Should a mother take control over her baby’s feeding schedule and the amounts that she feeds or leave it to her baby to indicate its need and when it has had enough?
Research in this field has been gathering momentum in an attempt to find a way to curb childhood obesity and obesity in later life.
The NZ Health Survey 2006/2007 found that one in twelve children (2 – 14 years) were obese (8.3%) and one in five (20.9%) were overweight. Statistics for adults during the same period was worse with one third (36.3%) being overweight and more than a quarter (26.5%) were obese.
(NZ Stats.Update: 2019/2020 Obese children 2-14yrs 9.4%; Obese adults 30.9%)
Research has shown that breast-feeding may offer some protection to the development of obesity in later life and is considered to be the best first mode of feeding an infant. In New Zealand the baby friendly hospital initiative reviewed breast-feeding targets to aim for infants to be exclusively and fully breastfed to: 74% at 6 weeks, 57% to 3 months and 27% at 6 months which is not far short of reported rates in 2010 of 66% breastfeeding a birth, 55% at 3 months and 25% at 6 months
(Update: 2018: Breastfed to : 79.4% at 6weeks (68.4% exclusively); 71.3% to 3 months (47.6 excl) and 56% 6months (2.5% excl)).
Breast milk or breast milk substitute is the most important nutrient source for the first year of an infant’s life and is the first control decision that a mother makes for her baby.
Factors of control
Mothers who choose to bottle feed their baby usually do so after much thought.
Some of the reasons for bottle feeding:
- High visibility – mothers can see how much milk the baby has consumed.
However the question does arise over where mothers get their information on how much the baby should consume?
- Growth – mothers are concerned about the baby’s perceived rate of growth.
However babies do grow at different rates and Midwives and Child Nurses (Plunket) can do much to allay such fears.
- Confidence – the mother may lose confidence breastfeeding , especially if the baby has difficulty latching on.
Lactation consultants can offer help when latching on is a problem. All child care workers need to guide, not take over, the feeding process. It is easy for mothers to become so bombarded by advice from manuals and the “well-meaning” that they may suppress their own natural ability to feed their baby, to tune into its hunger cues and to respond when the baby has had enough.
- Supply – the mother may worry about her ability to make sufficient milk to match demand.
This very process of worrying can affect her milk supply. Learning to drink more can help boost milk supply but requires not only meeting the mothers personal daily needs plus exercise but also allow around 200mls of extra fluids per baby feed.
- Embarrassment – some mothers feel self-conscious about breast-feeding in public.
Attitudes in society are changing and as communities learn to value breastfeeding amenities such as parents rooms in shopping centres and workplaces are being considered by architects and town planners.
- Convenience – bottle feeding can be handed over to others to help with when mothers are busy, working or have ill-health themselves.
Many breastfeeding mothers now express milk for times when baby feeding needs to be delegated to others.
- Contentment – some mothers believe that their baby is more contented, easier to settle and sleeps for longer if formula fed.
Accommodating a new baby into a busy household is a challenge no matter which mode of feeding is employed and parents need to trust their own instincts over the choices they make and seek support when in doubt.
Scheduling and encouraging
Irrespective of the feeding method mothers choose it is interesting to note that they may also exhibit their control over feeding in a number of other ways:
- The scheduling of feeds – how often they choose to feed and when?
- Waking the baby to feed.
- Using a feed to comfort a baby or control it’s behaviour.
- Control over the rate of flow such as by encouraging the baby to feed for longer at the breast by moving if their baby pauses or falls asleep when feeding. In the case of bottle feeding mothers may widen the hole on the teat to speed delivery.
- The length of time a mother chooses to feed solely milk before they wean.
Studies have found that mothers who choose to breast feed (even if just for a week) or for 6 months or more scheduled and encouraged milk feeds significantly less frequently than mothers who formula-fed their babies from birth. Also studies have shown that mothers who breastfed their infants are less likely to use restrictive or pressurising child feeding practices after weaning than mothers who used formula.
For most infants, complementary foods should be introduced by the time they are 6 months of age. While some infants may be ready to feed earlier complementary foods should not be given before 4 months of age as this is more in line with their physical development e.g. being able to hold their head up well, sit up, open their mouth when a spoon touches their lip and also when their tongue does not protrude.
See Healthed starting solids for more information.
Studies of toddlers aged 20 months to 6 years, that examined baby-led weaning versus traditional spoon-feeding methods have found that feeding method can influence food preferences and health related outcomes in later life.
Compared to the spoon fed group, the baby-led group demonstrated:
- Significantly increased liking for carbohydrates, especially vegetables in the higher social class (compared to sweet spoon fed foods).
- Lower body weight in the baby led group and more obesity in the spoon fed.
- No difference in the picky eating was found between the two groups.
The researchers concluded that infants weaned through baby-led approach learn to regulate their food intake in a manner that leads to a lower BMI and a preference for healthier foods like carbohydrates (bread, cereals, fruits and vegetables) which may lead onto reduced obesity in later life.
Interpreting the signals
Mothers who do spoon feed their baby’s need to be aware of the research on interpreting the reactions to taste sensations that infants may exhibit.
It is perfectly normal for a baby to lean forward and appear interested when offered sweet and salty foods and to recoil when offered foods that are sour or bitter. This recoil is an uncontrollable reflex or ‘shock factor’ when a child first encounters these tastes sensations and should not be interpreted as a baby not liking sour or bitter.
While pre-testing weaning food to check it’s temperature is not too hot or too cold is important before feeding mothers are encouraged not to add sugar or salt to weaning foods to suit their own taste preferences. Adding sugar can just lead onto dental carries and encourage a preference for sweet foods. Adding salt is discouraged because a baby’s kidneys are immature and unused to handling a higher salt load that can put stress on their fluid balance.
Allowing for messy eating and ‘play’ with foods encourages baby control over feeding and enables them to develop good hand and eye co-ordination.
Is obesity predetermined?
The Barker Theory
Barker looked at the health records of 60 year olds in the UK and found many who had died from heart disease, diabetes, etc. were small at birth or SGA (small for gestational age). He hypothesised that a foetus develops and adapts to under nutrition in the womb e.g. by developing smaller vital organs such as heart and pancreas with less insulin production etc. So that following birth the infant becomes overwhelmed by an abundance of nutrition and it is this rapid weight gain that increases disease risk in later life.
The Gene Theory
Studies of SGA individuals have found that they are at an increased risk of rapid postnatal weight gain, later obesity and diseases in adulthood such as Type-2 Diabetes, hypertension and cardiovascular disease. Environmental risk factors during pregnancy include smoking, low pregnancy weight, maternal short stature, maternal diet, ethnic origin of mother and hypertension can contribute to the problem.
However, in a large proportion of SGA where no underlying cause is obvious, then these individuals may have a larger genetic predisposition to later health problems. Research is now focusing on isolating the genes that in SGA appear to have the greatest effect on long-term health.
Nature or Nurture
Evidence of the effects of environmental factors on the health and diet of children can be seen in a 2009 study of Tongan children that migrated to New Zealand. While migration resulted in increased height and reduced stunting of infants and toddlers, older children (3-5 year olds) experienced increases in their body mass index (BMI) and obesity.
What can parents do to breed healthier adults
- Women contemplating pregnancy need to stop smoking, avoid alcohol and adopt a healthier lifestyle, diet and exercise.
- During pregnancy they should aim to gain a steady 10 – 12 kg and eat well throughout. Professional advice may be helpful if the mother is under or over weight.
- Ideally breastfeed or bottle feed their baby for at least 6 months according to demand and keep eating and drinking well themselves to maintain sufficient energy to cope.
- When introducing solids following the recommended guidelines outlined above may be helpful.
- Aim to create a healthy environment for their children which values a wide range of healthy food, sleep and exercise. This means adopting these values for themselves as well.
If you would like to discuss you or your families dietary needs then contact us for an online appointment.
Update July 2017 For more information on this subject
Update Oct 2018 Currently the NZ government does not recommend baby led feeding
Update July 2021 Baby Lead Weaning what role does it play in obesity risk?
The first 1000 days of life (i.e conception to a child’s second birthday) is considered to be a period of extreme vulnerability for growth and development.
A recent review of 747 articles, comprising 8 studies (2875 infants in total) 2 randomly controlled trials (RCT), 6 observational looked at baby led weaning BLW compared to traditional spoon- feeding SF methods and noted the following:
- Results were inconclusive and the risk of bias was moderate to high.
- Concern was expressed that most studies finished at 2 years without follow up and therefore missed recording the growth rates of children (BLW or SF) at 5-7 year when there is a greater chance of rebound adiposity.
- Some studies found 17% of SF infants were overweight at 12months compared to none who were in the BLW group.
- However more underweight (2-5%) infants were reported in the BLW group with concern being expressed about these children having lower zinc and iron levels and a greater risk of choking.
- In one RCT 98% of BLW and 83% of SF infants had normal weights at 12 months.
- Better results appeared to be in breast fed babies in both groups.
- Irrespective of feeding method solid introduction should be seen as a period not a specific moment in time and relates more to the nutritional needs, psychomotor, gastrointestinal and renal development of an infant and therefore is not recommended before 17 weeks by the European Society of Paediatrics, Gastroenterology, Hepatolgy and Nutrition (ESPGHAN).
Currently there is still insufficient evidence to recommend one method of feeding over another.In separate research, Pinho-Gomes et al (2021) found that for women who have developed gestational diabetes during pregnancy, breastfeeding was associated with a reduced risk of Type 2 Diabetes by almost one third. There are many possible reasons for this, including the effect of breastfeeding on reducing maternal weight.
- Risk of Overweight Among Adolescents Who Were Breastfed as Infants
- Baby Friendly Hospital Initiative – Part One: Background and Baby Friendly Implementation in New Zealand [PDF]
- Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case–controlled sample
- Starting Solids – A guide to introducing complementary foods to infants
- The thrifty phenotype hypothesis
- Obesity and diabetes genes are associated with being born small for gestational age: Results from the Auckland Birthweight Collaborative study
- Acquisition of food-related behaviours in children: critical windows for later health [PDF]
- The Impact of Immigration on Child Health: Experimental Evidence From a Migration Lottery Program1 [PDF]
- Martinon-Torres,N; Carreria, N et.al. Baby led weaning: what role does it play in obesity risk during the first years?A systematic review. Nutrients 21 March 2021 13 (3).
- Pinho-Gomes,A.C.etal Association of lactation with maternal risk of Type 2 Diabetes. Diabetes. Obesity Met. online April 28 2021.