Jodine's post about obesity and the "normalizing" of affect of living in a society where half
the population is obese got me to thinking about the solids-obesity connection, and the
"normalizing" affect of the AAP establishing one year as the minimum for breastfeeding.
I think one unintended consequence of setting the minimum so low is that mothers infer it
is ok to wean babies off BM and onto solids foods by their first birthday, and certainly the
"window of opportunity" theory has played a major role in this misconception.
I was emailed this quote from Breastfeeding: A Guide for the Medical Profession by Ruth
and Robert Lawrence 2005 edition (page 360), which refers to the "research" I mentioned
(without citation) in my first post about the "window of opportunity" theory:
....by 7 to 9 months, rhythmic biting movements occur regardless of the presence of
teeth. Biting and masticatory strength and efficiency progress throught infancy. If a
stimulus is not applied when the neural development is taking place, Merchant believes
that the chewing reflex will not develop and the infant will always be a poor eater. There
is a relationship between prolonged sucking without solids and poor eating. The clinical
model for this is the child sustained on parenteral feedings or gastrostomybeyond a year
who has tremendous difficulty accepting foods.To me the operative words in Lawrence
are "Merchant believes..." She did not say "Merchant, demonstrated that infants who
were not introduced to solid foods between 7-9 months of age never developed the
capacity for "chewing" and were always poor eaters."
Adherents to the "window of opportunity" theory accept prima facie Merchant's wild
extrapolation, that ALL babies- not just ones who haven't been fed orally from birth- but
ALL babies have a "window of opportunity" between 7-9 months of age. Secondly they
extrapolate that the "stimulus" that must be "applied" must be solid food- they fail to
consider that breastfeeding is much closer to "chewing" than bottlefeeding. Thirdly they
extrapolate that if the "stimulus" must be solid food, solid food must be good for babies.
In my opinion the "window of opportunity" theory and the susbsequent extrapolations
have done a lot of harm to the proper management of breastfeeding, and even to the
nutrition of babies who never have been breastfed, because adherents of the "window of
opportunity" theory encourage practices which displace BM (or ABM) from the infant's diet
with solid food, as if there were no harm in doing so- as if it were good to wean babies
off BM and onto solids during 4-12 months of age.
As my mentor in LLL used to say, "What do they (zealous proponents of weaning) think
happens to breastmilk after six months? Do they think it turns into Kool-Aid?"
Solids are not good nutrition for a baby, and the over-use of solids is the number one
cause of infant and toddler malnutrition all over the world- not food scarcity. Overfeeding
solids so diminishes the nutritional status of the baby and toddler that it makes the child
more vulnerable to death from disease.
In the West often (but not always) we can save our babies and toddlers with drugs and
therapies from the diseases that result from the displacement of breastmilk from the
infant's diet. We are so successful at saving these babies that the much of mainstream of
the medical profession sees no problems with displacing BM from the infant diet with
solid food.
This is absolutely analogous to the consensus opinion about displacing BM from the diet
with ABM-the attitude is "breast is best" but "ABM does no harm." Just as it is false that
ABM does no harm, it is false that solid foods do no harm. Besides the obvious
immunological and metabolic disadvantages of going from BM to ABM there are
nutritional and simple mechanical problems from going from BM to solid food too early.
If a baby or young toddler is forced to get his nutrition primarily from solid food it puts
him at risk of becoming an obese older child and adult. Since solid food is not
nutritionally or calorically dense- since it is bulky- a baby and young child is forced to
stretch his stomach beyond its normal physiologic capacity in his efforts to get all the
nutrition he needs from solid food.
Babies who have reflux, or other issues, have even more difficulty than the healthy child
in trying to make this compensation, but they are merely canaries in the coal mine-their
problems are noticed first and are the most severe but all babies have negative health
consequences when they are overfed solids.
Babies who are having difficulty making the compensation (eating beyond the normal
physiologic capacity) tend to be thin or FTT, but over-feeding solid to infants, even if it
does not make them skinny as babies, tends to make them fat as older children and
adults. This paradox is known as the "double burden of infant malnutrition." The
malnourished infant and toddler is more likely to become an obese adult.
How much of the American obesity epidemic, how many gastric by-pass operations could
be traced to infant and toddler feeding practices? How ironic that so many diets use
nutrient dense liquids and eating small frequent meals as part of their regimen!
With the exception that in early infancy babies get more efficient with their use of
calories so fewer calories are needed per pound of body weight over time, in otherwise
healthy older babies caloric intake is kept more or less constant for weight. When
mothers feed solids without nursing first they are displacing breastmilk from the child's
diet and replacing a superior food with an inferior one, and setting their children up for
weight control issues in later life.
Wherever the "window of opportunity" theory reigns, mothers will displace solids from
their babies' diets instead of maintaining their milk supplies and letting the baby slowly
incorporate solids as he needs them. Until the medical profession abandons its bogus
"window of opportunity" theory babies and toddlers will be fed less than optimal amounts
of breastmilk.
It is prudent to offer solids after breastfeeding after six months in case there is a small
shortfall between infant need and mother's supply, but when a mother has a normal milk
supply, and she nurses before offering solids, the quantity of solid food the baby 6-12
months of age will consume can be measured in teaspoons to a couple of tablespoons per
day, not tablespoons or ounces per meal.
If a baby is consuming more than a couple of tablespoons per meal to ounces of solids
per day assess the mother's milk production- it will be low. When a mother does not have
a normal milk supply, and her supply cannot be quickly improved, (and donor milk is
unavailable), the shortfall should be made up primarily with ABM not solids.
It is not enough to put weight on a baby-not all weight put on a baby is equal-the weight
needs to be from nutrient dense foods- BM preferred followed by ABM-to combat the
double burden of malnutrition that too much solid food imposes.
Solid food is too bulky, not caloric or nutritionally dense enough to be good nutrition for
any child under a year and half of age even if he is NOT failure to thrive. The principles
of good nutrition apply even more to the sick baby than to the well baby and that means
virtually every calorie put into a failure to thrive baby or toddler should be nutritionally
and calorically dense therefore more solid food should not be the prescribed treatment
for a FTT baby or the baby whose mother has a low milk supply, the treatment should be
mother breastfeeding and if the mother is unwilling or unable ABM should be preferred
over solid food.
Just my two cents (or so) ;-)
Jen O'Quinn IBCLC
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