NHD clinical - weaning
After 14 years as Community Dietetic Team Leader in Rotherham,
Sheila Turner recently moved to Sheffield. Her passions are infant
by Sheila Turner
feeding, weight management and training professionals to be
Community Dietetic Team Leader
confident and consistent.
Weaning onto solid foods: does baby know best?
We use our kitchen appliances without ever opening the instruction manual. Lambs in the local fields gradually suckle less
and learn to crop the grass with their elders. Although babies are more intelligent than microwaves and humans more so-
phisticated than sheep, parents’ confidence seems to have become so undermined that they feel unable to use their intimate
knowledge of, and opportunities to observe, their own babies, to guide them as they plan the introduction of solid foods.
It would not be considered to be good parenting to say, ‘To- needs without resorting to prolonged use of formulae, the fol-
day is the day my child will stand up,’ and place them on their lowing seem to be convincing:
feet in the middle of the floor, or similarly with the first time they • Introduce several tastes each day from the first day, or soon
sit alone, place a toy in their mouth or say their first word. Yet after, to thus introduce the foods that would later be less ac-
parents use the calendar, advice from their friend or mother, the ceptable (e.g. green vegetables) at an age where these are
labels on commercial baby foods or even ‘the instruction book’ a taste that easily develops.
of choice rather than trusting their observations and the instinct • Offer foods unmixed so that the child can learn each taste
of their intelligent child. along with the look, feel and texture (I would expect this
In recent years, I have had to review the evidence and prac- to trigger debate about the use of recipe books and mixed
ticalities of this emotive milestone for the revision of the Trusts’ commercial foods).
Infant Feeding Guidelines (1) in my previous post, and produc- • Rapidly introduce foods that have different textures from
tion of the same (2) in my new one. We have struggled with one another, although at first not those that have mixed
the dual meaning of the word ‘weaning’ to mean either moving textures in one mouthful. This means not sticking with the
from breast to formula or moving from milk to solids. This leads traditional spooned purees, but using foods that the baby
to some confusion about the conclusions that can, and have can feed themselves – although I remember from my own
been, drawn from the copious world-wide evidence that differ- children that this is likely to include foods that a polite adult
ent organisations and governments use to make their recom- would feel require cutlery!
mendations. We have also seen that more recent advice has • Consider the baby-led approach where the child takes
led to problems for parents who follow it and those encouraging the majority of the responsibility for choosing and feeding
them to do so. My hypothesis is that these are because the themselves from the selection of the family meal (6). This
recommendations about the timescale are unsupported by an is controversial as the concept of ‘baby led weaning’ is too
understanding that changing the timing also necessitates a re- new in this country to be backed with better than anecdotal
think of the method. evidence.
• Probably most importantly, remember that babies learn a lot
When to wean
from observation and imitation. A food that the baby sees
Few readers of this publication will be unaware of the recom-
a carer apparently enjoying themselves, and offering with
mendation in this country (based on WHO advice) (3) to start
positive words and facial expressions, is likely to be happily
the introduction of solid foods at around six months for breast
accepted.
fed, and by extrapolation rather than copious evidence base,
also for formula fed, infants. However, there are fewer advisors,
These changes to the traditional approach are underpinned
and even fewer parents who are aware that later weaning ne-
by the aim to get to at least the same stage of experience of
cessitates a change from the traditional (and well established
tastes and textures that the traditionally weaned baby reach-
since the 1994 COMA guidelines (4) that embedded the prac-
es at seven months (7). Although we have yet to have a big
tice of weaning at 17 weeks) method of taking several months
enough cohort in this country to produce a convincing body of
to move from one spoonful a day of very sloppy, lump free,
evidence to endorse this approach, anecdotal evidence indi-
low allergen foods towards three meals and lumps at seven
cates that it is a quick way, with a limited period of messiness,
months.
that develops children who happily eat a wide variety of types
The easily found and trustworthy Change4life website (5)
and textures of foods; thus ensuring the healthy balanced diet
endorses the ‘expert baby’ approach with the following advice:
described in Nigel Denby’s article Early years’ nutrition (NHD
‘Your baby is ready if they can:
Dec/Jan pg 10).
• stay in a sitting position and are able to hold their head
steady; References
• co-ordinate their eyes, hands and mouth, can look at food,
1 Rotherham Infant feeding Guidelines. www.rotherhampct.nhs.uk/trific (accessed Jan 2010)
2 Sheffield Infant Feeding Guidelines. www.sheffield.nhs.uk/professionals/infantfeeding.php
grab it, and put it in their mouths all by themselves;
(Accessed Jan 2010)
• swallow their food. Babies who are not ready will often push
3 Department of Health NHS Choices website. www.dh.gov.uk London (accessed Jan 2010)
4 Department of Health (1994) Report on Health and Social Subjects No. 45. Weaning and the
their food back out, so get more around their faces than
Weaning Diet: Report of the Working Group on the Weaning Diet of the Committee on Medical
they do in their mouths.
Aspects of Food Policy. HMSO London
5 www.nhs.uk/start4life (accessed Jan 2010)
6 Rapley G, Murkett T. (2008) Baby-led Weaning: Helping Your Baby to Love Good Food. ISBN-
These signs tend to appear together at around six months.’
10 0091923808. Random House, London
To achieve multiple taste and texture acceptance, along with
7 Coulthard H, Harris G, Emmett P. (2009) Delayed introduction of lumpy foods to children dur-
ing the complimentary feeding period affects a child’s food acceptance and feeding at 7 years of
progression to a diet high enough in iron to meet the child’s age. Matern Child Nutr: Jan; 5(1): 75-85
NHDmag.com Mar '10 - issue 52 23
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