Age of Weaning - Recommendations

In 2003 the Department of Health (DH) issued new recommendations that mothers should exclusively breastfeed their baby for the first 6 months of life¹. At the same time they also reviewed their guidance on the introduction of solid foods.

This guidance states:

• Breastmilk is the best form of nutrition for infants
• Exclusive breastfeeding is recommended for the first 6 months (26 weeks) of life
• Six months is the recommended age for the introduction of solid foods for infants
• Breastfeeding (and/or breastmilk substitutes, if used) should continue beyond the first six months, along with appropriate amounts of solid foods

These recommendations apply to all healthy infants regardless of whether they are breast or formula fed.

More recently, the European Society of Pediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN) Committee on Nutrition published a review paper on infant feeding².

They concluded that:

• Exclusive or full breastfeeding for about 6 months is a desirable goal
• Complementary feeding (i.e. solid foods and liquids other than breastmilk or infant or follow-on formula) should not be introduced before 17 weeks and not later than 26 weeks.

What does this mean for Healthcare Professionals?
Healthcare professionals should follow the DH advice and encourage mothers to exclusively breastfeed their baby for 6 months and introduce solid foods thereafter. However, it is important that infants are managed on an individual basis to ensure adequate nutrition and growth¹.

Why has the DH guidance changed?
In 2000, the World Health Organisation (WHO) commissioned a systematic review of the scientific literature on the optimal duration of breastfeeding³. This assessed the effects on health, growth and development of infants in studies where they were exclusively breastfed for 6 months compared to infants exclusively breastfed for 3-4 months.

They concluded that:

• There were no differences in growth between those exclusively breastfed for 6 versus 3-4 months
• No benefits of introducing solid foods between 4 and 6 months have been demonstrated
• Infants who are exclusively breastfed for six months experience less gastrointestinal or respiratory infection

On the basis of these findings the DH changed their recommendation to advise that mothers should exclusively breastfeed to 6 months and that solid foods should be introduced thereafter.
What if parents want to introduce solid foods to their baby earlier than 6 months?
If parents are thinking of weaning their infant before six months then it is important that as a healthcare professional you are able to offer appropriate advice and ask relevant questions to establish whether a baby is really ready for solid foods. Typical questions could include:

• Is baby showing signs of being ready to wean?
  Examples of signs include; sitting up, taking interest in what others are eating, waking in the night when they’ve previously slept through.
• Is baby going through a growth spurt?
  Babies usually have a growth spurt at around 14-16 weeks. During this time they may demand more milk feeds but not necessarily be ready to wean. Parents should be reassured that this phase usually only lasts 1-2 weeks.
• How many feeds is baby getting each day and how long are they going between feeds?
  It may be that parents need to increase the feed volume or offer feeds more frequently. If breastfeeding, mums should increase the duration of the feed.
• If parents are formula feeding, enquire as to which milk they are using.
  It may be beneficial to move to a hungrier baby milk if they are not using one already.
  Click here for more info on products available.

Overall, all infants are individuals and will require a flexible approach to feeding to ensure adequate health. If an infant is showing signs of being ready to wean before 6 months then they should be encouraged¹ and parents should be supported in their decision by their Healthcare Professional. However, parents should be advised that 17 weeks (4 months) is the earliest that solid foods should be introduced¹.

Why should solid foods not be introduced before 17 weeks/ 4 months?
Before 4 months an infant’s renal and gastrointestinal functions are not sufficiently developed to be able to cope with solid foods^4,5. Infants also do not posses the motor skills to cope with foods other than those in a liquid form. This is because their skills are largely confined to sucking and swallowing, making it physically difficult for them to cope with other textures.

Introducing solid foods before an infant is ready can increase the risk of infections and the development of allergies¹.

Strategies to help parents delay introducing solid foods until at least 17 weeks:

• Give advice on why solid foods should not be introduced before 17 weeks and reassure parents that milk is more appropriate than food at this stage even if the volumes are large
• Suggest increasing the milk volume at each feed, or the duration of the feed if breastfeeding
• Suggest increasing the frequency of feeds
• If formula feeding, suggest changing to a hungrier baby milk. Click here for more information on products available.

Click here for informationon Cow & Gate Growing Up Milk for toddlers from 1 - 2 years.Click here for Cow & Gate`s Iron Calculator to help parents check if their toddler is getting enough iron


For more information visit:

DH Infant Feeding Recomendations (click to access)

Nurture & Nutrition article - "The age of weaning, practice and practicalities"

For parents - for practical advice and information on weaning including meal planners, weaning stages, recipes and hints & tips, visit the Cow & Gate website using this link:

Cow & Gate parents website - weaning information

References

1. Department of Health. Infant Feeding Recommendations. 2003. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance
   /DH_4097197 [accessed August 2008]
2. Agostoni C, et al. Complementary Feeding: A Commentary by the ESPGHAN Committee on Nutrition. Journal of Paediatric Gastoenterology and Nutrition 2008; 46: 99-110.
3. Kramer MS & Kakuma R. The optimal duration of exclusive breastfeeding: A systematic review. Cochrane Database of Sysytematic Reviews. 2002. Available at: http://www.mrw.interscience.wiley.com/cochrane/clsysrev/articles/CD003517/frame.html [accessed August 2008]
4. Department of Health. Report on Health and Social Subjects 45 Weaning and the Weaning Diet. London: HMSO, 1994.
5. Fleisher Michaelsen K, Weaver L, Branca F & Robertson A. Feeding and Nutrition of Infants and Young Children. Denmark: WHO, 2000.