Why weaning must be done with extra care, sensitivity —Experts

For several mums, the transition of their babies from the breast to the bottle or cup is war but experts say it doesn’t have to be. Find out how to choose the right time to wean without upsetting your baby in this report by VERA ONANA.

WHILE there is no underestimating the positive effects breast feeding has on the development of a child, there must come a day in a child’s life when a child must give up the mother’s nipples for an alternative source of nourishment. However, for many mums, especially new ones, getting the baby to give up breast and transit smoothly to other semi-solid food is a herculean task. “Temi, does not eat,” a worried mother lamented. “I have tried different brands of baby food, even the imported ones. She just would not take it, meal time is war and she is beginning to lose weight. When I was exclusively breast feeding her, we didn’t have to fight over meals. She is eight-months-old now, I am trying to start weaning gradually but it has been so difficult.” Temi’s mother is not alone as this is the predicament of many mothers.

When is the best time to start weaning?

Consultant paediatrician at the Obafemi Awolowo University Teaching Hospital Complex, Dr Henry Anyabolu, while elucidating on when it is best for a mother to commence weaning, stated that according to the Infant and Young Child feeding Guideline, from six months of age may be optimal. “From six months of age, a mother could start weaning but not before 17 weeks of age. If weaning is started before 17 weeks, the risk of development of allergy is high.”

While weaning can commence from six months of age, Dr Anyabolu stated the need for a proper type of feeding, adding however that, “the correct type of weaning as currently recommended by the Federal Ministry of Health and the United Nations International Children’s Fund (UNICEF) and the World Health Organisation (WHO) is referred to as complementary feeding,” which the physician explained as a type of feeding in which the child continues to take breast milk till two years of age while also taking other semi-solid, solid or adult diet.

According to experts, it is often easiest to begin weaning when your baby initiates the process. Changes in breast-feeding patterns leading to eventual weaning often begin naturally at age 6 months, when solid foods are typically introduced. Some children begin to seek other forms of nutrition and comfort at around age one. By this age, children typically eat a variety of solid foods and might be able to drink from a cup. Other children might not initiate weaning until they become toddlers, when they’re less willing to sit still during breast-feeding.

However, medical experts say that initiating the weaning process as a mother may be more difficult than following the child’s lead. Hence, it must be done with extra care and sensitivity.

Benefits of starting weaning from six months

Health and breastfeeding experts agree that it’s best to wait until your baby is around six-months-old before offering any food other than breast milk. There has been a large amount of research on this. In 2014, a group of researchers- A. A. Onayade, T. C. Abiona, I. O. Abayomi and R. O. A. Makanjuola, published the paper “the First Six Month Growth and Illness of Exclusively and Non-exclusively Breast-fed Infants in Nigeria” in the East African Medical Journal with an objective to compare the growth and illness pattern of infants who were exclusively breast fed for six months with those of infants commenced on complementary feeding before the age of six months and ascertain reasons for the early introduction of complementary feeding. Those researchers and others, who worked on the subject, came up with a number of reasons why it is appropriate to wait six months via their findings.

• Baby will have greater protection from illness.

Although children continue to receive many immunities from breast milk for as long as they breastfeed, the greatest immunity occurs while a baby is exclusively breastfed. Breastmilk contains 50+ known immune factors, and also facilitates the development of “good bacteria” that protect baby’s gut.  Studies have shown that many illnesses and conditions are less likely to occur when baby receives any amount of breast milk. Exclusive breastfeeding for at least 3-4 months (compared to non-exclusive breastfeeding) further decreases the risk of respiratory tract infections, ear infections, necrotizing enterocolitis (NEC), sudden infant death syndrome (SIDS), allergic disease, celiac disease, and type 1 diabetes.  Exclusive breastfeeding for 6 months (compared to 4-6 months), further decreases the risk of gastrointestinal infection and respiratory infection.

• Baby’s digestive system will have time to mature

If solids are started before a baby’s system is ready to handle them, they are poorly digested and may cause unpleasant reactions like digestive upset, gas and constipation.  Digestion of fats, protein and complex carbohydrates is incomplete in infancy, but human milk contains enzymes that aid efficient.

In addition, from birth until somewhere between four and six months of age babies possess what is often referred to as an “open gut.” This means that the spaces between the cells of the small intestines will readily allow intact macromolecules, including whole proteins and pathogens, to pass directly into the bloodstream. This is great for your breastfed baby as it allows beneficial antibodies in breastmilk to pass more directly into baby’s bloodstream, but it also means that large proteins from other foods (which may predispose baby to allergies) and disease-causing pathogens can pass right through, too. During baby’s first 4-6 months, while the gut is still “open,” antibodies (sIgA) from breastmilk coat baby’s digestive tract and provide passive immunity, reducing the likelihood of illness and allergic reactions before gut closure occurs. Baby starts producing these antibodies on his own at around 6 months, and gut closure should have occurred by this time also, researchers say.

• Baby may have more protection from iron-deficiency anemia.

The introduction of iron supplements and iron-fortified foods, particularly during the first six months, reduces the efficiency of baby’s iron absorption. In one study of healthy, full-term infants, some researchers discovered. The researchers concluded that babies who were exclusively breastfed for 7 months and were not give iron supplements or iron-fortified cereals, had significantly higher hemoglobin levels at one year than breastfed babies who received solid foods earlier than seven months. The researchers found no cases of anemia within the first year in babies breastfed exclusively for seven months and concluded that breastfeeding exclusively for seven months reduces the risk of anemia. Mum is less likely to become pregnant.

Breastfeeding is most effective in preventing pregnancy when your baby is exclusively breastfed and all of his nutritional and sucking needs are satisfied at the breast Research has discovered that mothers who exclusively breastfeed for 6 months as opposed to those that breast feed for 4 months, have a longer duration of lactational amenorrhea, which is the natural postpartum infertility that occurs when a woman is not menstruating due to breastfeeding.

When it is not safe or smart to start weaning

“There certain times that it wouldn’t be healthy to commence weaning,” explained Dr Anyabolu. “When a baby is sick, especially when it coincides with the time the mother had earlier planned to start weaning, the mother must wait till the child starts recovering from the illness so that if the baby manifests allergy to the weaning diet, it may be easily identified.”

Also, experts advise mothers to consider delaying weaning when a major change has occurred at home. If your family has recently moved or your child care situation has changed, for example, postpone weaning until a less stressful time.

Best way to start weaning

Dr Anyabolu encouraged mothers to start weaning one step at a time and not abruptly. “The best method of weaning is to start slowly, with one food at a time. Mothers should first introduce their babies to semisolids and then gradually increase the consistency of the food. But, if the food is too watery, the child may start losing weight,” the paediatrician said.

Dealing with engorgement in the process of weaning

Breast engorgement means a mother’s breasts are painfully overfull of milk. This usually occurs when a mother makes more milk than her baby uses. The breasts may become firm and swollen, which can make it hard for the baby to breastfeed. Dr Anyabolu explained that engorgement usually occurs when weaning is done incorrectly. “The wrong type of weaning which was done in the past was to stop breast feeding abruptly and totally. When that is done, engorgement would arise.” However, the expert added that if engorgement occurs, certain measures could be taken to gain relief. “A mother can place cold compress on the area. Also, analgesia could be helpful in relieving the pain.”