Mary Fewtrell_SMALL

Can optimal complementary feeding improve later health and development?

Prof. M. Fewtrell | Posted: Sep 01, 2016

In this blog prof. Mary Fewtrell discusses exclusive breastfeeding and impact of timely introduction of solids in managing allergies and celiac disease.


Prof. Fewtrell, you talk about feeding practices in general and the important aspect of breastfeeding, duration of breastfeeding and the key recommendations by WHO. 

When we look around the European countries where the cultures are different in each country, they have different reports on duration of breastfeeding, in UK, for example, it's the duration is even shorter. 

What are the reasons? What do you think? 

We may have better figures than some other areas so the data could be perhaps more reliable. Breastfeeding rates are actually increasing, mothers are taking note of the advice of breastfeeding and we emphasize this importance, so breastfeeding rate is increasing what is not increasing is the proportion of exclusively breastfeeding for six months as they have advised.

Actually there has been a shift in when solid foods are being introduced so if you look at the figures over the last 10 or 15 years there has been quite a change from the majority of babies having solids before four months. Now it is more than five months. Most mothers are now introducing solids at four or five months. 

Is there any disadvantage if mothers introduce solids after four months rather than after six months, in terms of allergies, preventions and celiac diseases? 

Recent evidence on celiac disease from two randomized trials that looked at the timing of introduction of gluten neither of them suggested that introducing gluten either from 4 to 6 months or from 6 to 12 months had any impact on the eventual occurrence of celiac disease. 

It was basically determined on underlying genotype whether you had one of the risk alleles so in that sense probably it may not matter when you introduce gluten. 

In terms of allergy at the moment I don't think we have sufficient data to say that introducing allergenic foods beyond 4 months is either the good or bad. 

We have a number of randomized trials in progress which are looking at introduction of eggs, peanuts and a variety of allergenic foods from 3 to 4 months versus delaying them and I think by next year we should have some more data which will allow us to get better advice. 

In the meantime when solids can be introduced probably depends on where the babies are living. 

As we have repeatedly said if a baby is in a low-income country with no clean water or adequate complementary foods, then more prolonged exclusive breastfeeding is clearly the right thing because it protects against infection and may be life-saving in that situation. 

If we are talking about Europe for example, the UK, where the risk of the baby come to harm from infection is less, then potentially there could be some advantage having the solids from 4 months maybe we need to be less dogmatic and advising moms to exclusively breastfeed for 6 months doesn't seem to be what they feel is right for their baby. 

One last question: Is there evidence if you that introducing solids before 4 months of age are related to an increased risk to childhood obesity? 

The data for most of these outcomes is not exactly black and white and there is a suggestion from some observational studies that babies that had solids introduced before 4 months have a higher risk percentage of fat rate in childhood. 

However it is an observational studies and of course there are lots of potential confounders that could explain the relationship. I think we are being cautious but the data that we have although it is not perfect, would suggest that we should not probably introduced before 4 months and in any case there is no nutrition requirement for the baby to have solids at that point, 4 months is a pragmatic figure at the moment.

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