BMJ 2011: 342: 179 – 236 (22nd Jan)

Only one article of note, but an absolute doozy of one – a paper by Mary Fewtrell, David Wilson, Ian Booth, and Alan Lucas (yes, I am shamelessly courting the Googlers), questioning the current advice to delay solids until six months.  The whole topic of whether or not babies should remain exclusively breastfed until six months happens to be a special interest of mine, so I have been spending hours and hours reading the various papers referenced by both sides of the argument and forming my own opinions.  I actually plan to write about this in a lot more detail on my other blog, so a quick summary here:

1. Despite what everyone is heatedly claiming, there is no good evidence that delaying solids until six months has any health benefits for babies in the Western world over and above introducing them in the preceeding couple of months.  (This is my conclusion from reading the WHO review and the PROBIT trial findings, not the conclusions of the authors of the BMJ paper.  Despite the accusations being hurled left, right, and centre that they’re mere stooges for the baby food industry, they were, in fact, far easier on the gaping weaknesses on the whole delay-solids-until-six-months guideline than I would have been.)

1. Iron deficiency may be a problem in babies whose umbilical cords were clamped immediately after birth and who delay solids until six months, especially if they were small for dates and/or premature.  Male sex is also something of a risk factor.  Whether or not this is likely to be a clinically significant problem in terms of affecting development is uncertain; however, it probably isn’t, for reasons which I shall go into on my own blog.  Of course, given that delaying solids seems to have so little clinical advantage, you could always give some pureed meat or spinach before six months if you’re concerned.

3. There is some evidence that introduction of gluten before six months may reduce risk of coeliac disease (celiac disease, for the Googlers from the USA) or Type 1 diabetes in infants with a strong family history (i.e. a first-degree relative) of either of those conditions.  It’s not conclusive as yet, especially for diabetes, but it’s harmless as interventions go and I do have to say that if I had a baby with a family history of either of those conditions I would try giving small amounts of bread from about 4 – 5 months.  Other useful strategies for preventing these problems in high-risk children include breastfeeding, introducing gluten-containing foods slowly and gradually, and continuing to breastfeed until after the baby has got to the point of taking reasonable amounts of gluten in the diet.  (And, in the case of babies with a family history of diabetes, delaying the introduction of cow’s milk – this is one of the few situations in the developed world where avoiding even occasional formula supplements may well be important.)

I’ll put the links to my other blog in when I have them.


About Dr Sarah

I'm a GP with a husband and two young children.
This entry was posted in Paediatrics and tagged , , , , . Bookmark the permalink.

One Response to BMJ 2011: 342: 179 – 236 (22nd Jan)

  1. I’m not sure where you are getting your information, but good topic. I needs to spend some time learning more or understanding more. Thanks for great information I was looking for this info for my mission.

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