Download So why from around 6 months?

MILK & MORE
Helping children eat for
a healthy life
Rosemary Brown
CPHVA conference
June 2013
What are we aiming for?
 Healthy, active child able to enjoy life –
now & later
What are we aiming for?

Happy, secure child through good
relationships
What are we aiming for?
 Child who enjoys food…
… without feeding
becoming a battleground
What are we aiming for?
 Child who eats enough for their needs
…but not too much
How can we achieve that?
 Encourage what will build positive
relationships from the beginning


Harness a child’s inbuilt ability to regulate
his/her own intake
Enhance parents’ knowledge, skills and
confidence in enabling development of
healthy eating habits
Government recommendations:
Breastfeed
exclusively for 6
months, then

Continue to
breastfeed until at
least 1 year, whilst
offering solid foods
from around 6
months

How does breastfeeding help?
 Custom-made food and drink for baby,
adapting to meet changing needs of
baby
How does breastfeeding help?
Nucleotides
F
O
Contains many
ingredients not
present or active
in formula
A
Anti-inflammatory
R
Bifidus factors
E
Oligosaccharides
A
Antibodies
S
Growth factors
M
L
Viral fragments
B
Enzymes
R
U
White blood cells
T
Transfer factors
M
Vitamins/minerals
Vitamins/minerals
I
Fats
Fats
Carbohydrates
Carbohydrates
L
Protein
Water
Protein
Water
K
How does breastfeeding help?

Breastmilk contains many protective
factors, lowering the risk of infection &
other diseases for babies and mothers:

reducing all common childhood infections

1/3 risk of SIDS

reduced risk of breast and ovarian cancer for mum

15% fewer GP visits in first 6 months

2004)
decreased hospital admissions
(McConnachie et al
(DH quarterly figures)
How does breastfeeding help?

The hormones of breastfeeding (prolactin &
oxytocin) and physical closeness facilitate:

connecting up helpful pathways in brain

good bonding & protective instincts in mum

stabilise baby’s heartrate,
breathing, temperature,
blood sugar

calm the baby & help the
mum relax & rest
How does breastfeeding help?

Facilitates baby regulating intake to meet
needs:

hunger cues enable responsive feeding

more control over flow and how much they take

leptin: hormone regulates appetite and energy

learn to recognise when they are full – need
metabolism
several weeks of breastfeeding before this begins
(Brown & Lee 2012)

lower protein and energy in breastmilk reduces fat
deposition -> lower risk of obesity (McCrory et al 2012)
Enabling breastfeeding

Skin to skin contact at and after birth

Help to ensure effective attachment:
C close to mum, chin indenting breast
H head able to tip back – nipple protected, big
mouthful more from underneath of breast
I in line – head & body in line helps swallowing
N nose to nipple – stimulates wide gape
S sustainable & comfortable for mum
Recognising effective feeding


Use breastfeeding assessment ourselves
Empower mum to look for signs of effective
feeding
 deep suckles AND swallows





baby calm at breast
baby content after most feeds
at least 6+ wet and 2+ dirty nappies a day
pain-free for mum
baby alert, when awake, with good colour and tone
How can we achieve that?
 Bottle feeding: intake depends on:
 teat stimulating baby to suck, whether hungry
or not


size of teat
expectations of mum/tin/society as to
quantity and frequency
 tends to be more mother-led

can involve less interaction &
closeness & more people
How can we achieve that?
 Bottle feeding : important to encourage
responsive feeding

watch out for and follow hunger cues

let baby decide quantity

allow baby to draw teat into mouth

take bottle out from time to time

hold baby close with eye contact, smiles, talking

limit caregivers

use first stage milk
How can we achieve that?
 Start offering solids when:
 they are developmentally ready to cope well &
eagerly with solids
 nutritional needs no longer met completely in
breastmilk or formula
 usually around 6 months – not too early or too
early or too late
 Allows baby to continue to
control own intake
 Baby develops skills & good eating lifestyle
So why from around 6 months?
 Breastmilk,
or formula,
has all they need till then:
- energy for growth
(Nielsen et al 2011; Wells et al 2012)
-
for adequate iron stores
(Jonsdottir et al 2013)

Giving anything else
displaces breastmilk
(Wells et al 2012)
So why from around 6 months?
 Their
body systems
are mature enough


Needed enzymes are
present
Breastfeeding whilst
whilst starting solids
seems to reduce risk of
allergies (Akobeng et al 2006)
So why from around 6 months?
 Can
sit up
with
support
 Safer
 More
able to
reach out
for food
So why from around 6 months?
 Interested
in food – no
coaxing
needed!
 Start by
watching
people eat
from 4-5
months
So why from around 6 months?
 Then
reach out and grab objects, take
to mouth & chew on them
So why from around 6 months?
 Eager
to eat and feed themselves
 Encourages baby-led feeding & may
reduce parental anxiety
So why from around 6 months?
 Good
eye
& hand
coordination
& motor skills
(Wright et al 2011)
 Feeding
themselves
develops skills
So why from around 6 months?
 Tongue
able
to move
food
around
mouth
 Munching
action
So why from around 6 months?


Able to swallow solid
foods – learn to gum and
gnaw before learning to
swallow (Naylor & Morrow 2001)
Can cope with lumpier
foods from beginning, so
no need for purees &
less work for mum
 Breastfed babies accept
new tastes more easily
So why from around 6 months?
 Able
to take food
off spoon without
constantly pushing
it out with tongue
 Able to eat almost
everything (e.g.
fish, eggs, dairy
foods)
So why from around 6 months?
 Reflex
causing
baby to gag
moves
further
back,
but still
is safety
mechanism
So why from around 6 months?
 Great
sense of achievement!
Look for 3 signs together:



Can sit and hold head steady
Picks up food & puts it in mouth
Swallows some – not pushing it
all out again
How to start

Start with 1 meal a day, after or between milk
feeds – time when baby not too hungry or
tired

Build up to 3 meals & 2 healthy snacks by 1 yr –
baby’s stomach small

Give baby finger foods to pick up in fists to
eat – finger-shaped pieces (Baby-led weaning cookbook)

Offer softly cooked or mashed foods on a
spoon – can add a little breastmilk or formula
to mix.
How to start



Offer wide variety of food from all the
food groups from the beginning
Increase lumpiness of foods quickly
Be prepared to offer new food many
times (up to 20) – babies show they
recognise new food by spitting it out!
 Baby’s
tummy about the size of baby’s
fist – use this as guide to portion sizes
Encourage good eating lifestyle




Sit baby up to eat and stay with him/her
Let baby participate in
family meals - and
preparation when older
Avoid distractions during
meals
Be prepared for messy eating – bib, food on clean
highchair surface, plastic sheet on floor
Follow baby’s pace & cues
 Wait
for baby to open mouth for spoon
Follow babies’ cues
showing they have had
enough – turning head
away, pushing food away

Learning to drink from a cup
 Use
open cup (or one with
free flow spout) to give
fluids – water, milk
 Wean
off any bottles &
dummies by 1 year
Encourage a relaxed approach




Praise good eating
Don’t use food as
rewards
Look at what baby
eats over a week
rather than a day
If they are not
interested, wait till
next mealtime
So what do they need?


Milk still major source of
nutrients until 2 years - and
protection, if breastfeeding
Food from all food groups:

raw or softly cooked vegetables and fruits –
starting once day, 4 times a day by 1 year


starchy foods – potatoes, rice, pasta, plantain
protein foods – soft well-cooked meat and
chicken, fish, eggs, meat, pulses and beans, dairy
foods - 1-2 a day by 1 year
Just a few guidelines:

Use whole milk – wait till 2 yrs to use semi-skimmed &
5 yrs for skimmed milk – young children need the fat
content for calories without bulk and to carry vitamins
Cut up any small round or coin-shaped food
 Make sure egg is well-cooked – yolk & white firm
 Avoid:

salt & sugar or salty/sugary snacks, including juices
and squash.
 honey, in 1st year – rare danger of botulism
 reduced calorie or low fat food
 very high fibre food – fills stomach too quickly
 tea/coffee – reduce absorption of vitamins
 whole nuts till 5 years – danger of inhaling
 rice or soya “milk” or goat’s milk – not suitable

Vitamin supplements

Vitamin drops A, C & D are
recommended :
From 6 months, if:
- breastfed
- taking less than 500ml
formula per day
For all children 1-5 years
From 1 month if mother has not
taken vitamin D in pregnancy
Help parents know where & how to
obtain them
Mums to take Vit D and folate while
pregnant and breastfeeding
Why is Vitamin D needed?
Healthy diet is not enough: 90% of
our vitamin D comes from sunlight
 Sunlight not enough Oct-March
 1 in 4 people in UK have low vitamin D
 Darker skins take longer to
absorb enough from sunlight
 Hijabs etc -> less sunlight exposure
 Safe sun messages – only a short time
of exposure needed
 Increased indoor pursuits
 Obesity: affects production & use
 Deficiency -> rickets, seizures in
babies, smaller pelvis, lower immunity

Make mealtimes fun…
& eat together!
Many thanks to Maya Tammam & the Goodinge support group for being wonderful
visual aids! (Maya photos ©Jonathan Tammam)
Resources
• Leaflets (Start4Life - DH):

‘Introducing Solid Foods’

‘Building blocks for a better life’

‘Off to the best start’ (breastfeeding)

‘Guide to bottle feeding’
Islington (PDF in English & 7 other languages):

‘Milk & More: starting your baby on solid foods’

‘ Drinks for children up to 5’

‘ Snacking for children under 5’

‘ Vitamins and minerals for children 1-5 years old’
• ‘Milk and More’ training pack and recipe book
• Websites:
Resources
 www.firststepsnutrition.org
 ‘Infant Milks in the UK’: independent info re
formula milks
 Eating well in the first years of life’ – for
parents and carers – coming in 2013
 www.chew.org.uk
 Breastfeeding and starting on solids:
 www.babyfriendly.org.uk – research & resources
 www.nhs.uk/conditions/pregnancy-and-baby
• The Baby-led weaning cookbook (Rapley & Murkett)
References:
Akobeng A.K et al (2006) Effect of breastfeeding on risk of coeliac disease: a systematic review and meta-analysis
of observational studies, Archives of Disease in Childhood, 2006(91), 39-43
Brown, A. & Lee, M. (2012) Breastfeeding during the first year promotes satiety responsiveness in children aged 1824 months. Pediatric Obesity.2012, 7, 382-390
Cameron, S., Heath, A-LM.., & Taylor, R.W (2012) How feasible is baby-led weaning as an approach to infant
feeding? A Review of the evidence, Nutrients 2012, 4, 1575-1609
Cameron, S, Heath, A-L.M. & Taylor, R.W (2012) Healthcare professionals’ and mothers’ knowledge of, attitudes to
and experiences with, Baby-led Weaning: a content analysis study, BMJ Open 2010:2:e001542
DH quarterly figures, including comparison between breastfeeding prevalence and prevalence of hospital
admissions
DH (2013) Diet and Nutrition Survey of Infants and Young Children, 2011 (available on DH website)
Jonsdottir O.H. et al (2012) Timing of the introduction of complementary foods: a randomized trial, Pediatrics,
2012:130:1038-1045
McConnachie A. et al (2004) Modelling consultation rates in infancy: influence of maternal and infant
characteristics, feeding type and consultation history, British Journal of General Practice, 2004, 54, 598-603
McCrory C. & Layte, R.(2012) Breastfeeding and the risk of overweight and obesity at nine-years of age, Social
Science and Mediecine 2012:Jul:75(2):323-30
Naylor, A.J. & Morrow, A.J (2001) Devclopmental readiness of normal full term infants to progress from exclusive
breastfeeding to the introduction of complementary foods, Wellstart International and the LINKAGES project
Nielsen S.B. et al (2011) Adequacy of milk intake during exclusive breastfeeding: a longtitudinal study, Pediatrics
2011:128:e907
Rapley G. & Murkett T. ( 2011) The Baby-led Weaning Cookbook
UNICEF (2012) Preventing disease and saving resources: the potential contribution of increasing breastfeeding
rates
Wells, J.C.K et al (2012) Randomized controlled trial of 4 compared with 6 mo of exclusive breastfeeding in Iceland:
differences in breast-milk intake by stable-isotope probe, American Journal of Clinical Nutrition, May 16, 2012
WHO (1998) Complementary feeding of young children in developing countries: a review of current scientific
knowledge, WHO
Wright, C.M. et al (2010) Is baby-led weaning feasible? When do babies first reach out for and eat finger foods?
Maternal and Child Nutrition
Contact
• For more information:
Rosemary Brown
Infant Feeding Coordinator, Islington
0203 316 8441
rosemarybrown1@nhs.net