Wednesday 17 October 2018

Food for thought: The whys and when of weaning

From eating well during pregnancy to breast vs bottle, and weaning, nutrition plays a hugely significant role in the long-term health of mothers and babies, writes Kathy Donaghy

Kathy Whyte

As well as working at a busy children's hospital, Cathy set up weaning.ie to help parents on the journey through weaning and to empower them to make healthful choices in terms of feeding their families.

A mum of two, Cathy says lots of parents are fearful of the weaning process. "There is so much conflicting information that it's hard for parents to know what to believe. There are lots of recipe books available for weaning and I find that sometimes parents are putting too much time and effort into following recipes rather than learning how to adapt what they are already eating and making it suitable for baby," she says.

"I believe it's better to keep things as simple as possible but ensure the nutritional adequacy of the diet. This is more sustainable in the long term," says Cathy.

In terms of when to start weaning, she says the recommendations from the Food Safety Authority of Ireland (FSAI) are that solid foods be introduced for full-term babies at around six months and never before 17 weeks.

"Not every baby develops at the same rate so not all are ready at exactly the same time. We know that all babies should be on solids by six months as their natural stores of many nutrients are decreasing," says Cathy.

"Six to 12 months is considered the 'feeding window' where we shape a baby's taste buds to eat the foods and flavours that we want them to eat, setting a good foundation for life," she says.

According to Cathy, there are no nutritional aims in the first week or two of weaning and it should be a relaxed and enjoyable experience for parent and baby. "Let them get messy. Choose savoury flavours before sweet flavours. Your baby was born with a sweet tooth and in weaning we are trying to help them develop a taste for more savoury flavours. After 26 weeks you can progress through different flavours and textures."

From the age of six months on, Cathy says babies should be on a balanced diet with the correct proportion of proteins, fats, carbohydrates, vitamins and minerals for their age. "A healthy/balanced diet for an adult is not the same as a balanced diet for a baby. At four to six months of age, a baby's stomach is little bigger than an egg, yet they are expected to triple their birth weight by year one. Careful consideration around food choices is vital."

She points out that one in 10 two-year-olds in Ireland suffers from iron-deficiency anaemia. Because iron is vital for healthy brain development, deficiency in childhood can have long-term consequences. And she recommends three portions - a portion being the size of your baby's palm - of red meat per week to help prevent this.

"Due to a baby's small stomach size and high requirements it is difficult to meet a baby's iron needs from vegetable sources alone. I strongly recommend that anyone considering a vegetarian or vegan diet for their baby see a paediatric dietitian," she says.

In terms of additional supplements to give babies, Cathy says that all babies, whether bottle or breast-fed, should be given the Vitamin D3 supplementation and that this is something that should be continued during the dark winter months throughout life.

"In Ireland we don't get enough Vitamin D3 from sunlight and a lack of Vitamin D3 has been shown to increase the risk of certain diseases - Type 1 and 2 Diabetes and heart disease. There has also been an increase in rickets in recent years and Vitamin D supplementation helps prevent this," she says.

Rather than choose a particular style of weaning, Cathy says she encourages parents to treat their baby as an individual and progress at a rate that suits baby.

"Choking is a genuine hazard that can have devastating consequences. I focus on the nutritional needs of your baby. I believe in making the weaning process as simple, straightforward and sustainable as possible. I don't believe in being too rigid," she says.

Cathy's next classes providing theory-based nutrition information for parents will begin in September in Dublin. See weaning.ie for more information

You are what you eat, the old saying goes. As more and more research is unveiled about how pre-conception, breastfeeding and weaning provide the greatest opportunity in life to influence the long-term health of mothers and babies, this adage has never been more relevant.

Kathy Whyte (pictured right), who set up her business Nurture Mum almost a year ago, wants to start a revolution in the way society in general thinks about nutrition for mothers-to-be and babies, given that this is such a crucial time in their lives.

Originally from Clonmel, Co Tipperary, Kathy did her nursing and midwifery training in London. She then did a masters in nutritional medicine at Surrey University, carrying out her thesis research at the Coombe Hospital in Dublin.

She developed a keen interest in how the early days of life, from pre-conception to the age of two, provide a massive opportunity to promote the long-term health of a baby and their mother.

Her interest in this area was sparked by the fascinating work of the late Professor David Barker, who came up with the Barker Hypothesis. This established the link between the foetal environment and the long-term health and well-being of the baby.

Kathy believes that while we have concentrated on lifestyle interventions to address big health issues like obesity and diabetes, this thinking needs to change by putting more of a focus on early development instead.

And in her work she hopes to provide something of an awakening on the impact of nutrition in early pregnancy and in the early stages of a baby's life.

According to Kathy, the health of a mother is crucial to the health of her baby. She says that because more and more mothers are now obese, this presents a challenge in pregnancy as there is an increased risk of diabetes and pre-eclampsia and generally being unwell in pregnancy.

She points out that obese women are up to three times more likely to have a premature child during their first pregnancy.

While the average rate of premature delivery is 5.9pc, obese mothers pregnant with their first child have a 16.5pc risk, she says.

Contrary to the old platitude that in pregnancy you're eating for two, Kathy says mums-to-be only need 200 to 300 extra calories a day in the third trimester and she uses the phrase "thinking for two" instead.

"[The] 200 to 300 extra calories translates into one slice of wholemeal bread and a banana. That's all you're talking about," she says.

In terms of healthy eating in pregnancy, Kathy says it's important that mothers-to-be try to eat a good variety of foods with a rainbow of colours and whole grains on their plates.

Half their plate should be made up of fruit and veg, she says, with three good servings of calcium-rich foods a day.

She also recommends that mums-to-be consume oily fish in pregnancy twice a week or take an Omega-3 supplement because the research shows it contributes to reducing the prevalence of allergic disorders, including food allergies, atopic dermatitis, and wheezing illnesses in the first year of a baby's life.

"It provides essential fatty acids and the body has to take this in. We know that up to 80pc of the foetal brain is essential fatty acid so babies depend on mum's nutrition," she says.

In relation to sugar, she says expectant mothers should try to move away from sugar-laden foods and replace them with fruit. While she says there are natural sugars in fruit, it's also packed with micro nutrients.

And she points out that the foetus drinks one litre of amniotic fluid each day in last month of pregnancy, exposing them to flavours from the maternal diet, and this exposure influences baby's long-term food choice.

In terms of supplements, Kathy says taking folic acid is still a message that has to be delivered. "We know taking folic acid is fundamental to the health of the baby. It needs to be taken up to 16 weeks pre-conception. Basically anyone who can conceive should be taking it because it reduces the risk of spina bifida and hydrocephalus by 70pc."

"Vitamin D is advised for all women during pregnancy as there is increasing evidence that it has a role in reducing risk of pre-eclampsia, pre-term labour and it's also important for the immune system," she says.

In relation to alcohol, Kathy believes the relationship between alcohol and pregnancy is too comfortable in this country, whereas in the US it's a complete no-go area.

"We are very tolerant of it here. I don't think it has a place at all in pregnancy," she says.

While Kathy says mums-to-be can't be paragons of perfect nutrition all the time, the 80/20 idea of eating well applies. "You don't have to be a perfect mum to be a healthy mum. You can have something if you want or fancy it as we don't want to over-burden mums. I ask the question 'would your grandparent recognise this food?' Try and keep your diet as natural as possible using natural products, choosing things like real butter over margarine. There were no food trends in our grandparents' time and there was no obesity either," she says.

After baby arrives, Kathy says mums have to be mindful to keep up their healthy nutrition and with breastfeeding, these nutritional needs are taken to a whole different level.

She says a good tip for people coming to see the new baby is for them to bring something healthful and nutritious for mum to eat.

Kathy points out that it's not true to say that breastfeeding means dads don't have a role to play in feeding the baby. "They can contribute to the quality of the breast milk by making delicious food and making sure mum is healthy," she says. In terms of choosing to breastfeed, Kathy believes new mums need much more support in this area given the well-documented benefits of breastfeeding for both baby and mum.

"We know breastfed babies grow slower than bottle-fed babies and have a reduced risk of childhood obesity, diabetes and heart disease later in life," she says.

"The nutrients in breast milk are tailored to the baby's age. We know that it reduces the risk of childhood obesity. This is due to the fact that the breastfed baby can self-regulate - you can't force them to take any more. With bottle-fed babies very often we override their satiety hormones because you want to get the whole bottle in."

And in relation to the benefits to women, ovarian cancer is reduced by 30pc in mums who breastfeed, she says.

Kathy says mums can be vulnerable and tired after the birth of their baby which is why the support of a midwife or lactation support to get breastfeeding off to a good start is crucial.

She acknowledges that parents can find the weaning stage - the introduction of solid foods - a minefield. When to do it and what kinds of foods to introduce can leave parents at sea, she says.

A good rule of thumb she says is never before 17 weeks for both bottle-fed and breastfed babies and, she says, parents should trust themselves to cook for baby themselves rather than reaching for shop-bought packets and pouches.

"Telling this story of nutrition is a slow burner, but essentially who doesn't want to have the healthiest baby or to be the healthiest they can be themselves? We used to think that genes were fixed. Now we know that lifestyle affects genetics. I'm on a mission to have this story told," says Kathy.

For more information, see nurturemum.ie

The whys and when of weaning

When it comes to weaning your baby, parents are often confused by conflicting information. Senior Paediatric Dietitian Cathy Monaghan at the Children's University Hospital in Dublin's Temple Street offers advice

As well as working at a busy children’s hospital, Cathy set up weaning.ie to help parents on the journey through weaning and to empower them to make healthful choices in terms of feeding their families.

A mum of two, Cathy says lots of parents are fearful of the weaning process. “There is so much conflicting information that it’s hard for parents to know what to believe. There are lots of recipe books available for weaning and I find that sometimes parents are putting too much time and effort into following recipes rather than learning how to adapt what they are already eating and making it suitable for baby,” she says.

“I believe it’s better to keep things as simple as possible but ensure the nutritional adequacy of the diet. This is more sustainable in the long term,” says Cathy.

In terms of when to start weaning, she says the recommendations from the Food Safety Authority of Ireland (FSAI) are that solid foods be introduced for full-term babies at around six months and never before 17 weeks.

“Not every baby develops at the same rate so not all are ready at exactly the same time. We know that all babies should be on solids by six months as their natural stores of many nutrients are decreasing,” says Cathy.

“Six to 12 months is considered the ‘feeding window’ where we shape a baby’s taste buds to eat the foods and flavours that we want them to eat, setting a good foundation for life,” she says.

According to Cathy, there are no nutritional aims in the first week or two of weaning and it should be a relaxed and enjoyable experience for parent and baby. “Let them get messy. Choose savoury flavours before sweet flavours. Your baby was born with a sweet tooth and in weaning we are trying to help them develop a taste for more savoury flavours. After 26 weeks you can progress through different flavours and textures.”

From the age of six months on, Cathy says babies should be on a balanced diet with the correct proportion of proteins, fats, carbohydrates, vitamins and minerals for their age. “A healthy/balanced diet for an adult is not the same as a balanced diet for a baby. At four to six months of age, a baby’s stomach is little bigger than an egg, yet they are expected to triple their birth weight by year one. Careful consideration around food choices is vital.”

She points out that one in 10 two-year-olds in Ireland suffers from iron-deficiency anaemia. Because iron is vital for healthy brain development, deficiency in childhood can have long-term consequences. And she recommends three portions — a portion being the size of your baby’s palm — of red meat per week to help prevent this.

“Due to a baby’s small stomach size and high requirements it is difficult to meet a baby’s iron needs from vegetable sources alone. I strongly recommend that anyone considering a vegetarian or vegan diet for their baby see a paediatric dietitian,” she says.

In terms of additional supplements to give babies, Cathy says that all babies, whether bottle or breast-fed, should be given the Vitamin D3 supplementation and that this is something that should be continued during the dark winter months throughout life.

“In Ireland we don’t get enough Vitamin D3 from sunlight and a lack of Vitamin D3 has been shown to increase the risk of certain diseases — Type 1 and 2 Diabetes and heart disease. There has also been an increase in rickets in recent years and Vitamin D supplementation helps prevent this,” she says.

Rather than choose a particular style of weaning, Cathy says she encourages parents to treat their baby as an individual and progress at a rate that suits baby.

“Choking is a genuine hazard that can have devastating consequences. I focus on the nutritional needs of your baby. I believe in making the weaning process as simple, straightforward and sustainable as possible. I don’t believe in being too rigid,” she says.

Cathy’s next classes providing theory-based nutrition information for parents will begin in September in Dublin. See weaning.ie for more information

Irish Independent

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