Nutritional Update

June 12, 1997. Mothers Weaning Babies Too Early

The majority of American infants are being weaned and introduced to solid foods too early, experts say.

"How infants are fed seems to have little relevance to how we, as nutritionists, think infants should be fed," says pediatrician Dr. William Klish, of Texas Children's Hospital in Houston.

Klish's comments are published in the June issue of the Journal of the American College of Nutrition, which also includes a study of the feeding of American infants in their first year of life.

University of Tennessee nutritionists conducted in-home interviews with 98 mothers during their newborn's first year. Feeding patterns were tracked as the infants grew. All of the mothers were from white, middle- and upper-class homes - the population segment thought to 'lead' the nation in adopting recommended childrearing techniques.

However, even these mothers seemed to fall short of the American Academy of Pediatrics (AAP) guidelines for infant feeding. These guidelines stipulate that breastfeeding should be the only source of food for most infants during the first four months (at least) of life, that breastfeeding continue as part of an infant's diet through to (at least) his or her first birthday, and that solid foods be introduced at between 4 to 6 months of age.

Registered dietitian Sheah Rarback, a spokesperson for the American Dietetic Association, and assistant professor at the Department of Pediatrics at the University of Miami School of Medicine, believes these recommendations have a solid basis in science. She says, "Breastfeeding is the perfect food for an infant, and all the formulas are just trying to catch up to breast milk." She says that while formula can supply some of the nutrients of breast milk, it lacks the immunological properties which breast milk contains. Studies have shown that babies suckling formula alone may face increased risks for ear and other infections, Rarback said.

Solid foods need to be introduced when babies are ready. Rarback explains that babies younger than 4 to 6 months of age may be ill-equipped to ingest solid foods. "The way the baby's tongue moves across the nipple is done to extract breast milk," she explains. When infants are spoon-fed foods, this instinctual motion often pushes the food out of the mouth. Rarback says, "Many parents say, 'Oh, the baby didn't like it, she pushed it out.' That's not the case."

But the Tennessee researchers discovered that while experts recommend breastfeeding or formula only during the first year of infancy, "half of the (study) infants were receiving cow's milk by 12 months of age." Exclusive breastfeeding may have ended for many babies long before that time - while 83% of new moms breastfed initially, this percentage "decreased significantly by about 6 months; 33% at 4 months, and 12% at 6 months," researchers say.

Solid foods (like cereals) were introduced earlier than recommended as well. In the study, the first cereals were fed to the babies at an average of just under 4 months - below the minimum set by the AAP. Juice, fruit, and vegetables were added to infant diets about a month later, the researchers say.

Rarback says the early introduction of cereal is problematic. "(Babies) need what's in the breast milk, so by introducing a cereal, you might decrease the intake of breast milk." And she disagrees with the common practice of putting baby to bed with a bottle full of cereal. Many mothers believe this can soothe hunger and put the babies to sleep, although both the Tennessee researchers and Rarback say studies show it simply doesn't work this way. However, "It's a very strongly ingrained belief in this society," she said. She says constant access to cereals can help develop patterns of overeating in infants who otherwise would cease eating upon satiation.

Rarback isn't exactly sure why moms are speeding up infant food transitions. She speculates that "a lot of the problems with breastfeeding (cessation) arise from the mom not getting enough education, enough support." Past generations relied on the 'been there, done that' over-the-clothesline network of experienced moms to help guide new mothers through the process. Rarback believes that with more and more women at work, those networks have weakened.

And she believes early weaning may also be a matter of expense and convenience. "Most moms are working, and maybe they go to the store and (pick) up milk for the rest of the family," she says. "They're seeing a toddler... and thinking, 'what's the difference? he's 10... months old, why not give him (cow's) milk?"'

However, Rarback says it's important that mothers not get overly alarmed. "Babies are very resilient," she says, and infant reactions to dietary changes vary from infant to infant. "Maybe the baby who's getting constant ear infections would've benefited from a longer term of breastfeeding. And maybe another baby wouldn't." She says it's impossible to know which babies will be more or less sensitive to early weaning. "Since we don't know which baby will get the most benefits from following these practices, we feel it's a good idea for everyone to follow (them)," she says.

Rarback believes more - and earlier - parental education is key. "Maybe we have to move our emphasis to a pre-conception nutrition for mom and baby," Rarback said. "Not only just doing the counseling just once the baby's born."

SOURCE: Journal of the American College of Nutrition (1997;16(3):189, 209-213)

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