Getting on to Lactnet was one of my summer priorities, and here I am, still
computer-illiterate but tuned in via Macintosh. Kathleens A and B, I am
sure to do something dreadful in the process of learning, but am trying not
to! G'day everybody and hugs to those of you I've been missing from ILCA
BOD and other times. I have great resolutions to say little, which those of
you who know me know will be almost impossible, but I REALLY can't spare
the time to even read all this stuff I'm getting, fun though it is, much
less join in. My desk is full of unanswered letters and faxes after 6 weeks
off having surgery and recovering. For those of you I haven't yet met, I'm
one of the original IBCLCs from 1985, not grandmothered then although a
part of that original meeting setting up IBLCE; facing the exam again this
year after 11 years certification. I'm an historian, writer, advocate,
educator of health professionals, self-employed and loving my work, which
this year will include teaching in most Australian states and overseas.
Mother of 3 great kids 20, 18, 16, who were responsible for getting me into
breastfeeding and out of academia twenty years ago. (They are also
responsible for some of my grey hairs.) I worked as a volunteer for Nursing
Mothers for many years under different titles; still run a course with them
to benefit the Lactation Resource Centre (you should all be subscribers to
the LRC); was one of the founders of ALCA (Australian Lactation Consultants
Association); member no 23 in ILCA;ILCA PAB member and former BoD member;
have worked on BFHI and lots of other international projects with WHO among
others: in short one of the middle-aged dames of this movement who has
watched the field blossom beyond belief...Well, I was going to lurk for a
while but then I read Jan Barger's (g'day, darlink) bit re 4 month solids:

"Somewhere I read/heard/? that the reason for the 4-6 months was that ABM fed
babies needed the vitamins, iron, etc. that was in the solid foods at 4
months because the formula wasn't adequate for their needs beyond four
months.  Brfed babies didn't need it until around 6 months -- so as not to
offend anyone, the AAP made the recommendation 4-6 months so that it covered
everyone.  (But, maybe this is all wishful thinking on my part.  Anyone else
"hear" this?)" end of quote.

How can I resist giving this detail, from p. 311 of Breastfeeding Matters
(1985), which won't be back in print (new edition) for another few months,
so I can't recommend you read it there: square brackets indicate current
annotations.
"We must insist upon this sort of clear-cut distinction between human milk
and its artificial substitutes, and not permit breastfed babies to suffer
because of some desire to average it all out and keep everyone happy.  This
moral cowardice masquerading as pragmatism is best exemplified by the
current recommendations for the introduction of solid foods. The American
Academy of Pediatrics Committee on Nutrition made a recommendation in 1980
that all babies be introduced to solid foods between four and six months of
age, after previously exclusively breast milk or formula-feeding.  As a
later letter to Pediatrics pointed out, their reasoning was: disappearance
of the extrusive reflex at four to five months; ability to indicate satiety
by five to six months; development of appreciable IgA levels by seven
months.  A more appropriate recommendation (but unpopular) would have been
to introduce other foods no earlier than six to seven months where
possible. This squares with Kajosaari and Saarinen's work on allergy,
where exclusive human milk feeding to six months rendered negligible the
rates of food allergy at 12 months. For infants given solids between three
and 6 months, the incidence was 37 per cent. For infants given solids after
six months, it was 7 per cent; the children had strong family history of
allergy, yet only 14 per cent (compared with 35 per cent) had eczema at 12
months.  Clearly six months' exclusive human milk feeding must be the
optimum goal.

But why did the AAP Committee recommend between four and six months?
Because of the possible risks of prolonged exclusive artificial feeding, as
a letter from the Committee Chairman, Lewis Barness, published in
Pediatrics, makes clear: 'Trying to convert from previous practices of
feeding solids at 1 month of age to the present recommendations must be
done step-wise.  A compromise was felt to be necessary.  For breastfed
infants there seems no advantage and some disadvantage to early
supplements. When one uses an artificial formula, no matter how good, one
must beware of possible missing ingredients. Weighing advantages and
disadvantages, the Committee on Nutrition felt that 4 to 6 months of age
was reasonable with present evidence.'
But why penalise breastfed infants because of 'possible missing
ingredients' in formula?  Why not have two distinct sets of recommendations
for the breast- and bottle-fed infant?

* Exclusive human milk feeding FOR AS LONG AS GROWTH AND HEALTH REMAIN
GOOD. [I'd strongly emphasize that, as babies are all individual and many
need other food after 4 months; many others not till 7 months or even
later. WHO recommendations are the way to go. And a WHO monograph on the
growth of exclusively breastfed kids is available from the Nutrition Unit,
WHO, 1211 Geneva 27.] Only a generation ago many mothers took it for
granted that nine months was the age for giving other foods, and many
thriving Australian babies are exclusively breastfed for similar
periods.[But by the way, there are good studies from the 1920's onwards
suggesting poor intellectual outcomes if exclusive breastfeeding is
prolonged beyond 12 months, though what those studies usually don't say is
that infants who refuse all other foods past 12 months despite appropriate
offers of interesting food are usually infants with severe intolerance
problems, and most of the rest live in conditions where breastmilk is all
there is to offer. That said, the protein demands of the older child are
hard to meet with breastmilk alone. And I have talked with the parents of a
baby who died of malnutrition at 19 months on breastmilk alone, despite its
parents' best efforts to give other foods. Basic problem was prematurity
and lung damage not appropriately followed up with oxygen therapy: kid
couldn't breathe when eating anything else and so refused to try; parents
were being told by a naturopath that breastmilk alone was fine; the child
became progressively more lethargic. No one talked to them of the
importance of the quality of weaning diet, and what they offered was
vegetables, low in fat and protein, the kind of diet that so often leads to
poor weight gain betwen 4 and 6 months once parents introduce such solids.]

* Exclusive use of a new, yet-to-be developed low-allergy formula for
infants unable to be given human milk, with the addition of other foods
after three or four months to try to guard against possible unsuspected
deficiencies in the formula, industrial accidents, and the like.

Why not?  This is clearly the logical solution, but it would cause mothers
to ask questions about the 'equivalence' of formula..." end of quote from
BFM.

Best wishes, Lactnetters (Lactnutters? my children enquire.) Remember the
turtle, "who only makes progress when he sticks his neck out" (but who also
knows when to pull his head in: both are essential to survival without
burnout.) And may you all develop the necessary tough shell to cope
long-term with the knocks in this fascinating profession.  MM