>There are a few colleagues who omit these key references from their
>discussions of the timing of complementary feeding, and insist on
>recommending complementary foods from 4 months or using the outdated
>terminology of "4-6 months."
I would hardly call the World Health Organization "a few colleagues." The
4-6 month terminology is still the language of the WHO, so it can hardly be
described as outdated. Once it has officially been changed by the WHO (if
that EVER happens), then it would become outdated, but it is not currently
outdated.
>It is of course important to recall that according to international
>definitions, an infant who receives expressed breastmilk in the mother's
>absence is exclusively breastfed.
Also, any infant who has received only breast milk for the past 24 hours is
"exclusively breastfed" according to WHO research protocols. So the sick 3
year old who hasn't had any solids for the past 2 days is exclusively
breastfed.
>[The point I (Ted) would add is that the definition of what constitutes "not
>gaining weight adequately" in breast-fed babies is not always well
>understood and indeed will be clearer once WHO has completed its ongoing
>multi-center study of the growth of predominantly breast-fed babies. But
>health workers ought perhaps to be warned that a seeming reduction in the
>velocity of growth during the period 3-6 months may in many cases be at
>least partly due to problems inherent in using the WHO (NCHS) growth curves
>to monitor growth in breast-fed babies. These standards were based on babies
>who were largely bottle fed and we now know that their pattern of growth is
>different.
With all sincere due respect to Dr. Greiner, the NCHS growth curves are a
mixture of breastfed and bottle-fed kids, and most of them (breast and
bottle) started on solids quite early, and some of them were drinking
home-made formulas and not a single one of them were drinking the
commercial formulas available today.
And what we know about the "different" patterns of breastfed babies' growth
comes mainly from the DARLING studies of Dewey and colleagues, and
(according to Kay Dewey herself) they were studying US children who were
*mostly* breastfed on a 3-4 hour schedule and who *mostly* slept in cribs
in separate rooms and who *mostly* were sleeping through the night from an
early age. So it isn't at all clear how exclusively BREASTFED babies grow
when they are fed on demand and throughout the night and cosleep with their
mothers. We do not in fact know whether their growth patterns are similar
to the NCHS standards, whether as a group they start to falter between 3-6
months relative to the NCHS standards, or if, in fact, they grow faster
than the NCHS standards.
Even the new and improved WHO standards due out in 2003 based on babies fed
according to current WHO guidelines of exclusive bf for 4-6 months followed
by appropriate and safe solids are not taking into account how often babies
are breastfed, where they sleep at night, or whether they are encouraged
not to breastfeed at night. Thus, we may NEVER know what the normal growth
patterns are like of co-sleeping babies fed on demand. Remember that it
takes HUGE sample sizes to encompass enough variation to construct growth
standards.
I know I sound like a broken record . . . .
----------------------------------------------------------------------------
-------
Katherine A. Dettwyler, Ph.D. email:
[log in to unmask]
Anthropology Department phone: (409) 845-5256
Texas A&M University fax: (409) 845-4070
College Station, TX 77843-4352
http://www.prairienet.org/laleche/dettwyler.html
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