20 Oct

Baby-led weaning: where are we now?

Gill Rapley & Tracey Murkett are speaking at the BfN online conference on the 24th October 2020. If you can’t wait until then to delve in to this fascinating topic, here’s a little insight into what they have in store for us:

As baby-led weaning becomes increasingly established around the world, we are often asked about the traditions around introducing solid foods in other countries. This is a difficult question to answer, partly because childcare customs are not always written down and partly because, over the last century, the practice of spoon feeding with pureed foods has penetrated most cultures, pushing out the more traditional ways.

In terms of history, archaeologists have found evidence, from jaw bones, that babies in prehistoric times would have been chewing quite tough foods by around 7 or 8 months. The practice of mothers pre-chewing foods for their babies is also well documented; this persists today although, since the advent of cooking (which enables all types of food to be made soft), it’s more of a symbolic act, rather than being part of day-to-day eating.

We know that it’s normal, in some societies, for babies to forage for molluscs and invertebrates as soon as they can crawl, picking up grubs and insects to taste and eat. We also know that for most of history – and still in much of the world – babies had breastmilk for much longer than is now common in the West. Breastmilk formed an important part of babies’ diets until they were at least three years old, which is likely to have made the move to solids a more gradual process. And we’ve heard from many parents around the world (as well as in the UK) that their grandparents recount how they simply shared their own food with their baby, and the babies fed themselves when they were ready – essentially baby-led weaning, but without the name.

There are now few countries where traditions of childcare and food are simply passed on, mother to daughter. Childcare in the 20th century was marked by ‘experts’ and doctors telling parents what to do, from Truby King to Gina Ford.  One of the effects of taking the expertise away from mothers allowed a new industry to emerge, making money from commercial baby food (and formula), and promoting it as better and more convenient. In most countries today, parents are influenced to some degree by the baby food industry, often via the health care system (despite the best efforts of the World Health Organization and others over many years). The result is similar everywhere: an approach to the introduction of solid foods that is controlled and directed by adults, based on spoon feeding, and structured around timing, measured amounts and the need to introduce foods in a certain order.

Interestingly, the order in which foods are supposed to be introduced, and the list of foods that are not allowed before a certain age, varies from country to country – although each would claim their recommendation is based on science. The amounts dictated (or implied) are different, too. For example, the size of a jar of commercial babyfood is often taken as an indication of the amount the average baby is expected to eat for a main meal by, say, 8 months. But a jar of baby food in Japan is roughly two thirds of the size of the average jar sold in the UK! And of course, the issue of when complementary feeding should start is still hotly debated in many countries, with the babyfood industry campaigning to revert to, or retain, the 4-month rule.

In the UK, as in much of the rest of the world, the perceptions and practices around introducing solid foods to babies have followed a similar path to those relating to breastfeeding. Throughout the 20th century, most guidance for mothers was based on timing and limiting breastfeeds. Babies’ and mothers’ instincts weren’t to be trusted, and the amount of milk a baby consumed needed to be measured and controlled. This was clearly much easier to achieve with formula than with breastmilk.  So, rather than allowing the baby’s development and instincts to lead the way, or relying on the parent’s understanding of what their baby may need, there was unnecessary intervention. The effect of this was to take away the baby’s autonomy and undermine the mother’s confidence (and that of those around her), so that the baby was no longer considered capable of knowing his own needs.

However, there’s been an enormous amount of research around breastfeeding in recent decades. We now know far more now about how babies control their intake of breastmilk naturally at the breast, how the instincts and hormones of mother and baby work together and how babies’ natural behavior should be trusted, rather than controlled or changed. The research around introducing solid food is lagging way behind, and is often compromised by industry involvement. But, as baby-led weaning becomes more mainstream around the world, it’s becoming increasingly clear that we need to take a closer look at babies’ natural behaviour and development around food and eating. Maybe, rather than making assumptions that adult intervention is needed, we should use babies’ instincts and capabilities as our starting point for introducing solid foods.

To find out more about the conference and purchase tickets click here.

12 Oct

Helen Ball: Sleep, Baby & You: development of a support intervention for UK families

Helen Ball has been researching the sleep of infants and their parents for 25 years. She conducts research in hospitals, the community, and her lab, and she contributes to national and international policy and practice guidelines on infant care. She is a Board Member of ISPID (the International Society for the Study and Prevention of Infant Deaths), Chair of the Scientific Committee for the Lullaby Trust, and Assessment Board member for Unicef UK Baby Friendly Initiative. In 2018 Durham University received the Queen’s Anniversary Prize for Further and Higher Education for Helen’s research and outreach work.

In her talk at this year’s BfN Conference, Helen will provide an overview of her latest project to develop and trial a support intervention for parents who may be struggling with infant-related sleep disruption or post-partum fatigue. Here is a brief abstract of the project to whet your appetite!

Disrupted parental sleep, presenting as post-partum fatigue and perceived as problematic infant sleep, is related to increased symptoms of depression and anxiety among new mothers and fathers. Previous research indicates that UK parents would value an approach that facilitates meeting their infants’ needs while supporting their own sleep-related well-being throughout their infant’s first year.

Six initial stakeholder meetings were held with 15 practitioners and 6 parents with an interest in supporting parent-infant sleep needs, to explore existing service provision and identify gaps. The Possums Sleep Program, developed and delivered in Brisbane, Australia in a GP clinic setting, was chosen as an appropriate approach.

Working collaboratively with a stakeholder group, we translated the Possums Sleep Program into an intervention that could be universally delivered in the UK via NHS antenatal and postnatal practitioners. Parent and practitioner views of the initial materials were obtained via feedback questionnaires and the tool was revised. The intervention was then field-tested by 164 practitioners who delivered it to at least 535 new parents and babies over 5 UK locations, to capture anonymous parent and practitioner views of the intervention concept, the materials, and their experiences with both.

The intervention helps parents recalibrate their expectations of infant sleep development, encourages responsive parenting and experimentation to meet their infant’s needs, offers parents strategies for supporting the development of their babies’ biological sleep regulators and promote their own well-being, and teaches parents to manage negative thinking and anxiety that can impede sleep using the principles of Acceptance and Commitment Therapy. The ‘Sleep, Baby & You’ discussion tool, a 14 page illustrated booklet for parents, was field-tested and evaluated by practitioners and parents who offered enthusiastic feedback.

Practitioners reported the ‘Sleep, Baby & You’ materials were easy for them to explain and for parents to understand, and were a good fit with the responsive parenting approaches they employed in other areas of their work. Parents who received the intervention postnatally understood the material and found the suggestions easy to follow. All parents who provided feedback had implemented one or more of the suggested changes, with the majority of changes (70%) being sustained for at least two weeks. Practitioners recommended development of digital and antenatal versions and offered feedback on circumstances that might challenge effective uptake of the intervention.

‘Sleep, Baby & You’ is a promising tool for promoting parental attitude and behaviour-change, that aims to adjust parental expectations and reduce negative thinking around infant sleep, promote responsive infant care in the face of infant-related sleep disruption and fatigue, and support parental well-being during the first year of parenthood. Initial field-testing provided insights useful for further development and subsequent testing via a randomised trial. Support exists for incorporating ‘Sleep, Baby & You’ into an anticipatory, universal intervention to support parents who may experience post-partum fatigue and infant sleep disruption.

 

Ready to hear more? Get your ticket for the conference here:
https://www.breastfeedingnetwork.org.uk/conference/