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Sunday, September 25, 2011
Wednesday, September 21, 2011
New Study: Exclusive Breastfeeding Can Support Infant Growth to 6 Months of Age
A new study published this week in the
journal Pediatrics found that exclusive
breastfeeding up to six months provides enough calories for infants.
Quick and Dirty Summary:
This study addressed two common concerns about
breastfeeding: 1) Many moms simply
can’t produce enough milk for their babies; and 2) Exclusive breastfeeding,
while adequate in younger infants, may not provide enough calories for babies
up to 6 months of age. The data
from this study indicate that when moms
are given breastfeeding support, milk
production is not a limiting factor and provides enough calories for normal
growth, even in 6-month-old infants. However, this study was
small and had several limitations (which I will discuss).
How was this study conducted?
This was a longitudinal study of 50 mothers and their infants in Glasgow,
Scotland. All of these mothers
intended to exclusively breastfeed (EBF) for at least 6 months and were recruited
from breastfeeding support groups, so we can presume that they were already set
up to succeed with breastfeeding.
EBF is defined by the World Health Organization (WHO) and in this study
as giving the infant only breast milk for nutrition (no solids or formula),
with oral rehydration, vitamins, minerals, or medicines allowed as needed. 60 mothers were recruited, but only 50
were still EBF at the first assessment around 15 weeks of age. Assessments included measurements of
infant growth, milk intake, total energy intake, and milk energy content. Mothers also completed questionnaires
and infant behavior diaries in order quantify the number of feedings and total
time spent nursing. These
measurements were all repeated at 25 weeks of age (6 months). At this second time-point, 3 mothers had
dropped out of the study and 41 mothers were still EBF. The remaining 6 mothers had begun
feeding their babies some solid foods.
How,
you might ask, did the researchers manage to measure milk intake in nursing babies?
Excellent question. They used a technique called the
doubly-labeled water method, which involves feeding the baby a tiny and safe dose of stable
isotope-labeled water (2H218O) and then
collecting samples of their pee (which is easy enough to do when you change a diaper)
to measure how long it takes those isotopes to come out. Then they did a bunch of
calculations. Really. Trust me when I tell you that this
method is safe, non-invasive, and pretty much the best way to measure milk
intake in nursing babies. I’ve
actually had a little experience (in a previous life) using this method in nursing
bottle-nosed dolphins.
What are the most important findings of
the study?
-The
exclusively breast fed infants in this study grew just fine, right in line
with the WHO Child Growth Standards.
EBF to 6 months didn’t set them back in their growth curves.
-Milk intake was slightly but significantly higher at
25 weeks compared with 15 weeks (997 vs. 923 grams; P=0.001), showing that milk production increased to meet the
increasing demands of the infant.
Milk energy content (as in calories per liter) did not change between
time points.
-Moms reported breastfeeding 8-9 times
per day at both 15 and 25 weeks, but time spent feeding decreased from 173 minutes
per day at 15 weeks to 140 minutes at 25 weeks. That means that at 25
weeks of age, babies were drinking more milk but doing so more efficiently than
at 15 weeks. No surprise
there.
-There was no difference in infant weight
or milk intake at 25 weeks between the EBF infants and the 6 that had started solid
foods. The moms of these babies said
they started solids because their babies seemed ready.
What can we conclude from this study?
The
study shows that in most women with good breastfeeding support, infant milk
intake is sufficient to support normal growth with EBF for 6 months.
The authors of the study assert that
their findings support the recommendation that all babies should be EBF for the
first 6 months, but there are some problems with jumping to that conclusion…
What are the limitations of the study?
-10 of the 60 moms initially enrolled in
the study were not still exclusively breastfeeding at 15 weeks, and the study authors
don’t tell us what happened to those 10 women. Did they stop breastfeeding or supplement with formula
because of a fear, real or not, that they weren’t producing enough milk? We just don’t know.
-The mothers in this study were older
(mean age 33) and more affluent than the average mom. They were highly motivated to exclusively breastfeed and had
good support to do so. Just
guessing, but this type of mom is also more likely to take good care of herself
and have support at home to do that.
All of those factors might impact her breastfeeding success.
-The 6 babies that started solid foods prior to 6 months had similar caloric intake from milk as
the EBF babies. These babies were
also getting some additional calories from food, but the study did not report this. It is possible that these
babies were truly ready for solids before 6 months and needed the added energy
from solids, in addition to breastmilk.
The authors don’t address this possibility.
-This study only looked at calories from
milk intake. It doesn’t consider
micronutrients such as iron and zinc that may become limiting at this age
without the addition of some solid foods in the diet.
My take:
This study shows that exclusive breastfeeding
to 6 months can provide enough energy to support normal growth in babies. However, the mothers in this study were highly-motivated and had great support for breastfeeding. We don't know why 10 women dropped out of the
study or if the babies consuming solid foods actually needed the
additional calories from that food. Due to these limitations, the results of this study
may not apply to the general population.
It is easy to over-simplify the results
of a study like this, but when we really look at the data, we find that it just
isn’t that simple. Unfortunately,
most science isn’t.
The perception of low milk supply remains a major barrier to exclusive breastfeeding, and more work needs to be done to show whether or not this is a physiological or psychosocial problem.
What do you think? Did you or a friend have a problem with low milk supply? There is nothing worse than thinking that your baby is hungry and not being able to feed her!
Monday, September 19, 2011
Shareworthy Recipe: Israeli Couscous and Mushroom Pilaf
I'm still trying to figure out exactly what I want the ScienceofMom blog to be. Is it a science blog? Not completely. A mommy blog? I want it to be more... A food blog? Sort of, if baby food counts. I don't want it to be too scattered, but I'm finding that my readers are responding to all of these things, at least so far. So maybe some balance is good. Besides, I'm still trying to finish up that last research paper, so I haven't had much time to work on sciency posts.
If I was going to have a food blog, it would probably focus on easy, healthy ways to prepare local food. These days, I don't tackle anything in the kitchen unless it is simple enough that I can do it while a baby crawls around my feet, steals my kitchen utensils, and otherwise distracts me every two minutes. I'm also looking for recipes that a 10-month-old will enjoy - that is, things that are soft and easy to chew. And BabyC loves new flavors, but this is probably not the time to experiment with fire-hot chili.
I tried a new recipe this week that was a hit with everyone in our family: Israeli Couscous and Mushroom Pilaf from the Washington Post, which credits Stephanie Witt Sedgwick for the recipe. I adapted it only slightly.
I only recently discovered Israeli couscous, and I love it. Israeli couscous is actually known as "Ptitim" in Israel. It is a toasted pasta shaped like "little balls" - sorry, that's just the best way to describe it. Here is a tidbit from the Wikipedia page:
"While considered a children's food in Israel, elsewhere in the world
Israeli couscous is treated as an ingredient for "trendy delicacies." In the United States, it can be found on the menus of contemporary American chefs and can be bought in gourmet markets."
So Israeli couscous is both child-friendly and gourmet. Excellent. I found it in the bulk foods section of our local Market of Choice, a beautiful regional grocery store here in Oregon, but I'll bet you might find it in the Middle Eastern section of your local grocery store.
Here are a few reasons to love this recipe:
1. It took 20 minutes, start to finish, and I am not one of those expertly fast food choppers. Plus I had a baby crawling at my feet.
2. Israeli couscous has really fun texture that I love. BabyC was WAY into it, and I bet toddlers would get a kick out of it, too.
3. This recipe would be easily adaptable to use whatever you have on hand. Substitute or add other veggies, and throw in some shredded chicken, and you have a beautiful one-pot meal.
Israeli Couscous and Mushroom Pilaf
Stephanie Witt Sedgwick, Washington Post
6 servings
Ingredients:
-2 Tbs. olive oil
-1 small onion, diced (about 1/2 cup)
-3/4 lb. assorted mushrooms, stemmed and cut into 1/2 - 3/4 inch chunks
-1 3/4 c. Israeli couscous
-2 c. low-sodium chicken broth
-2 Tbs. finely chopped fresh parsley
-2 Tbs. finely chopped fresh chives
Directions:
Heat the oil in a large, deep saucepan or pot over medium heat. Add the onion and cook, stirring occasionally, for 2-3 minutes, until it softens and is translucent. Continuing to stir occasionally, add the mushrooms and cook 6-7 minutes, until they are soft.
Add the couscous to the pan and push it around to lightly toast it. Then add the chicken broth, and season with salt and pepper to taste. Stir, then cover and cook for 8-10 minutes over medium heat until the liquid is absorbed and the couscous is soft. Remove from heat. Add the herbs and stir to incorporate.
Enjoy! And let me know if you try any fun adaptations!
Trying to spread the word about ScienceofMom
So today I plopped a link to my Exploring and Enjoying Food with Baby post on The Miss Elaine-ous Life, which is a pretty nifty blog if you haven't seen it! I'm working on slowly building an audience but really trying to reach those who will return again and again. It is fulfilling to find that people are actually reading my blog, but it takes some work to get the word out! And I've never been much of a self-promoter, so that's something I have to work on. Anyway, check out Elaine and her blog - I think it is awesome that she provides a place to spread the love for new blogs!
Sunday, September 18, 2011
Camping with Baby: A Photo Essay
We took BabyC camping for the first time a few days ago. We hadn't been camping since I was 20 weeks pregnant, at which point I was already too uncomfortable to be sleeping on the hard ground. Before my pregnancy though, Husband and I did a lot of outdoor exploration together - hiking, camping, climbing, backpacking. Being outdoors together grew our relationship in the early days and strengthened it as the years went by. There is nothing like being out together on a multi-pitch climb up a rock face, just the two of you, to erase any doubt that you trust the other person wholly and completely. And nothing quite like tackling all the tasks of setting up a camp and getting a one-pot dinner cooked after a long day of backpacking to make you glad you are on the same team. These experiences have shaped who we are as friends and as husband and wife.
But now we have a baby in the mix. There are no more multi-pitch climbing expeditions or long backpacking trips in our near future. That's the way it is, we thought. We'll make do with car-camping. I was excited about the trip.
It was not the same. We were too tired to stay up late around the fire and share a bottle of wine. I was so nervous about BabyC waking up the neighboring campers that I jumped to soothe her every time she made a peep, which she took as a signal that I wanted to play in the middle of the night. Husband was grumpy because it wasn't the same. I was grumpy because Husband was grumpy and bummed because camping used to be our thing.
Looking back, though, I think BabyC had a great time, and that makes me happy.
| Out here, I can explore the world and see what choking hazards it has to offer. |
| We can play in the tent - all night long if you want! |
| We'll go walking on the chilly beach, but I have my dad to snuggle me. |
Oh yeah, and the dog had a great time, too!
| Happy dog, typical Oregon coast evening. |
| In action. |
| Nice catch! |
Thursday, September 15, 2011
10 Tips for Starting Your Baby on Solid Food
10 Tips for
Starting Your Baby on Solid Food
Starting solid foods is one of the major landmarks of
a baby’s first year. You play a
very active role in your child’s experience with food, and your goal is to make
that experience healthy, fun, and safe.
Here are 10 tips to get you off to a good start.
1. Start
feeding your baby solids between 4 and 6 months of age. There is currently a big debate in the pediatric community about exactly
when babies should start solids, and it is particularly heated when it comes to
breastfed babies. The World Health
Organization recommends that babies be breastfed exclusively for the first
6 months. The AmericanAcademy of Pediatrics Committee on Nutrition uses more confusing language, stating that babies
should be breastfeed exclusively for 4 months but preferably 6 months. If you want to get a taste of the
arguments for 4 months vs. 6 months, check out the paper published in British
Medical Journal earlier this year by Fewtrell et al. (Six months of exclusive
breastfeeding: how good is the
evidence?) [1], and scroll to the bottom of the page to see the 23 published
responses to the article. I love
scientific debates, but this one quickly overwhelmed even me.
After doing lots of reading and going through the
process with my own baby, I concluded that the data aren’t really that strong
one way or another. Start solids
at 4 months, and your baby is slightly more likely to get a GI infection, but
wait until 6 months, and he’s slightly more likely to become anemic. If you are worried about this decision,
talk to your pediatrician, but also ask your baby what he thinks. If your 4-month-old is trying to grab
food off your plate and still seems hungry after breastfeeding, he’s
probably ready to give solids a try.
After much deliberation, we started trying solids with BabyC at 5
months, but she really wasn’t interested in more than a few tastes until around
6.5 months.
2. You can
skip the white rice cereal. Yes, it is fortified with iron, and that is a good
thing, and yes, it is easy to digest.
On the other hand, white rice cereal is basically pure starch (refined rice flour)
and not that tasty or nutritious, except for the added iron. Try whole grain baby cereals like
oatmeal, barley, or brown rice cereal, which are also fortified with iron.
Just start with single-grain cereals so that you know the culprit if
your baby has an allergic reaction (see #5) and avoid wheat (includes spelt) for
the first month or so. There is
also no reason that cereal has to be your baby’s first food. Whoa, you say, now you’re really
blowing my mind. I know, keep
reading…
3. Focus on
meats, legumes, veggies, and fortified cereals. Meat is a great
complement to breastfeeding in older infants, because it is a good source of
iron and zinc, both of which are low in breast milk [2].
However, there is a common misconception among parents that meat should
not be used as an early food for infants.
In a 2008 survey of the dietary habits of infants and toddlers, only 8%
of 6-9-month-old infants ate meat or poultry at least once per day (more ate
those baby food “dinners” which contain some meat but also a lot of crap) [3]. There is no reason to
wait on meat – you can make it one of your baby’s first foods. Legumes are also packed with protein and fairly high in iron - try lentils, hummus, or mashed beans. Vegetables are a great choice and are
usually well received by your budding foodie. Offer some fruits, but know that they don’t give you as much
nutritional bang for your buck, being higher in sugar and water. Including two servings of fortified cereal
in your baby’s diet will help ensure that he is getting enough iron, but check
out my recent post (Practical
Ways to Increase Iron in Your Baby’s Diet) for other tips. Dairy products such as cheese and
yogurt are also fair game but should be fed in limited amounts.
4.
Wait until your baby’s first birthday to try high
allergy foods. If you have food allergies in your
family, talk with your pediatrician, who will probably recommend waiting even
longer. High allergy foods include peanuts, egg
whites, shellfish, fish, and tree nuts. Also avoid honey
until your baby is one year old because of the risk of botulism.
5.
Wait 2-3 days between introducing new foods. This
gives you time to watch for symptoms of a food allergy, and if those symptoms
should appear, you will know that they are likely due to the new food. Common food allergies include wheat,
cow’s milk, soy, citrus, and berries.
You can introduce these foods, but watch for symptoms of allergies,
which include diarrhea, rash, and vomiting.
6.
Experiment with different textures. Your
baby may prefer a thinner or thicker puree. Or he may prefer to skip the purees altogether. We tried giving BabyC purees for at
least a month with very little success, but then we discovered that she loved
finger foods and moved straight to those.
Soft fruits, avocado, cooked vegetables, and pasta were a big hit. There is a movement called Baby Led Weaning that advocates for skipping
purees all together. We basically
ended up following their method, though not by design. I do think it is best for babies to
take charge of their meals as soon as possible, so that they decide how fast
and how much food to eat.
7.
Do you know what to do if your baby starts
choking? Make sure you do. Learn the baby
Heimlich maneuver. The
Heimlich is easy enough, if you haven’t already, this is a good time to take an
infant/child
CPR class, which will include handling a choking emergency. At this age, any number of things in
your house and the world, including food, can be choking hazards, and you
should be ready. Obviously, avoid
giving your baby foods that are small and firm such as raisins, popcorn, and
nuts.
8.
Start slow. Start with one solid meal per day,
which may be just a tablespoon or two at first. As your baby starts to show more interest in food, gradually
increase the amount offered and the number of meals up to three solid meals per
day around nine months of age. Think
of this time as a gradual transition towards more solid foods, but let your
baby set the pace. At first, your
baby will not be eating enough solids to affect breast or bottle feeding, but
you will gradually decrease the number of milk feedings as your baby gets more
and more calories from solids.
9.
Know that every baby is different. Some
babies will eat like a pro on day one.
Ours did not. If your baby
is slow to start solids, don’t worry and don’t rush him. Just trust that he’ll get it eventually. Meal timing may be important to your
success. If your baby is too
hungry or too full, he may not be interested in solids. Many parents find that nursing on one
side, then trying some solid food, then returning to nurse on the other side,
works well.
10.
Set your baby up for a lifetime of healthy eating by
modeling healthy eating habits. Your baby will reach an age when he
wants to eat what is on your plate, so if there are french fries on your plate,
that’s what your baby will want.
Babies are remarkably adept at recognizing hypocrisy when they see
it. Make an effort to sit
down to eat as a family, with your baby included. Make mealtime a social, pleasant time. It should never be rushed or
forced. For more ideas, check out
my recent post - Enjoying
and Exploring Food with Baby.
I hope these tips help as you embark on your baby
food adventure! But like I said,
every baby is different. If you
are just beginning this process, what other questions do you have? Experienced mamas and papas – what did
I leave out?
REFERENCES
1. Fewtrell, M., D.C. Wilson,
I. Booth, and A. Lucas. Six months of exclusive breast feeding: how good is the
evidence? BMJ. 342: p. c5955. 2011.
2. Krebs, N.F. and K.M.
Hambidge. Complementary feeding: clinically relevant factors affecting timing
and composition. Am J Clin Nutr. 85(2): p. 639S-645S. 2007.
3.
Siega-Riz, A.M., D.M. Deming, K.C. Reidy, M.K. Fox, E. Condon, and R.R.
Briefel. Food consumption patterns of infants and toddlers: where are we now? J
Am Diet Assoc. 110(12 Suppl): p.
S38-51. 2010.
Saturday, September 10, 2011
Exploring and Enjoying Food with Baby
At almost 10 months old, BabyC spends at least two hours per day in her
high chair. She loves finger foods
and takes her time with them. For
me, this is a great time to catch up on the dishes or work on preparing a meal,
all the while chatting with BabyC, replenishing her high chair tray, and
listening to some music together.
As much as I value that productive, multi-tasking time, I’ve been making
a real effort to prepare food for both of us and sit down to enjoy meals with
her. Due to his hectic work
schedule, my husband is rarely both home and awake during our meals, but we’re
sitting down to eat with Dad when we can, too. I want BabyC to know that mealtime is family time.
| BabyC examines the ingredients of lasagna, a dish we can both enjoy. BabyC now notices when I have something on my plate that she doesn’t have, so it is nice to eat the same foods. |
Next, I cut
the fruit open on the counter while BabyC watches. Then I show her the inside of the fruit and let her touch it
and smell it again. By this point,
BabyC is usually really excited and ready to eat. Finally, I cut the fruit into pieces that are a little more
manageable for her, and we both sit down to enjoy eating together. What a great way to engage all your
baby’s senses!
| If this was the first time you’d seen the inside of a cantaloupe, wouldn’t you be interested in exploring it further? |
We also had a 2- and a 4-year-old with us, and they loved checking out the veggies, especially hunting for ripe beets. (I’m not sure the beets were supposed to be u-pick, but how can you deny a 4-year-old that is really excited about beets?) BabyC had a great time, too.
I’m sure BabyC’s
understanding of where her food comes from is pretty rudimentary at this point,
but I like to think that there is now some wiring in her brain associating delicious
food with the texture of dirt and the fragrance of an orchard. In fact, I’m pretty sure that she
thinks dirt is a food right now, because it goes straight in her mouth.
Responsible
mama note: If you are going to do
some tasting of freshly-picked foods, be sure to check the farm’s policy on
spraying pesticides and choose an organic farm to be safe. Also, be aware that there are risks of foodborne
illness associated with eating even organic foods without washing them
first. This post depicts
irresponsible parenting behavior – eating produce fresh off the farm. I grew up on a farm where we ate
straight out of the garden all the time, but I should really take this more
seriously because I hate the thought of my kid getting sick! It is best to pick first and save the
tasting until both food and hands have been washed.
Thursday, September 8, 2011
New Study: Harsh Discipline is Associated with More Behavioral Problems
There was an interesting study published online this week in
the journal Pediatrics:

The most important finding of this study was that harsh
discipline tactics don’t lead to healthy, well-behaved children.
This was a longitudinal study (meaning that the same groups
of kids were studied at several different time points) of Australian children
in which 5107 infants (3-19 months) were monitored several times up until age
4-5 years and 4983 preschoolers (4-5-year-olds) were monitored up until age 8-9
years. Between enrollment in the
study and the final assessment, 86% and 87% of the infants and preschoolers,
respectively, remained in the study.
That makes this a relatively large study with a good retention
rate.
Child mental health was assessed with the Strengths and
Difficulties Questionnaire. The
SDQ, which can be downloaded in just about any language HERE, asks the parent or caregiver to mark
whether statements about their children are “not true,” “somewhat true,” or
“certainly true.” For example, the
SDQ asks if your child is “restless, overactive, cannot stay still for long,”
or is “nervous or clingy in new situations, easily loses confidence.”
The study authors used the SDQ to determine if children had
symptoms of externalizing or internalizing mental health problems. Externalizing problems are related to
aggression and oppositional defiance.
Internalizing problems include anxiety and depression. Among the kids in this study, 20% had
externalizing problems and 24% had internalizing problems at 6-7 years of
age. In the 8-9-year-old group,
17% had externalizing and 24% had internalizing problems.
The researchers measured a wide array of potential risk
factors for mental health issues, including family factors (such as mother’s
age, education, single parent home, socioeconomic status), child factors (sex,
race, physical health, language development, sibling), parenting practices,
mother’s mental health, various family life stressors (conflicts,
grief/illness, job quality), and community factors (type of childcare, rough
neighborhoods). I would say that
the study was fairly comprehensive in measuring a wide range of factors that
might influence a child’s mental health.
However, a major limitation of the study was that they didn’t look at the
fathers at all, except for noting whether or not they were present – nothing on
the fathers’ mental health or parenting practices.
The researchers built statistical models in which they tried
to explain the children’s mental health outcomes using all of those risk
factors that I just listed. They
found that 20-30% (depending on the group) of mental health problems were
associated with the risk factors I listed above. The other 70-80% are associated with factors that the study
didn’t examine, such as genetics, exercise, diet, or factors related to the
kids’ fathers. 20-30% doesn’t seem
like much, but that isn’t surprising when you consider that behavior
and mental health are so complicated.
Here are the most important findings of this study:
Of all of the potential risk factors that I listed above, harsh discipline was the strongest and most
consistent predictor of externalizing problems in both age groups
evaluated. That is, as defined in
this study, kids that were smacked or yelled at were more likely to be aggressive
and defiant.
Internalizing
problems (anxiety and depression) were also higher in kids who were harshly
disciplined, but in addition were consistently associated with kids with health
problems, only children, and maternal emotional stress. In the 4-5-year-olds, over-involved and over-protective parenting
styles were also associated with internalizing problems.
A limitation of any longitudinal study like this one is that
it is purely observational. It can
show that factors are associated with one another, but it can’t prove a causal
relationship. That is, this study
can’t prove that harsh discipline causes more behavioral problems, it only
says that kids that are disciplined harshly also have more behavioral
problems. This can lead to chicken
and egg type questions. For
example, it is possible that kids that the kids are disciplined harshly because for whatever reason they have more behavioral
problems, and their parents just don’t know how else to respond. Finding out if harsh discipline makes
the situation worse would require a study with an intervention – something that
would compare two groups of kids, one whose parents had coaching on respectful,
nonviolent discipline and another whose parents did not. Either way, this study does show that in kids with behavioral problems, yelling and hitting are not an
effective discipline strategy.
If harsh discipline worked, then the study would have shown that it was
associated with kids without
problems.
I wasn’t surprised by these findings, and you probably
aren’t either. Here’s why the
study is important: It gives
people who work with young kids and their parents specific risk factors to
watch for. Pediatricians,
educators, and social workers can use these factors to identify high-risk kids,
check in with them, and talk with kids and their parents about mental health. They might mention that hitting and
yelling at kids doesn’t resolve their behavioral problems, at least not in
Australia.
One surprise finding…
Mothers who had at least two alcoholic drinks per day had
kids with fewer externalizing and internalizing problems. Having been on the science side of
research before, I can just imagine the authors of this study groaning when
they found this result. They tried
to find another way to explain it but couldn’t. That’s science for you. It doesn’t always make sense. The authors of this study guess that this particular finding
is “attributable to chance.” It is
more fun to imagine that these moms put their feet up and enjoyed a couple of
glasses of wine after the kids went to bed, maybe helping to offset some of
that maternal emotional distress.
Pure speculation on my part (NOT medical advice!), but on
that note, I think I’m done for the night:)
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