Weaning practices and iron status of exclusively breast fed infants
In 2001 the World Health Organisation (WHO) issued a public health recommendation that all infants should be exclusively breastfed for the first six months of life. The Department of Health adopted this recommendation in 2003 (Department of Health, 2003). However, as breast milk is very low in iron content (0.3–0.5 mg L−1), there has been concern about the possible impact of this advice on the development of anaemia, a condition that if left untreated could cause irreversible developmental delays (Lozoff et al., 2000). The purpose of this research is to explore the weaning practices (dietary patterns and adequacy) and haemoglobin levels of long term breastfed infants. Methods:
Twenty pairs of mothers and infants were recruited in Brighton through baby clinics and breastfeeding drop-ins. Eligibility criteria were a full-term, singleton birth and breastfeeding intensity of at least 80% (as defined by Labbok et al., 1990) for the first six months. The infants were seen twice in their homes at ages 6 and 8 months. The first home visit involved the collection of baseline data including demographic information, weight and length measurements. For the second home visit, mothers were asked to complete a 3 day food diary and a diet questionnaire. If consent was granted, a heel prick blood sample was also obtained from the infants for haemoglobin measurements. The study received ethical approval from the University of Brighton and the Kent Research Ethics Committee. Results:
The mean maternal age was 34.5 years (SD 4.2) and 80% of them possessed higher education qualifications (undergraduate or postgraduate degree). The infants (11 male and nine female) had a mean birth weight of 3502 g (SD 518). Haemoglobin was found to be normally distributed (Mean116.8 g L−1, SD 7.8, n = 14). Of the 14 infants, two (14%) had haemoglobin levels below the WHO cut-off for anaemia of 110 g L−1. The age of solid introduction did not show normal distribution. The majority of infants were introduced to solids (of various textures) on or around 6 months (median: 6 months, IQR 0.5, n = 20). Seven (35%) of the mothers reported that they followed a baby-led weaning approach, whereby pureed foods are omitted and weaning begins with lumpier textures or soft finger foods. When asked if they avoided giving the infants specific foods 32% reported avoiding poultry, 32% beef and 37% any other type of red meat. Discussion:
In the 2005 Infant Feeding survey (Bolling 2007), 51% of mothers introduced solids before four months and 2% introduced solids at 6 months. In this study none of the infants were introduced to solids before 4 months and 13 infants (65%) were introduced to solids at 6 months. Maternal characteristics are consistent with the 2005 Infant Feeding Survey data where mothers of the highest level of education and aged 35 or over are three and five times respectively more likely to breastfeed compared with mothers aged below 20 and of low educational level (Bolling et al., 2007). Haemoglobin levels at 8 months in this study correspond to haemoglobin measurements of babies of the same age done for the purposes of the ALSPAC study (Emond et al., 1996). A large proportion of mothers in this study avoided giving their babies any type of red meat which constitutes a very good source of readily absorbable iron. Conclusion:
There could be implications for this group of infants with regards to their iron status as the requirements for iron increase with age. Combined with the fact that there is no specific guideline for including iron rich foods in the weaning diet, it could be a key area for public health intervention. References:
Bolling, K., Grant, C., Hamlyn, B. & Thornton, A. (2007): Infant Feeding Survey 2005. Available at: http://www.ic.nhs.uk/pubs/ifs2005
Department of Health (2003): Infant feeding recommendation. Available at: http://www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPolicyAndGuidance/DH_4097197
Emond, A.M., Hawkins, N., Pennock, C. & Golding, J. (1996) Haemoglobin and ferritin concentrations in infants at 8 months of age. Arch. Dis. Child. 74, 36–9.
Labbok, M. & Krasovee, K. (1990) Toward consistency in breastfeeding definitions. Stud. Fam. Plann. 21, 226–230.
Lozoff, B., Jimenez, E., Hagen, J., Mollen, E. & Wolf, A.W. (2000) Poorer behavioural and developmental outcome more than 10 years after treatment for iron deficiency. Pediatrics105, e51.