hat-eating-fresh-carrot-317499134?src=rrXOFS-8ON9Z09hG8fSb_w-1-2">LeManna/Shutterstock</a></span>
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</figure>
<p>However, things are more difficult for vegans. Even a varied vegan diet has the potential to cause a range of problems for babies’ growth and development. Not eating dairy or eggs removes an easy way to supply those vital vitamins and minerals. A vegan diet is also lower in fats (an important energy source for a small growing body) and may be lower in natural sugars because of the lack of milk, a natural source of the sugar lactose.</p>
<p>Without eating any animal products, the only reliable sources of vitamin B12 are <a href="https://www.bda.uk.com/foodfacts/plant-based_diet">fortified foods or supplements</a>, and not getting enough of the vitamin can lead to <a href="https://www.ncbi.nlm.nih.gov/pubmed/28660890">nerve damage</a>. Iodine is also difficult to come by, but is vital for <a href="https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3074887/">mental development</a>. You can buy iodised salt but this wouldn’t be suitable for babies, and nor would iodine supplements because of the risk of giving them too much. One solution is to eat seaweed, which can be very versatile, although it can take some time to learn how to use it in the kitchen. Some plant milk alternatives are fortified with iodine, but not all of them.</p>
<h2>A plant-only diet is less than ideal</h2>
<p>Children are surprisingly resilient. They survive in less than ideal circumstances. But what we really want is to encourage optimal growth and development based on the evidence. Relying on only plant-based foods to provide all a baby’s needs is not out of the question, but is less than ideal. </p>
<p>We don’t yet have enough evidence to say how current vegan practices affect babies’ health at a population level. But it’s not hard to find examples of vegan diets <a href="https://metro.co.uk/2017/05/11/vegan-diets-could-be-damaging-childrens-health-nutritionists-warn-6630965">being blamed</a> for a variety of child health problems. Research on children in the Netherlands being fed a particularly strict plant-based macrobiotic diet showed they suffered <a href="https://www.researchgate.net/publication/15027383_Macrobiotic_nutrition_and_child_health_results_of_a_population-based_mixed-longitudinal_cohort_study_in_The_Netherlands">nutrient deficiencies and retarded growth</a>, mainly between the ages of six and 18 months. There have even been incidents of vegan parents accused of child abuse related to <a href="http://europepmc.org/articles/PMC2528709">their children’s poor growth</a>.</p>
<p>However, if parents have a sensible attitude and are well-established vegans, there is no reason why a baby cannot largely follow a varied, mainly vegan diet. This would ideally have limited amounts of bulky wholegrains and some occasional egg and milk to complement their plant-based foods.</p><img src="https://counter.theconversation.com/content/108466/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors 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>Vegan diets can come with significant risks for babies if not planned and supplemented very carefully.Shirley Hinde, Senior Lecturer in Nutrition, Cardiff Metropolitan UniversityRuth Fairchild, Senior Lecturer in Nutrition, Cardiff Metropolitan 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">
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<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>
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<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/887692017-12-07T05:41:39Z2017-12-07T05:41:39ZWhat is meningococcal disease and what are the options for vaccination?<figure><img src="https://images.theconversation.com/files/198090/original/file-20171207-31539-fgs9bf.jpg?ixlib=rb-1.1.0&rect=5%2C142%2C992%2C523&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Children aged under two are at increased risk of meningococcal disease.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/cute-little-boy-stting-on-mother-767951725?src=0popTvu1ZqoPELcl7VVUCQ-1-7">Shutterstock</a></span></figcaption></figure><p>As a medical researcher and parent of two teenagers there is one bug, <em>Neisseria meningitidis</em>, that really scares me. This is mainly because of the speed and severity of the infection it causes, called <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">meningococcal disease</a>, and its predilection for infecting healthy adolescents and younger children. </p>
<p>Meningococcal is a rare but very serious infection that <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">can lead to</a> blood poisoning (septicaemia) and/or brain infection (meningitis). </p>
<p>The initial symptoms can be vague and non-specific. This includes the sudden onset of fever and a rash. The rash can be either red-purple spots or bruises – detected by the classic <a href="http://www.meningococcal.org/the_rash.html">pushing-a-glass-on-the-skin test</a> to see if the rash goes away (and is therefore less likely to be meningococcal) – or a flat or raised non-specific rash. </p>
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<em>
<strong>
Read more:
<a href="https://theconversation.com/explainer-whats-meningococcal-meningitis-and-what-are-the-signs-64170">Explainer: what's meningococcal meningitis and what are the signs?</a>
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<p>Other symptoms can be mistaken for disease like the flu and include headache, neck stiffness, reduced consciousness, muscle aches, joint pain, nausea and vomiting. If you are at all worried see your GP.</p>
<figure class="align-center zoomable">
<a href="https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=45&auto=format&w=1000&fit=clip"><img alt="" src="https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=399&fit=crop&dpr=1 600w, https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=399&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=399&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=502&fit=crop&dpr=1 754w, https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=502&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/198067/original/file-20171207-31532-t9o1bt.png?ixlib=rb-1.1.0&q=15&auto=format&w=754&h=502&fit=crop&dpr=3 2262w" sizes="(min-width: 1466px) 754px, (max-width: 599px) 100vw, (min-width: 600px) 600px, 237px"></a>
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<span class="caption">Symptoms of meningoccal disease can be vague and non-specific, or mistaken for other illnesses.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/291045173?src=X8ALwvwlKUCxgYFHvEroRQ-1-3&size=vector_eps">Shutterstock</a></span>
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<p>Once infected the <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">death rate</a> is around 5–10%. About 10–30% of children and adolescents who survive the disease <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">can develop permanent complications</a>, such as limb deformity, skin scarring, deafness and neurological deficits. </p>
<p>Early diagnosis and treatment with antibiotics can improve the patient’s outcomes but the disease can largely be prevented by vaccination.</p>
<h2>How common is meningococcal disease?</h2>
<p>Using differences in the surface “sugars” (polysaccharides) of the <em>Neisseria meningitidis</em> organism’s outer membrane capsule, we are able to classify the bacteria into serogroups (types), and each serogroup is given a letter of the alphabet, for example, A, B, C and so on. There are 13 different serogroups. </p>
<p>Globally, most meningococcal disease is caused by serogroups A, B, C, W and Y. These were chosen as the targets for vaccines. </p>
<p>The bug poses the greatest risk of infection in those people with immune system weaknesses. But healthy people in our community who are smokers, live in crowded living conditions, engage in intimate kissing with multiple partners (hence adolescents and young adults), and those with a recent or current viral respiratory infection are also targets.</p>
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<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/health-check-which-vaccinations-should-i-get-as-an-adult-81400">Health Check: which vaccinations should I get as an adult?</a>
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</em>
</p>
<hr>
<p>The burden of meningococcal disease fluctuates naturally over time. The rate declined from 2002 to 2013, but has been on the increase since 2014. </p>
<p>Serogroup C disease has become very rare (<a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">accounting for only 1.2% of cases</a> in 2016) since the introduction of a free vaccine in 2003. </p>
<p>Serogroup B disease <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">has been dominant until recently</a>, but has been naturally declining in most states and territories, even without widespread vaccination against this serogroup. </p>
<p>Serogroup W disease has increased since 2013. This is now the main cause of meningococcal disease in Australia, <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">accounting for 44.7% of cases</a> in 2016. </p>
<p>Children aged under two years have the highest rates of meningococcal W and Y disease, followed by older adolescents. </p>
<h2>Vaccination options</h2>
<p>No single vaccine offers protection against all serogroups that cause meningococcal disease, but there are safe and effective vaccines that can protect against five serogroups (A,B,C,W,Y). The vaccines cover different serogroups and it does get confusing so here are the basics.</p>
<p>There are three types of meningococcal vaccines registered in Australia, which cover the following serogroups: </p>
<ul>
<li>Meningococcal C (MenC)</li>
<li>Meningococcal B (MenB) </li>
<li>Meningococcal A, C, W, Y (MenACWY). </li>
</ul>
<p>All these vaccines include “killed” parts of the bacteria in order to stimulate an immune response. This means if someone comes into contact with the bacteria, for example via kissing, then they already have immunity and don’t get the nasty disease. It’s not possible for the vaccine to cause meningococcal disease.</p>
<h2>Menigococcal C vaccine</h2>
<p>The MenC vaccine is given for free to all Australian infants at 12 months of age under our <a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/national-immunisation-program-schedule">National Immunisation Program</a>. It’s given as a combination vaccine with the trade name Menitorix® and protects against meningococcal C and another bacteria called <a href="http://www.immunise.health.gov.au/internet/immunise/publishing.nsf/Content/immunise-hib"><em>Haemophilus influenzae</em> type b</a>.</p>
<p>The MenC vaccine has reduced the rate of meningoccocal C <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-fact-sheet.pdf">by 96%</a> since its introduction. </p>
<p>Although serogroup C disease is now not common, it’s not completely eradicated so get your child vaccinated at 12 months. </p>
<h2>Menigococcal B vaccine</h2>
<p>The <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-FAQ.pdf">MenB vaccine</a>, which has the trade name Bexsero®, is not on the national immunisation program and will cost you around A$95-150 per dose, depending on what your pharmacist or GP charges. It might be worth calling a few different pharmacies to check their price. </p>
<p>It’s strongly recommended for people who either have immune system weaknesses, work in environments where there’s a high chance of exposure (such as health care or laboratory workers), or live in close proximity to others (such as military recruits and those in boarding houses or residential accommodation). </p>
<p>Children, especially those aged under two, and adolescents aged 15 to 19 years are also at increased risk. </p>
<hr>
<p>
<em>
<strong>
Read more:
<a href="https://theconversation.com/more-reason-to-use-meningococcal-b-vaccine-it-could-also-cut-the-clap-80739">More reason to use Meningococcal B vaccine – it could also cut the Clap</a>
</strong>
</em>
</p>
<hr>
<p>The younger you start the MenB vaccine the more doses you need. If starting between six weeks to five months old, the child needs three doses* plus a booster dose at 12 months old; if over six months old, then two doses as a minimum and a booster dose depending on the age at which you started. Adolescents need two doses.</p>
<p>Infants should be given a medicine like paracetamol at the time of vaccination to reduce the chance of the vaccine causing a fever. </p>
<h2>Menigococcal ACWY vaccine</h2>
<p><a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-FAQ.pdf">Three vaccines</a> are available in Australia, which have the trade names of Menveo®, Menactra® and Nimenrix®. </p>
<p>Like the MenB vaccine, the number of doses needed depends on the age you start vaccinating (babies under six months need four doses; 7- to 11-month olds need two doses and 12-23 month olds need one or two doses (either one dose of Nimenrix® or two doses of Menveo®); and if started over two years, the child only needs one dose). Menveo® is the only vaccine registered for use in babies under one. </p>
<p>In all states except South Australia (where a MenB program is currently underway), MenACWY will be given to adolescents in years 11 and 12 via high school-based programs. This is in response to the recent emergence of MenW disease around parts of the country. </p>
<p>Parents wanting to vaccinate younger children will have to pay around A$55-90 per dose, depending on the brand you choose and what your pharmacist and GP charges. (Again, different pharmacies may have different prices).</p>
<h2>What should you get?</h2>
<p>The inevitable question parents ask is, “should I pay to get my child vaccinated against MenB and MenACWY?” </p>
<p>In an ideal world, the answer would be “give both vaccines”. If you or your child has immune system weaknesses then definitely <a href="http://www.ncirs.edu.au/assets/provider_resources/fact-sheets/meningococcal-vaccines-FAQ.pdf">go for both optional vaccines</a>.</p>
<p>Another way to answer would be to state what we know. We know both vaccines are effective against severe disease. We know they can be given on the same day safely. But we also know no vaccine is 100% effective, and a person may still become infected even after immunisation. </p>
<p>If you are very worried your child may have meningococcal disease, whether vaccinated or not, seek medical advice immediately.</p>
<p><em>Editor’s note: since this article was first published, the meningococcal ACWY (Nimenrix®) vaccine has been added to the <a href="https://beta.health.gov.au/health-topics/immunisation/immunisation-throughout-life/national-immunisation-program-schedule">National Immunisation Program Schedule</a> for children at 12 months. The vaccine will also be available for all adolescents aged 14-19 from April 2019.</em></p>
<p><em>*Correction: this article originally said adolescents needed one dose of the MenB vaccine, rather than two, and did not mention boosters.</em></p><img src="https://counter.theconversation.com/content/88769/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Nicholas Wood receives funding from the NHMRC. The CHildren's Hospital at Westmead has had GSK support for investigator-initiated studies in the past. </span></em></p>Meningococcal is a rare but very serious infection that can lead to blood poisoning and brain infection. But no single vaccine protects against all the strains.Nicholas Wood, Associate Professor, Discipline of Childhood and Adolescent Health, University of SydneyLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/839922017-09-15T13:36:28Z2017-09-15T13:36:28ZAre baby advice books making mothers depressed and anxious?<figure><img src="https://images.theconversation.com/files/186208/original/file-20170915-8102-63ggqp.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">Seeking advice.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/pregnant-woman-belly-reading-book-expecting-658482742?src=Z9oGtEYKntM_gd4E5zM0fw-1-2">A and I Kruk/Shutterstock</a></span></figcaption></figure><p>Becoming a new parent certainly ranks up there in the exhaustion and anxiety stakes. Countless parents find themselves questioning at 3am whether their baby is feeding too much, if they should be sleeping through the night by now, and wondering if there is anything else they should be doing differently. Social media posts <a href="http://www.newstatesman.com/internet/2013/07/babies-are-brilliant-whats-behind-increasing-trend-social-media-baby-bragging">often boast</a> of sleeping, contented babies while in reality many parents feel unable to put their baby down. Some want a miracle solution – and quickly. </p>
<p>Ever since the publication of Dr Benjamin Spock’s multi-million selling baby and childcare title, the <a href="http://www.bbc.co.uk/news/world-us-canada-14534094">Common Sense Book of Baby and Child Care</a>, countless self-proclaimed experts have purported incredible solutions for infant sleep, feeding and care. Generations of parents have turned to books such as Dr Spock’s for advice over the years, but the thing is – beyond anecdotal evidence – we don’t actually know whether these books work.</p>
<p>The elephant in the room with many of these books is that actually, despite their popularity, they are not based on evidence. Some of them actually go against what we know about promoting <a href="http://www.psy.miami.edu/faculty/dmessinger/c_c/rsrcs/rdgs/attach/ainsworth.1979.amer_psych.pdf">positive, healthy infant attachment</a>, well-being and health. In fact <a href="http://www.tandfonline.com/doi/abs/10.1080/03004430.2017.1378650?journalCode=gecd20">our recent research</a> has suggested that some books’ impact on maternal well-being is not good, and that there is a link between their use and an increased likelihood of symptoms of depression and anxiety.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/186207/original/file-20170915-8121-xkrvaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/186207/original/file-20170915-8121-xkrvaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/186207/original/file-20170915-8121-xkrvaq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/186207/original/file-20170915-8121-xkrvaq.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/186207/original/file-20170915-8121-xkrvaq.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/186207/original/file-20170915-8121-xkrvaq.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/186207/original/file-20170915-8121-xkrvaq.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">Health is more important that perfect photos.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/adorable-happy-baby-colorful-towel-399052159?src=0vbjgWpB88zPhgtyR0nW6Q-1-38">Oksana Kuzmina/Shutterstock</a></span>
</figcaption>
</figure>
<p>The problem is that these there is a potential mismatch between expectations of what the books offer and the reality of being a parent. Our research found that mothers’ experience of following books’ advice played an important part in their well-being. If they found the books useful, the mothers’ well-being was not affected, but if they didn’t find them useful, they were at a higher risk of depression and anxiety. Unfortunately only around a fifth of mothers in the study found them useful – 22% reported feeling more in control – while over 50% found them harmful in some way, and 53% felt more anxious). </p>
<p>Only one in ten of the participants felt that the advice in the books made them less tired, while one in six actually reported feeling like a failure because of them. The promised nights of sleep did not emerge. Given that mothers who are already feeling anxious and miserable might be drawn to these books as a solution, the potential for things to be made worse is concerning. </p>
<h2>Unhelpful advice</h2>
<p>So why don’t these books seem to work for most parents? Most likely because the suggestion that you can encourage a baby into a parent-led routine goes against a lot of what we know about young babies’ needs. Babies need to feed often because <a href="http://birthingandbreastfeeding.blogspot.co.uk/2017/02/breastfeeding-truths-come-under-attack.html">their tummy is small</a>. Breast milk in particular is <a href="http://pediatrics.aappublications.org/content/80/3/434.short">really easily digested</a> so they need to feed lots – which also helps build a good milk supply. </p>
<p><a href="http://onlinelibrary.wiley.com/doi/10.1002/ajpa.20736/full">Waking at night</a> is normal too. After all, lots of adults wake up at night but can attend to their own needs such as pulling a cover back over them or getting a drink. Babies need help doing this. Finally, <a href="http://www.sciencedirect.com/science/article/pii/S0022347679805405">human infants are really quite vulnerable</a> compared to many other mammals. They can’t even hold their heads up let alone walk and feed themselves shortly after birth. This means that they are programmed to want to keep their caregiver close. </p>
<p>Trying to persuade babies that they want to feed less often, sleep through the night and lie contentedly on their own flies in the face of normal developmental infant needs. Although some parents may be lucky enough to find it works for them, many others will find it instead creates other issues. For example, trying to limit how much a baby feeds can reduce milk supply, making them distressed, and increasing the <a href="http://onlinelibrary.wiley.com/doi/10.1111/j.1365-277X.2010.01145.x/full">likelihood of breastfeeding difficulties</a>. Not responding to an infant’s cries at night is <a href="http://www.sciencedirect.com/science/article/pii/S014976340900075X">stressful for their developing brains</a> too. Meanwhile, sleeping close to their mother at night promotes a <a href="https://academic.oup.com/sleep/article/27/3/507/2707994/Mother-Infant-Bedsharing-is-Associated-with-an">steadier temperature, heart rate and breathing</a>. </p>
<h2>Miracle cure</h2>
<p>Saying all of this, you can fully understand why parents are drawn to books that promise that routines will work. <a href="http://journals.lww.com/jpnnjournal/Abstract/2007/04000/Patterns_of_Sleep_Disruption_and_Depressive.12.aspx">Motherhood is exhausting</a> and many new mothers are now <a href="http://familiesinsocietyjournal.org/doi/abs/10.1606/1044-3894.3684?code=afcf-site">isolated from family</a>, which can increase the risk of depression. Many may need to return to work while still dealing with sleepless nights. </p>
<p>It’s normal for parents to worry about whether they are doing it “right”. But they should remember that a baby having frequent needs and wanting to be kept close is normal. In fact, responding to babies’ needs helps the new-born to <a href="http://psycnet.apa.org/record/2006-08097-003">learn that the world is a good place</a>. </p>
<p>Books and “expert” advice may seem like a good idea but the fact of the matter is that little ones respond to biology, and haven’t been reading the same advice as mum or dad.</p><img src="https://counter.theconversation.com/content/83992/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>Parental well-being is being adversely affected by baby advice which isn’t backed by evidence.Amy Brown, Associate Professor of Child Public Health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/804032017-07-04T01:35:51Z2017-07-04T01:35:51ZNo, nanoparticles in baby formula will not harm your baby<figure><img src="https://images.theconversation.com/files/176674/original/file-20170704-12293-t2rt7k.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">The health scare surrounding nanoparticles might lead to people abandoning formula unnecessarily, with serious impacts on babies' health.</span> <span class="attribution"><a class="source" href="https://www.shutterstock.com/download/confirm/392125570?size=medium_jpg">from www.shutterstock.com</a></span></figcaption></figure><p>If you watched Channel 7 news this week, you would have learnt about a <a href="http://www.smh.com.au/business/consumer-affairs/study-finds-potentially-toxic-nanoparticles-in-australian-baby-formula-20170622-gwwb2j.html">study</a> commissioned by <a href="http://www.foe.org/projects/food-and-technology/nanotechnology/baby-formula">Friends of the Earth</a> that found “potentially toxic” <a href="https://theconversation.com/nanoparticles-and-nanosafety-the-big-picture-22061">nanoparticles</a> in Australian baby formula.</p>
<p>The study’s spokesperson said calcium phosphate nanoparticles (nano-hydroxyapatite, also known as nano-hydroxylapatite) caused kidney and liver damage. That claim was, how shall I put it kindly, just a little <em>misleading</em>.</p>
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<p>I have the <a href="http://pubs.rsc.org/en/content/articlepdf/2012/nr/c2nr00044j">study</a> the spokesperson mentioned before me, which was conducted in rats, not humans.</p>
<p>The researchers injected calcium phosphate nanoparticles directly into rats’ body cavities (instead of oral administration as happens with baby formula) at concentrations around a million times higher than found in the baby formula.</p>
<p>Let me quote from the study’s findings:</p>
<blockquote>
<p>The normal levels of AST, ALT and A/G [liver enzymes indicating liver damage] in the n-HA [nano-hydroxyapatite] group suggested no inflammation and necrosis induced by accumulation of 100 mg of n-HA particles. In the liver function there was almost no damage. Moreover, no significant change on values of BUN and CR [urea and creatine] than the control, which also suggested n-HA has no effect on renal function.</p>
</blockquote>
<p>In other words, there were <em>no</em> ill effects on liver or kidney function, the direct opposite of what the media reports were claiming.</p>
<p>Even <em>if</em> you injected 100 milligrams of pure nano-hydroxyapatite directly into a newborn baby’s body (equivalent in baby terms to the dose given to the rats) there would be <em>no</em> significant effect on liver or kidney function.</p>
<p>The spokesperson’s misleading message caused unwarranted concern. On a now deleted <a href="https://www.facebook.com/Sunrise">Sunrise Facebook</a> post discussing this report, the commentors’ concern and fear was palpable. Causing unreasonable fear is irresponsible.</p>
<h2>Nanoparticles occur naturally</h2>
<p>Nanoparticles have become the latest bogeyman, despite nanoparticles occurring naturally. The <a href="http://www.smh.com.au/business/consumer-affairs/study-finds-potentially-toxic-nanoparticles-in-australian-baby-formula-20170622-gwwb2j.html">media report</a> that fuelled the controversy failed to put nanoparticles in their natural biological context, provide any significant support that particles detected in milk are engineered nanomaterials, nor provide evidence of harm for the levels found.</p>
<p>Infant formula is based on milk, which naturally contains calcium and phosphorus (as calcium phosphates). Milk is an important source of calcium, which forms the basis of bones and teeth. The calcium and phosphates are in a complex balance between soluble and protein-bound forms.</p>
<p>One of the forms of calcium phosphate in milk is <a href="https://hal.archives-ouvertes.fr/hal-00900570/document">hydroxyapatite</a> (also found in <a href="https://en.wikipedia.org/wiki/Hydroxylapatite">tooth enamel</a>). So it is unsurprising that hydroxyapatite is found in dried infant formula, which is mainly dried milk powder. </p>
<p>Nanometre-sized particles of calcium phosphate also <a href="https://www.ncbi.nlm.nih.gov/pubmed/6626580">form naturally</a> in drying milk.</p>
<h2>Other studies have found no effect</h2>
<p>Researchers have studied the safety of consuming hydroxyapatite nanoparticles before.</p>
<p>Animals who ate the nanoparticles (added to their food, as opposed to having them injected) showed <a href="http://www.sciencedirect.com/science/article/pii/S0928493116315703">no toxicity</a> at levels well above those present in milk (up to 100 milligrams per kilogram of body weight a day for a year). </p>
<p>Even if you inject them (into veins or into body cavities), you need levels well above those found in infant formulas to <a href="http://onlinelibrary.wiley.com/doi/10.1002/jat.3073/full">cause damage</a> (50 milligrams nano-hydroxyapatite per kilogram body weight in rats).</p>
<p>To give you an idea of how much higher this is with respect to infant formula, the highest levels of hydroxyapatite nanoparticles in any formula is 287 particles in 10 grams of formula.</p>
<p>Yes, that’s <em>particles</em> not milligrams, not micrograms but actual particles. We are talking nano- to femtograms here, amounts so small it is hard to visualise. These levels are a million times or more less than levels found to have produced no effects in animals (and even lower than levels that do cause damage).</p>
<p>Hydroxyapatite nanoparticles have been widely developed to aid bone repair, deliver drugs and have been extensively tested. All results suggest that even <a href="http://onlinelibrary.wiley.com/doi/10.1002/cphc.201200080/full">levels required to be drug delivery agents</a>, well above those found in baby formula, have no significant adverse effects.</p>
<h2>The body dissolves the nanoparticles anyway</h2>
<p>These nanoparticles will also not stay nanoparticles: they dissolve in the stomach fluids, allowing their calcium to be absorbed. </p>
<p>Newborns and very young babies’ stomach fluids are less acidic than older babies and young children (pH5), but <a href="http://www.sciencedirect.com/science/article/pii/S0003996997000447">still acidic enough to dissolve hydroxyapatite</a>. </p>
<p>And particles are more easily dissolved the smaller they are. So, nanoparticles are likely to be even more rapidly dissolved into their component calcium and phosphate ions than larger particles.</p>
<h2>What’s the take-home message?</h2>
<p>There are no significant public health implications for these small crystals of naturally occurring calcium phosphates in milk-based baby formula. </p>
<p>The way the Friends of the Earth study results have been presented, with misleading references to irrelevant studies, has caused unnecessary fear and concern, and may lead some to abandon formula unnecessarily, with negative impacts on baby health.</p><img src="https://counter.theconversation.com/content/80403/count.gif" alt="The Conversation" width="1" height="1" />
<h4 class="border">Disclosure</h4><p class="fine-print"><em><span>Ian Musgrave receives funding from the National Health and Medical Research Council to study adverse reaction to herbal medicines, and has previously been funded by the Australian Research Council to study potential natural product treatments for Alzheimer's disease. In previous years he has collaborated on work on the formation of amyloids from milk proteins. </span></em></p>A widely publicised study that cast doubt on the safety of milk formula was misleading, based on dubiously reported studies and may have serious consequences.Ian Musgrave, Senior lecturer in Pharmacology, University of AdelaideLicensed 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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</figure>
<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/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">
<figcaption>
<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>
</figcaption>
</figure>
<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.tag:theconversation.com,2011:article/747932017-03-20T10:35:43Z2017-03-20T10:35:43ZPregnant women and new mothers feel like their health is ‘under surveillance’<figure><img src="https://images.theconversation.com/files/161414/original/image-20170319-6127-svcv1s.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/nice-pregnant-woman-baby-room-553895920?src=zodVDEfOIcQDnQJGMcNhgQ-3-11">Lopolo/Shutterstock</a></span></figcaption></figure><p>Pregnancy is a time when women are expected to make changes to their health in order to benefit their unborn child. The list of “risky behaviours” has increased significantly over the past 50 years, and expectant mothers are now advised to cut out <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/pages/alcohol-medicines-drugs-pregnant.aspx">alcohol</a>, <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/pages/smoking-pregnant.aspx">cigarettes</a> and a <a href="https://theconversation.com/health-check-what-to-eat-and-avoid-during-pregnancy-30356">range of foods</a>, among <a href="http://www.nhs.uk/conditions/pregnancy-and-baby/pages/pregnancy-exercise.aspx">other things</a>. After their baby is born, women are reminded of the superiority of breast milk over formula – and can <a href="https://theconversation.com/mothers-are-made-to-feel-guilty-whether-they-breastfeed-or-formula-feed-their-baby-66101">feel guilty</a> whichever they choose.</p>
<p>However, <a href="http://www.ingentaconnect.com/content/tpp/frs/pre-prints/content-ppfrsd1600032r3">we have found that</a> women aren’t left alone in their pre and postnatal health endeavours: friends, family and even strangers are all also policing their behaviour, focusing on anything thought to be risky to the baby’s health.</p>
<p>For our recently published study, we spoke to six mothers, with babies aged two years and under, and their own mothers (the grandmothers) to tell us their experiences of infant feeding. Most reported that as soon as they were pregnant, they were asked about how they were going to be feeding their baby by acquaintances, friends and family. Everybody who asked appeared to have an opinion on what the “right” choice should be.</p>
<p>Though some questioners acted with good intentions, some of the mums did report more intrusive and judgemental experiences. One mother explained that while pregnant she went for an afternoon tea with her mum. The waiter refused to serve them the full tea service, and instead provided them with cheese and pickle sandwiches. The waiter did not ask the expectant mum if there was anything that she was not “allowed” to eat by her health visitor, or anything she might be choosing to avoid, but instead spoke to the chef and decided what would be best to protect the foetus.</p>
<h2>Under observation</h2>
<p>This ever present <a href="http://www.spiked-online.com/newsite/article/policing-pregnancy-is-bad-for-babies/17793#.WM-oPBLyi9Y">low level surveillance and policing</a> continued when the babies were born too, this time focusing on feeding. In general, the mothers said that <a href="https://theconversation.com/fear-based-health-information-makes-new-mothers-anxious-43712">pressure from health professionals</a> was less than from other sources.</p>
<p><a href="http://www.spiked-online.com/newsite/article/policing-pregnant-women-moralism-dressed-up-as-evidence/17163#.WM-oNxLyi9Y">Unhelpful and sometimes incorrect</a> feeding advice came from a broad range of sources. We heard that friends would push women to feed their babies differently, and eventually the mums withdrew from these friendships to stop the flow of advice. Family and friends also judged women for how they fed their baby, criticising for breastfeeding frequently (a <a href="http://www.cardiffandvaleuhb.wales.nhs.uk/breastfeeding-faqs">normal behaviour</a> in young babies) and judging when the mum went out and drank alcohol while breastfeeding – regardless of any precautions she had taken to prioritise her baby’s health.</p>
<p>Most surprisingly, pressure continued to come from strangers. Mothers were questioned about what milk was being fed to babies from bottles in public. A stigma also existed around the preparation of formula: one mum reported hiding the powder under the table so as not to be seen.</p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/161417/original/image-20170319-6133-1kj5lar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/161417/original/image-20170319-6133-1kj5lar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/161417/original/image-20170319-6133-1kj5lar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/161417/original/image-20170319-6133-1kj5lar.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/161417/original/image-20170319-6133-1kj5lar.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/161417/original/image-20170319-6133-1kj5lar.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/161417/original/image-20170319-6133-1kj5lar.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">The judgement continues after birth too.</span>
<span class="attribution"><a class="source" href="https://www.shutterstock.com/image-photo/baby-feeds-on-mothers-breasts-milk-600103034?src=HsQRuy6-T3mewiWhuwjoYw-1-86">Yupa Watchanakit/Shuttestock</a></span>
</figcaption>
</figure>
<p>Two of our respondents continued to breastfeed beyond the early weeks, but neither felt fully free in doing so. One said that she aimed to take expressed breast milk with her whenever she went out, as she felt that feeding directly from the breast may be misconstrued as a sexual act. She described that it was as if people were watching her pole dance. When it was not possible to use expressed breastmilk, the mother used a large shawl to cover the baby and her torso. The second mother did not feel the same need to cover her baby with a shawl, but nonetheless had attempted to cover as much of her own body as possible when feeding.</p>
<p>Speaking to these mother’s own mothers, we found that their experience was quite different from their daughters. The grandmothers didn’t have the questions and pressures that their daughters had, and felt that this had made motherhood a less challenging time for them.</p>
<h2>Policing women’s bodies</h2>
<p>When women are subjected to this kind of regulation, it can have negative impacts on their self-esteem and <a href="https://www.google.co.uk/url?sa=t&rct=j&q=&esrc=s&source=web&cd=9&cad=rja&uact=8&ved=0ahUKEwil5fK-6OTSAhXoIsAKHTYhDq8QFghCMAg&url=http%3A%2F%2Ftheconversation.com%2Frules-about-how-to-behave-in-pregnancy-diminish-womens-freedom-57900&usg=AFQjCNHT73ah1SqMHDuE-J4SpJoCV2pq7A">make them behave</a> in ways that are overly <a href="https://theconversation.com/social-media-is-putting-pregnant-women-under-pressure-to-look-perfect-61881">self-aware</a> and <a href="https://theconversation.com/fat-bland-boring-incubators-ordinary-pregnant-women-dont-feel-like-beyonce-72419">self-conscious</a>. This has a particular impact on how they choose to feed their babies, and also on new mothers’ feelings about going outside their home.</p>
<p>If new mothers are to be able to leave the house and breastfeed their babies, it is important that they feel able to do so in public. In the UK, <a href="https://abm.me.uk/breastfeeding-information/breastfeeding-in-public/">breastfeeding mothers are protected</a> by the Equality Act 2010, which insists that businesses facilitate breastfeeding, allow women to breastfeed on their premises, and even protect them from other customers’ requests that they stop. Though it may not be currently <a href="http://journals.sagepub.com/doi/abs/10.1177/0890334415592403">widely enforced</a>, it becomes a totally useless protection if women feel that they will be subjected to intrusive comments and suggestions, and so will choose not to breastfeed away from home.</p>
<p>New motherhood is exhausting and finding the time to express breastmilk to use in public adds a further <a href="http://www.nhs.uk/Conditions/pregnancy-and-baby/pages/expressing-storing-breast-milk.aspx">time-consuming task to their days</a>. As such, the policing of new mother’s behaviour <a href="https://theconversation.com/a-decent-woman-the-breastfeeding-and-visibility-debate-is-nothing-new-57728">in public</a> is likely to contribute to the <a href="https://theconversation.com/stop-shaming-mothers-who-want-to-breastfeed-their-babies-54854">UK’s low rates of breastfeeding</a>.</p>
<p>The <a href="https://theconversation.com/dont-judge-pregnant-women-give-them-good-nutrition-advice-38724">best advice to take</a> is that if you see a woman you don’t know, who is pregnant or has a baby with her, think carefully before asking questions about infant feeding. Your enquiries could be making a difficult situation worse.</p><img src="https://counter.theconversation.com/content/74793/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>Family, friends and even strangers are judging pregnant women’s and new mothers’ behaviour.Aimee Grant, Research Associate - infant feeding, smoking, stigma, class, identity, Cardiff UniversityLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/661012016-11-15T12:21:44Z2016-11-15T12:21:44ZMothers are made to feel guilty whether they breastfeed or formula feed their baby<figure><img src="https://images.theconversation.com/files/142644/original/image-20161021-1785-1794qv5.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">shutterstock</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-70721215/stock-photo-mother-is-feeding-her-baby-with-a-bottle-very-tranquil-scene.html?src=I6XTUHB_iqAxbUfSASPPEw-2-54">Kzenon/www.shutterstock.com</a></span></figcaption></figure><p>From the first cry of their newborn baby, mothers are faced with a <a href="http://www.ncbi.nlm.nih.gov/pubmed/12746032">myriad of expectations</a> on how they raise their child. Now surely all they can do is try their best, right? Essentially yes, but one of the most fundamental parts of doing this is providing the “best” nutrition for their child from day one – a minefield of a topic to say the least. </p>
<p>The way mothers feed their babies has become a matter of international public interest. Take a quick glance at the <a href="http://www.unicef.org.uk/BabyFriendly/What-is-Baby-Friendly/benefits-of-breastfeeding/">extensive list of breastfeeding benefits</a>, against <a href="http://www.who.int/nutrition/databases/infantfeeding/en/">current rates</a>, and the concern is understandable. In the UK, over 80% of women initiate breastfeeding, yet less than 1% of mothers <a href="http://digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf">exclusively breastfeed to the recommended six months</a>. This means that the majority of babies receive at least some formula supplementation during those critical first few months. </p>
<p>Unfortunately, <a href="http://onlinelibrary.wiley.com/doi/10.1111/mcn.12392/full">our recently published study of formula-feeding women</a> found that the large majority of mothers who supplement their babies’ feedings with formula are made to feel guilty, stigmatised, defensive, and dissatisfied over their decision to top-up or swap from breast to bottle. Mothers who initiate exclusive breastfeeding but stop, and mothers who intend to exclusively breastfeed during pregnancy but are unable to do so, are at a much higher risk of experiencing guilt and dissatisfaction too. </p>
<p>It’s not much easier for mothers who do manage to feed their baby by breast alone for at least six months either. In a second study we found that though these mums did not have negative emotional experiences as often as formula-feeding mothers, <a href="http://onlinelibrary.wiley.com/doi/10.1111/mcn.12364/full">they still occurred</a>, particularly for those who supplemented breastfeeding with formula. </p>
<p>Mums can’t win either way.</p>
<h2>Social barriers</h2>
<p>Society makes it very difficult for mothers to breastfeed. Family members, with the best of intentions, suggest formula to “help baby settle”; partners want their share of the feeding responsibilities to “give mum a break”. Add to that the barrage of media stories of mothers being asked to <a href="http://www.huffingtonpost.co.uk/entry/breastfeeding-mum-water-park_uk_57723086e4b08d2c5639c959">cover up</a> or <a href="http://www.couriermail.com.au/news/queensland/liana-webster-forced-to-leave-bribie-island-aquatic-centre-after-breastfeeding-her-daughter-rori/story-e6freoof-1226555303135?nk=43873cb082ec8c6e6fa271d218cfcb3e-1474910982">leave</a> public spaces and it is little wonder mums feel confused, conflicted, and contemplating formula over breastfeeding. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/146277/original/image-20161116-13509-1ioanb9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/146277/original/image-20161116-13509-1ioanb9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/146277/original/image-20161116-13509-1ioanb9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/146277/original/image-20161116-13509-1ioanb9.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/146277/original/image-20161116-13509-1ioanb9.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/146277/original/image-20161116-13509-1ioanb9.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/146277/original/image-20161116-13509-1ioanb9.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">Breast or bottle?</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-295587896/stock-photo-mother-holding-a-baby-bottle-with-breast-milk-for-breastfeeding-at-foreground-mothers-breast-milk-is-the-most-healthy-food-for-newborn-baby.html?src=bPkVl52Z1B7XrN0-ruOUWw-1-0">Pavel Iluyukhin/www.shutterstock.com</a></span>
</figcaption>
</figure>
<p>Promotional efforts, on the other hand – like the “breast is best” message – make women who intend to exclusively breastfeed but turn to formula, either on rare occasions or more permanently, feel guilty and dissatisfied about the prospect of feeding their child <a href="http://www.dailymail.co.uk/health/article-1288431/Breast-best-slogan-actually-harms-cause.html">something less than breastmilk</a>. The mantra was originally designed to convey the health benefits of breastmilk, and tackle the prolonged slump in breastfeeding rates. But, assuming every new mother wants the “best” for their baby, the slogan and associated promotions take on a profoundly moralistic dimension, which has become intertwined with the concept of “good parenting”. </p>
<p>Regardless of whether they breastfeed or not, this catch-22 situtation is making life unnecessarily difficult and stressful for mums.</p>
<h2>A lose-lose situation</h2>
<p>Some mothers simply cannot breastfeed, others plan not to, or don’t initiate breastfeeding after birth. Our research found that these mums were more likely to feel stigmatised than breastfeeding mothers, and were also less likely to ask for infant feeding advice from health professionals. </p>
<p>Instead they were more likely to turn to family members or use their own accord and experiences to inform their feeding practices. It seems that our portrayal of formula as <a href="http://www.naturalnews.com/019338.html#">“risky” or “dangerous”</a> alongside the “breast is best” message may alienate those who intend to exclusively formula feed and create reluctance among women to seek professional advice about their “suboptimal” feeding method. This is a vicious circle that embeds the formula feeding culture down the generations, and has considerable implications for infant health. If formula is not <a href="https://www.foodsafety.gov/keep/types/babyfood/">prepared carefully</a>, there is a much higher <a href="http://www.telegraph.co.uk/news/health/news/5818854/Bottle-feeding-with-formula-milk-may-risk-babys-health.html">risk of contamination and illness</a>. </p>
<p>Negative emotions like stigma can also lead to other harmful behaviours, from trying to make <a href="http://www.foodinsight.org/Good_Intentions_that_May_Lead_to_Bad_Outcomes_Home_Made_Infant_Formula">“homemade” formula</a>, to early introduction of solids, and even, thankfully isolated, cases of <a href="http://metro.co.uk/2016/09/21/mother-jailed-and-father-fled-uk-over-starving-newborn-baby-6141631/">food deprivation</a>. </p>
<p>Breastfeeding has profound and long-lasting health advantages, but the risks of poor maternal well-being run just as deep. The “breast is best” message has, in many cases, done more harm than good for both breastfeeding and formula feeding women. Words carry a lot of power and we need to be very careful of their use in future breastfeeding promotion campaigns. </p>
<p>For many, the current WHO recommendation of six months of exclusive breastfeeding is simply not realistic and can discourage mothers from even initiating breastfeeding. Instead we should follow a woman-centred approach where mothers are empowered to set their own realistic targets.</p><img src="https://counter.theconversation.com/content/66101/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>The authors 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>Breast really best makes many mums feel bad.Sophia Komninou, Lecturer in Infant and Child Public Health, Swansea UniversityVicky Fallon, Lecturer in Psychology, University of LiverpoolLicensed as Creative Commons – attribution, no derivatives.tag:theconversation.com,2011:article/635502016-08-05T14:58:40Z2016-08-05T14:58:40ZTraumatic breastfeeding experiences are the reason we must continue to promote it<figure><img src="https://images.theconversation.com/files/133155/original/image-20160804-466-1i6c6nk.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=496&fit=clip" /><figcaption><span class="caption">It's not all sunshine and roses for some mums.</span> <span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-301455563/stock-photo-mother-holding-her-crying-little-son-in-studio.html?src=7IxJ0dyhYy-BiDVgEKrUyA-1-0">Shutterstock/Konstantin Tronin</a></span></figcaption></figure><p><a href="http://worldbreastfeedingweek.org">World Breastfeeding Week</a> was designed to promote, protect and encourage breastfeeding. To celebrate the marvel of women nourishing a whole new tiny person. To highlight why we need to invest in our new mothers, babies and the future. </p>
<p>Yet for many mums, this week sends a chill straight through their core. It makes them want to shout and throw things because breastfeeding certainly isn’t something to celebrate for them. </p>
<p>For far too many women, any mention of breastfeeding reminds them of <a href="http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4738467/">pain</a>, <a href="https://bfmed.wordpress.com/2013/05/30/breastfeeding-and-depression-its-complicated/">anxiety</a> and a <a href="https://www.breastfeedingnetwork.org.uk/crisis-in-bf/">lack of support</a>. It reminds them of their determination to do what had been promised to them as simple, enjoyable and the right way to feed their baby. Determination which slowly turned to desperation when it didn’t work for them. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133157/original/image-20160804-473-yjfs9t.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">Babe in arms.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-281210201/stock-photo-happy-baby-in-the-mothers-breast.html?src=n_8bJP6qeNiu3YXOJTZ79g-1-21">Shutterstock/Luca Elvira</a></span>
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<p>It reminds mothers of the heartbreak they felt as they stopped breastfeeding <a href="http://www.herfamily.ie/parenthood/5-mums-stopping-breastfeeding-ready-no-one-listened/227281">before they were anywhere near ready</a> – it wasn’t just about the promised health benefits but the feeling that their body wasn’t doing what it was meant to do, and the fact they just really wanted to do it. </p>
<p>All the pain, regret and anger that mothers feel is the reason we need to shout so loudly about breastfeeding. This hurt comes from women being so badly let down by a society that does not protect breastfeeding. Because, while there are many mums and babies who experience health problems that stop them from breastfeeding, there are even more who would breastfeed if the right support was in place. </p>
<p>We need to change this attitude, and one of the best ways we can do that is by drawing attention to its importance. Because although it might not seem like it to some, breastfeeding has become the underdog in a society that might shout about its importance but actually works rather hard <a href="https://blogs.unicef.org.uk/2016/04/11/breastfeeding-call-to-action/">to undermine it</a>. </p>
<h2>Breaking down barriers</h2>
<p>Britain has ended up in a situation where, despite the <a href="http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/Health-benefits/">known health</a> and <a href="http://www.unicef.org.uk/BabyFriendly/About-Baby-Friendly/Breastfeeding-in-the-UK/Financial-benefits/">economic benefits of breastfeeding</a>, rates are abysmal. In fact they’re <a href="http://www.unicef.org.uk/BabyFriendly/News-and-Research/News/The-Lancet-Increasing-breastfeeding-worldwide-could-prevent-over-800000-child-deaths-every-year/">the lowest in the world</a>. More importantly, 80% of mothers who stop breastfeeding in the first six weeks <a href="http://digital.nhs.uk/catalogue/PUB08694/Infant-Feeding-Survey-2010-Consolidated-Report.pdf">are not ready to do so</a>, and stop because breastfeeding has become seemingly impossible for them. </p>
<p>Breastfeeding should not be so difficult for so many and should only be impossible for a <a href="https://bfmed.wordpress.com/2012/10/15/how-often-does-breastfeeding-just-not-work/">very, very small minority of mothers</a>. However, while society appears to promote breastfeeding, there are actually <a href="https://blogs.unicef.org.uk/2016/07/07/removing-barriers-breastfeeding-uk/">numerous barriers</a> ranging from formula milk adverts to a lack of community support, that ultimately make breastfeeding feel impossible. </p>
<p>Society <a href="http://online.liebertpub.com/doi/abs/10.1089/bfm.2015.0175">does not understand</a> what it is like to breastfeed. Women are given information that damages breastfeeding such as babies <a href="http://www.dailymail.co.uk/health/article-2084874/Study-finds-babies-fed-formula-milk-easier-to-sleep.html">should sleep through the night</a>, rather than wake to feed, for example. Some think misunderstand studies, and come to believe that breastfeeding causes things that are actually <a href="https://www.theguardian.com/lifeandstyle/2012/jan/10/breastfeeding-babies-temperamental-study">just normal baby behaviour</a> and that formula is the solution. Others believe self-styled experts who make money out of telling mothers that their baby should be in a routine – despite research showing that strict routines are actually <a href="http://www.swansea.ac.uk/humanandhealthsciences/news-and-events/latest-research/newresearchsuggestsearlyparentingroutinesmayharmbreastfeeding.php">incompatible with or discourage breastfeeding</a>. </p>
<h2>Invest in breast</h2>
<p>Rather than protecting breastfeeding, the government doesn’t invest properly in the services, support and expertise that would actually enable mothers to breastfeed – despite reports finding it could actually <a href="https://www.theguardian.com/lifeandstyle/2012/oct/18/increase-breastfeeding-nhs-savings-unicef">save the NHS money</a>. Instead, <a href="http://www.nursingtimes.net/news/news-topics/public-health/warning-of-uk-breastfeeding-crisis-amid-budget-cuts/7002416.fullarticle">cuts to services</a> take away essential volunteer groups and funding of breastfeeding specialists. What should be an easily fixable issue gets turned into months of suffering. </p>
<p>Though <a href="http://www.telegraph.co.uk/news/uknews/1570179/Clampdown-on-milk-firms-targeting-newborns.html">no longer allowed</a> to advertise to mothers of babies under six months, the multi-billion formula milk industry <a href="http://www.telegraph.co.uk/women/mother-tongue/11697178/Breastfeeding-Formula-industry-has-hijacked-breastfeeding-for-profit.html">still dominates</a>. Some might argue that the world doesn’t need a week celebrating breastfeeding but in reality, every week is world formula feeding week. </p>
<figure class="align-center ">
<img alt="" src="https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&fit=clip" srcset="https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=600&h=400&fit=crop&dpr=1 600w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=600&h=400&fit=crop&dpr=2 1200w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=15&auto=format&w=600&h=400&fit=crop&dpr=3 1800w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=45&auto=format&w=754&h=503&fit=crop&dpr=1 754w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.jpg?ixlib=rb-1.1.0&q=30&auto=format&w=754&h=503&fit=crop&dpr=2 1508w, https://images.theconversation.com/files/133151/original/image-20160804-466-3hoezn.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 in public should be the norm.</span>
<span class="attribution"><a class="source" href="http://www.shutterstock.com/pic-333965063/stock-photo-thessaloniki-greece-november-1-2015-mother-breastfeeding-her-baby-on-the-6th-nationwide-public-breastfeeding-in-celebration-of-world-breastfeeding-week.html?src=n_8bJP6qeNiu3YXOJTZ79g-9-92">Ververidis Vasilis / Shutterstock.com</a></span>
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<p>Mothering is not <a href="http://www.nhs.uk/news/2014/09September/Pages/Mums-feel-shame-about-how-they-feed-their-babies.aspx">valued or supported</a>. Instead <a href="http://www.dailymail.co.uk/femail/article-2090277/How-I-banished-baby-belly-Celebrity-mums-ping-shape-weeks-easy-real-women-regain-figures-One-mother-shares-diary-.html">weight loss is celebrated</a>, tips on reviving your sex life are published, and the focus is on “getting your life back” post-pregnancy. Celebrities are <a href="http://www.instyle.com/celebrity/celebrity-moms/star-bodies-after-baby">snapped back in their jeans</a> and out partying a week after having a baby. “Normal” mothers meanwhile are <a href="http://www.mirror.co.uk/news/uk-news/mum-left-humiliated-after-being-7945539">ridiculed and criticised</a> for simply trying to feed their hungry baby in public. </p>
<p>The simple truth is that we set women up to fail. Most breastfeeding problems are created by a society that is not breastfeeding friendly: the actions of others are <a href="https://blogs.unicef.org.uk/2016/07/07/removing-barriers-breastfeeding-uk/">responsible for poor breastfeeding rates</a> and the trauma of mothers. And we must change this.</p>
<p>If as a society we encouraged breastfeeding, properly supported women and the government cracked down on the way in which formula is promoted, there might not be this level of problem. </p>
<p>Ultimately if we did all of this then there would be no need to shout about breastfeeding and no need for special events. Because it would just be normal. Just how babies are fed.</p>
<p>In the words of the <a href="https://act.unicef.org.uk/ea-action/action?ea.client.id=375&ea.campaign.id=52979&ea.tracking.id=g8yt4l55">UNICEF Baby Friendly Initiative Call to Action</a>: “It’s time to change the conversation.” We need to keep speaking out about breastfeeding and direct our trauma into action, until everyone who can plays their part in creating a supportive environment for new mothers.</p><img src="https://counter.theconversation.com/content/63550/count.gif" alt="The Conversation" width="1" height="1" />
<p class="fine-print"><em><span>Amy Brown has previously received funding from the ESRC. </span></em></p>Negative breastfeeding experiences can make special drives to encourage it all too painful for some.Amy Brown, Associate professor of child public health, Swansea UniversityLicensed as Creative Commons – attribution, no derivatives.