Weaning

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Weaning is the process of gradually introducing a mammal infant, either human or animal, to what will be its adult diet and withdrawing the supply of its mother's milk.

The process takes place only in mammals, as only mammals produce milk. The infant is considered to be fully weaned once it no longer receives any breast milk (or bottled substitute).

Normally, at the end of the weaning process, mammals experience reduced lactase production, becoming lactose intolerant. This is estimated to be the case with 70% of humans, with the rest being lactase persistent.

Protecting, Promoting and Supporting Continued Breastfeeding from 6-24 + Months: Issues, Politics, Policies & Action

6 pages 403 kb

The Joint Statement on Continued Breastfeeding was produced following the WABA GBPM in October 2008 in response to shared concerns that breastfeeding after 6 months has slipped off the policy and programme agenda. Action and investment in improving complementary feeding or providing foods supplements seems to be taking place with little consideration for supporting or improving breastfeeding amongst 6 < 24+ month old children, despite estimates that 20% of deaths in 12 < 24 month age group in developing countries are due to lack of breastfeeding. The statement calls upon everyone involved in improving the health and development of infants and young children to take steps to ensure that continued breastfeeding 6-24+ months is protected, promoted and supported as the precondition for, and foundation of, appropriate complementary feeding. Steps for action encompassing communication, education and promotion; practical support; breastfeeding as part of complementary feeding; definitions and monitoring; addressing misinformation through marketing and special circumstances are described.

Click here for the statement.

Weaning a critical time for diarrhoea transmission

Infants are at greatest risk of diarrhoea when foods other than breastmilk are first given. This is because during weaning infants are being exposed to food-borne germs for the first time and they are losing the protection of breastmilk which has anti-infective properties.

High levels of contamination are often found in animal milks and traditional weaning foods, especially cereal gruels. Escherichia coli, which causes at least 25 per cent of all diarrhoea in developing countries, is commonly found in weaning food.

Feeding bottles and rubber teats, which are particularly difficult to clean, are often breeding grounds for germs.

The need for infants older than 6 months to receive more than just breastmilk in order to grow well, balanced against the risk that this will result in diarrhoea, has been called 'the weaning dilemma'.

It is important for health workers to work with local communities to identify and encourage safe weaning practices and to improve infants' nutrition to increase their resistance to infections such as diarrhoea.

Improved weaning practices

Complementary foods should normally be started when a child is 6 months old. These may be started any time after 6 months of age, however, if the child is not growing satisfactorily. Good weaning practices involve selecting nutritious foods and using hygienic practices when preparing them.

The choice of complementary foods will depend on local patterns of diet and agriculture, as well as on existing beliefs and practices. In addition to breastmilk (or animal milk), soft mashed foods (e.g. cereals) should be given, to which some vegetable oil (510 ml/serving) has been added.

Other foods, such as well cooked pulses and vegetables, should be given as the diet is expanded. When possible, eggs, meat, fish and fruit should be also given.

Weaning a Rural Child

Dr. Anil Mokashi MD., DCH, FIAP, PhD.

Weaning is a process by which food other than breast milk is introduced gradually into the baby’s diet first to complement the breast milk and then to replace it with thicker feeds. Weaning practices are vulnerable to social pressures. Majority of nutritional problems in rural areas are due to faulty weaning practices.

A. When to Start:
Following guidelines will be useful.
a. Child is above 6 month age.
b. Child weighs 7kg.

B. What to give
There are many weaning foods advised and available. Commercially available Farex, Cerelac, etc. have the advantage of palatability, convenience of preparation and fortification with vitamins and minerals. The disadvantage is the cost and improper use. Many mothers add a measure Farex to bottle of milk. This practice defeats the sole purpose of weaning. Mother gets the satisfaction of ‘giving Farex ‘ but child doesn’t get the advantage of ‘getting Farex‘. So Farex should not be used as a drink, it is to be given in form of a paste.

The ideal advice would be to take
(1) 2tsp. Cooked rice,
(2) 2 tsp. Cooked dal,
(3) 2 tsp. Cooked vegetables (before adding chilli and spices)
(4) a piece of roti.

Ground it to prepare a paste like ‘chutni‘ . It is to be given initially twice a day, then thrice a day and then quantity is increased gradually. For a malnourished or a child above 1 years age still not weaned, 2 tsp. Of groundnut powder and 2tsp. Of milk powder is to be added. This preparation overcomes the social, cultural, financial and nutritional restraints of successful weaning. There will not be any ‘protein gap‘ or ‘food gap‘.

As a rule after 1 year, child should be offered full family diet.

Problems of Weaning : Problems with Child
Infections, malnutrition and refusal to accept food are major problems. Proper weaning advice can prevent infections and malnutrition. If a child doesn’t accept food, following are the possibilities
(1) As yet he does not know it is a food. Within weeks of starting it, child will develop a liking.
(2) He doesn’t like taste or appearance of particular preparation.
(3) Child is being forced or rushed through a feed.
(4) Food is too hot.
(5) He wants a drink first.
(6) He is not hungry.
(7) He is uncomfortable due to heat, cold or a wet napkid.
(8) He wants his favorite cup or dist (s) He wants to feed himself.

Problem With Parent
Parents just do not know that child needs food. The religious ceremony required for ‘Starting food‘ is many times postponed. Either parents don’t get time or there is no motivation to perform the ceremony. Following slogan, if posted in the clinic, helps.

“Starting food ceremony should be performed in sixth months.“

Conclusion
Breast feeding exclusively for first six months, timely and adequate supplementation, maintaining breast milk long enough to ensure its replacement by a safe and nutritious diet and discouraging a bottle are therefore extremely important measures to ensure a healthy start in life.

From Wikipedia

Baby-led weaning (often also referred to as BLW) is a method of gradually weaning a baby from a milk diet onto solid foods. It allows a baby to control his or her solid food intake by self-feeding from the very beginning of the weaning process.

Infants are offered a range of foods to provide a balanced diet from around 6 months. They often begin by picking up and licking the food, before progressing to eating. Babies typically begin self feeding around 6 months, although some will reach for food as early as 5 months and some will wait until 7 or 8. The intention of this process is that it is tailored to suit each particular baby and their personal development. The 6 month guideline provided by the World Health Organisation is based on research indicating the internal digestive system matures over the period 4-6 months. It seems reasonable to posit that the gut matures in tandem with the baby's external faculties to self feed.

Initial self-feeding attempts often result in very little food ingested as the baby explores textures and tastes, but the baby will soon start to swallow and digest what is offered. Breastfeeding is continued in conjunction with weaning and milk is always offered before solids in the first 12 months.

General information

Baby-led weaning places the emphasis on exploring taste, texture, colour and smell as the baby sets their own pace for the meal, choosing which foods to concentrate on. Instead of the traditional method of spooning pur�ed food into the baby's mouth, the baby is presented with a plate of varied finger food from which to choose.

Contrary to popular belief there is no research supporting the introduction of solids by purees and proponents of baby-led weaning argue that babies can become very confused when stage 2 foods are introduced (with lumps) unsure whether to swallow or chew ^[1].

According to one theory, the baby will choose foods with the nutrients she might be slightly lacking, guided by taste^[2]^[3]. The baby learns most effectively by watching and imitating others, and allowing her to eat the same food at the same time as the rest of the family contributes to a positive weaning experience. At six months babies learn to chew and grasp and this is therefore the ideal time to begin introducing finger food.

Self-feeding supports the child’s motor development on many vital areas, such as their hand-eye coordination and chewing. It encourages the child towards independence and often provides a stress-free alternative for meal times, for both the child and the parents. Some babies refuse to eat solids when offered with a spoon, but happily help themselves to finger food.

As recommended by the World Health Organization and several other health authorities across the world, there is no need to introduce solid food to a baby’s diet until after 6 months, and by then the child’s digestive system and her fine motor skills have developed enough to allow her to self-feed. Baby-led weaning takes advantage of the natural development stages of the child.

Signs of readiness

It is very important that baby-led weaning is not started before the child shows developmental signs indicating that he/she is ready to cope with solid foods. The baby should be able to sit upright, either on a lap, in a highchair or unsupported, be eager to participate in mealtime and may even be trying to grab food and put it in his/her mouth.

Safety

Many parents are used to the idea of giving babies pur�ed food and to some, giving such a young child finger food might sound dangerous. However, babies weaned using the baby-led method are actually less likely to choke on their food, as they are not capable of moving food from the front of the mouth to the back until they have learnt to chew ^[1]. In turn, they do not learn to chew until they have learned to grasp objects and place them in their mouth. Therefore the baby's general development keeps pace with her ability to manage food.

If a child gets a piece of food too far back in their mouth, they will generally promptly clear it themselves by gagging or coughing the piece out ^[1].

Food should not be placed in the baby's mouth for him or her. If the baby is unable to pick up and grasp the food, it is believed that the baby will also be unable to cope with chewing and swallowing it. It is also very important that the baby is sitting up straight and well supported during mealtimes and never left unattended while self-feeding.

Basic principles

The basic principles of baby-led weaning are:

At the start of the process the baby is allowed to reject food, and it may be offered again at a later date.
The child is allowed to decide how much it wants to eat. No "fill-ups" are to be offered at the end of the meal with a spoon.
The meals should not be hurried.
Sips of water are offered with meals.
Initially, soft fruits and vegetables are given. Harder foods are lightly cooked to make them soft enough to chew on even with bare gums.
Food given is free of added salt and sugar.
Food is not cut into bite-sized pieces until the baby has mastered object permanence and the pincer grasp.
Initially, food is offered in baton-shaped pieces or in natural shapes that have a 'handle' (such as broccoli florets), so that the baby can get a good grip and the food is visible for babies that have not yet mastered object permanence.
Foods with clear danger, such as peanuts, are not offered.
Foods can be offered to the baby on a spoon, but the baby is allowed to grab the spoon and the adult helps the baby guide it to the mouth.

References

Rapley, Gill (6 November 2008). Baby-led Weaning. Vermilion. ISBN 9780091923808.

Footnotes

Rapley, G. 2006. Baby-led weaning, a developmental approach to the introduction of complementary foods. In Hall Moran, V and Dykes, F. eds. Maternal and Infant Nutrition and Nurture: Controversies and Challenges. Quay Books, London. pp 275-298.
Davis, Clara M. Results of the self-selection of diets by young children. Can Med Assoc J 1939 41: 257-61
Strauss, Stephen. Clara M. Davis and the wisdom of letting children choose their own diets. Can Med Assoc J 2006 175: 1199

External links

Gill Rapley's Baby-led Weaning website
Baby-led weaning website with busy forum
Baby Led Weaning Site & FAQ
IWMM Gill Rapley Webchat
Gill Rapley's Guidelines for Baby-led Weaning
Baby-led weaning: the UNICEF UK Baby Friendly Initiative's position
Association of Breastfeeding Mothers
Kellymom Breastfeeding & Parenting Site