When to wean - Gina Ford

THE LATEST DEPARTMENT of Health (DoH) guidelines were published in 2003 and were prompted by recommendations from the World Health Organisation. They advise exclusive breast-feeding for the first six months of a baby’s life, i.e. no solids or infant formula. The previous DoH advice was to wean between four and six months and not to give solids to any baby before four months (17 weeks). This is because it takes up to four months for the lining of a baby’s gut to develop and for the kidneys to develop. Introducing solids too early can put a strain on the immature gut and kidneys, and many experts now believe that introducing solids before the baby’s digestive system is ready to cope is the cause of the rapid increase in allergies over the last 20 years.

The advice in this latest edition of my weaning book is based on the recommendations of the DoH, and my personal experience of working with hundreds of babies plus the huge feedback that I have received from parents.

Up until 2003 when parents followed the previous DoH advice to wean between four and six months, I found that when a baby was ready to wean depended considerably on each individual baby. Because all babies are different and grow and develop at different rates, some needed weaning at four months, others would be nearer five months and some would manage to get to six months.

Weaning too early, increasing the amount of food too quickly or introducing the wrong types of food could result in some, if not all, of the following:

Possible damage to the baby’s digestive system. It takes up to four months for the lining of a baby’s gut to develop and for the kidneys to mature enough to cope with the waste products from solid food. Introducing solids before your baby has a complete set of enzymes required to digest food properly could put pressure on his liver and kidneys and impair his digestive system.
Physical problems when feeding. It is important not to start weaning before your baby’s neuromuscular co-ordination has developed enough for him to control his head and neck while sitting upright supported in a chair to be fed. He should also be able to swallow food easily by moving it from the front of his mouth to the back. He will only be able to do this if he is supported upright.
Introducing solids too early can put your baby at a higher risk of developing allergic conditions such asthma, eczema and hay fever.
Scientific studies in Scotland found that a persistent cough was more common in babies who had been given solids before 12 weeks.
A baby who is given solids too soon or increases them too rapidly may cut back too much on his milk and be denied the essential nutrients that milk provides.
Early weaning can sometimes lead to overfeeding, making the baby overweight, which, research suggests, can lead to obesity in later life and increase the risk of cancer, diabetes, heart disease, etc.

While writing the latest edition of this book, I have spoken to many health professionals as well as hundreds of mothers via my website. It is clear that there is some controversy and confusion surrounding the latest government recommendations. Certainly, there are health professionals who believe that it is not weaning before four and six months that threatens a baby’s health, but the kind of food the baby is given. It is also clear that there are some babies who seem not to be satisfied on milk alone for the full six months, and parents are struggling to cope with a miserable, fretful baby as they try to push him to six months on milk alone.

In this latest edition I give very detailed advice, which I hope will help you to get your baby happily to six months without introduction of solid foods. However, because I do not know your baby personally it is vital that you discuss with your health visitor or GP any concerns that you have about your baby showing signs that, despite reintroducing the extra feeds that I recommend, he is not being satisfied on milk alone. The following guidelines should help you identify possible signs of your baby being ready to wean. Your baby could be ready if:

He has been taking a full feed 4–5 times a day from both breasts or a 240ml (8oz) formula feed and has been happily going four hours from the beginning of one feed to the beginning of the next feed, but now gets irritable and chews his hands long before his next feed is due.
He has been taking a full feed from both breasts or a 240ml (8oz) formula feed and screams for more when the feed finishes.
He usually sleeps well at night, but starts to wake up earlier or in the middle of the night despite taking a full feed at 10/10.30pm. Daytime sleep becomes more erratic, waking up midway through a nap and not settling back or waking up earlier from naps.
He is at least four months (17 weeks) old, has doubled his birth weight and weighs over 6.8kg (15lb), and your health visitor is happy with his weight gain each week.

If your baby is at least four months and showing most of these signs, despite having 4–5 full feeds a day, it could be that he is ready for weaning. If your baby is under six months you should tell your health visitor or GP so they can help you decide whether to proceed with the introduction of solids.

If you agree that your baby should wait until six months before having solids introduced, it is important that his increased hunger is met by introducing further milk feeds. Babies who have been sleeping through the night with only a small feed, and are waking earlier, should have the 10/10.30pm feed increased. Babies who are taking a full feed at 10/10.30pm and waking in the middle of the night may need to have a small milk feed in the middle of the night to get them through until 7am.

It is very important to remember that as your baby grows, so will his appetite. It is unreasonable to expect him to manage on only four milk feeds a day, when he is showing signs of increased hunger. Therefore, even if you have dropped the fifth feed you will probably need to reintroduce it until he starts weaning at six months.

Breast-fed babies

With babies who are being fully breast-fed it is more difficult to tell how much milk they are receiving. If your baby is over four months and showing most of the signs, you will need to talk in depth to your health visitor or GP about the choices available to you.

If he is under four months and not gaining enough weight each week, it is possible that your milk supply is getting very low in the evening. All that may be needed is extra milk, and I would advise that you follow my plan to increase your milk supply as laid out in The New Contented Little Baby Book. The extra milk that you express can be given to him as a top-up feed when your milk is at its lowest – usually in the evening, or it can be used to replace the 10/10.30pm feed, if your baby is waking up more than once in the night. Encourage your partner to do this feed so that you can get to bed early, after expressing whatever milk you have at 9/9.30pm, to avoid your milk supply dropping even further.

If you find that you are only producing 90–120ml (3–4oz) at this time, which would be much less than your baby may need to feed, you will need to add milk that you have expressed earlier in the day to make the feed up to the amount that your baby needs.

If you do not have an expressing machine and your baby refuses to take a bottle, you would need to put your baby to the breast more often to increase your milk supply and help satisfy his appetite. I would advise that you feed your baby at 7am and 10am, and then top-up prior to his lunchtime nap with a further breast-feed. Then feed him at 2/2.30pm and re-introduce the 5pm feed. This will give him an extra two feeds a day. I would also advise that you try to get a short rest after dinner in the evening, and delay the 10/10.30pm feed to 11pm to try and increase the amount he is getting at that feed.

I hope that the above suggestions help with increasing your milk supply and satisfying your baby’s hunger. However, if your baby is still unsettled between feeds and his weight gain has not improved you should discuss with your health visitor about giving one complementary bottle of formula a day, preferably at the 10/10.30pm feed. By giving a full formula feed at this time, and expressing at 9.30pm, you can then use the milk that you expressed as a top-up during the day, thus avoiding further complementary feeding.

Introducing solid food

Quick links to important information

Breast-fed babies

Introducing solid food

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