S.I.T.! Feeding Your Child Using Stability and Independence at the Table

(Guest Post by Melanie Potock)

Here on Science of Mom, we’ve been discussed starting solid foods over the last few posts. It’s a topic that I spent a lot of time researching for my book, and I ended up devoting two chapters to feeding solids. It’s also highly relevant to me right now, because 5-month-old BabyM is just starting to dabble in solid foods, and I want to be sure that we get off to a good start with his lifelong relationship with food. I was thrilled when Melanie Potock, a pediatric feeding therapist, joined the discussion about starting solids on my Facebook page. She helped me understand the importance of trunk stability for eating solid foods, and I asked her if she could write a guest post about the nuts and bolts of setting children up for comfortable and successful eating at the table. I’m so glad she agreed. After reading her post, you’ll understand why I’m working on improving our high chair with duct tape today!

Melanie also has a book coming out this fall: Raising a Healthy, Happy Eater: A Parent’s Handbook. She’s a wonderful resource, so please feel free to ask your questions in the comments.

S.I.T.! Feeding Your Child Using Stability and Independence at the Table

By Melanie Potock, MA, CCC-SLP

As a pediatric feeding therapist, I visit homes, daycares and preschools to help hesitant eaters become adventurous, healthy, happy eaters. The very first thing I assess is how the child is positioned in their feeding chair. As mentioned in Alice’s recent post on readiness for solid foods here on Science of Mom, babies must be able to sit upright before safely introducing solid foods. Why? Because fine motor development is always dependent on gross motor stability. But, did you know that toddlers and preschoolers also require optimal stability when learning to try new foods? Follow the S.I.T. Model to ensure that your child is seated comfortably and with appropriate support: S.I.T. stands for Stability & Independence at the Table.

S: Stability

Most feeding chairs are designed to hold up to 50 lbs. with the assumption that a small six-month-old or a heavier toddler would be able to sit in the exact same chair. Here’s the problem with that: There is a huge difference in the size of a six-month-old baby just starting to eat solid food and an eighteen-month-old toddler. Every child needs stability while seated as I noted in this article:

“Gross motor stability (in this case trunk stability) provides the support for fine motor skills. It’s very hard to learn to eat purees off a spoon or do any sort of self-feeding of soft solids if the trunk is not supported. Try it yourself by letting your trunk relax and fall into the back of your dining chair, slightly slumped. Now stay that way and try to bite, chew and swallow. Imagine if you were just learning to eat this way!”

To achieve stability in the trunk, begin by sitting your child upright in her chair. Be sure that the pelvis is tilted forward just slightly, as shown in this diagram.

www.MyMunchBug.com-1First, put a rolled-up kitchen towel behind the arch of her back to ensure that the hip angle tilts forward or is slightly less than ninety degrees. Continue reading

4 Signs Your Baby Is Ready for Solid Foods

My last post went into great detail about the research on age of starting solids and health outcomes, including nutrition, growth, illness, and allergies. If you read that post, you know that there are small risks and benefits of starting earlier or later (in the range of 4-6 months), but there’s no evidence for an optimal age of starting solids for all babies. Here’s what to look for instead, starting with a brief summary of the data on age:

1. Your baby is at least 4 months of age.

Read my post on this if you want to know the details and see the references. If not, here’s a summary:

  • There is good evidence that it’s best to wait until at least 4 months of age to start solids, unless advised otherwise by a doctor for a specific medical reason.
  • Starting solids between 4 and 6 months of age may give babies a boost in iron nutrition, assuming they’re getting some good dietary sources of iron. Exposure to potentially allergenic foods, such as wheat and eggs, by about 6 months may reduce the risk of allergy to those foods.
  • Exclusive breastfeeding until 6 months of age may reduce your baby’s risk of minor gastrointestinal infections, although this isn’t shown in all studies. For moms, it may also result in greater weight loss and prolonged lactational amenorrhea.

Whether or not you start solids at 4 months, 6 months, or somewhere in between is up to you and your baby. The research on this topic is still evolving, and either is a fine choice. In fact, given that babies develop at different rates, it seems unlikely that all babies would be ready to start solids the moment the clock strikes midnight on their 4-month birthday or 6-month birthday.

This was the same sentiment eloquently expressed in a 2009 editorial by British pediatrician Martin Ward Platt, using the term “weaning” to mean starting solid foods:

“The weaning debate has been largely predicated on the notion that there is some magic age at which, or from which, it is in some sense ‘‘safe’’ or ‘‘optimal’’ to introduce solids. Yet it is highly counterintuitive that such an age exists. In what other area of developmental biology is there any such rigid age threshold for anything? We all recognize that age thresholds are legal inventions to create workable rules and definitions, and have no meaning in physiology or development, yet when we talk about weaning we seem to forget this.”1

Given this, it’s really up to you to follow your baby’s lead, watching for the developmental signs discussed in the rest of this post.

2. Your baby can sit upright and hold his head up straight.

These gross motor skills signal that your baby has the core body strength and stability needed to eat solid foods. Pediatric feeding specialist and certified speech language pathologist Melanie Potock explained why this is so important on my Facebook page:

“Gross motor stability (in this case trunk stability) provides the support for fine motor skills. It’s very hard to learn to eat purees off a spoon or do any sort of self-feeding of soft solids if the trunk is not supported. Try it yourself by letting your trunk relax and fall into the back of your dining chair, slightly slumped. Now stay that way and try to bite, chew and swallow. Imagine if you were just learning to eat this way!”

[I’m thrilled that Melanie Potock wrote a guest post explaining more about why stability is so important and how to best seat your baby comfortably at the table here: S.I.T.! Feeding Your Child Using Stability and Independence at the Table]

In other words, when babies have gross motor stability in place, they’ll have a much easier time with the fine motor and oral motor skills needed for feeding. That means that baby should be able to sit comfortably upright, on his own or with a little support, and hold his head up to face you. In one study, babies were able to sit in a caregiver’s lap without help at 5.5 months, on average, but this milestone was quite variable (standard deviation of 2 months).2

Trunk stability is also important because it allows you and your baby to be able to be face-to-face during feeding and for your baby to be an active participant in deciding whether, how much, and how fast to eat. You offer baby a bite, and he leans forward and opens his mouth if he’d like to accept, or he turns his head away to say no thanks. With good trunk stability, a baby can communicate his wants and needs to you, and you can be responsive to them. This way, feeding becomes a respectful and pleasant conversation between the two of you.3

Feed your baby responsively, watching for his cues of wanting more or being done, like a back-and-forth conversation.

3. Your baby has the oral motor skills to handle solid foods.

At birth, most babies are already skilled at sucking. Sucking is an involuntary reflex that develops around 32 weeks of gestation, and babies practice it in utero before birth. Sucking gives them the skill to efficiently transfer milk through a nipple, whether from breast or bottle.

To eat from a spoon, a baby needs a different set of oral motor skills. Continue reading

Starting Solids: 4 Months, 6 Months, or Somewhere In Between?

Science of Mom reader Roxanne left a comment on my post about the recent peanut allergy study. She wondered about starting solid foods with her 4-month-old baby boy:

“Do you have an opinion on starting solids at 4 months versus 6 months? I noticed that many of the studies on allergy include babies in the 4-6 month range, but I think that the current recommendation is to wait until 6 months. I ask because my baby WILL NOT drink out of a bottle while I’m at work. He is miserable all day. I’m only gone 8-3 including travel time, so if he could just get a little something at 11am, I think he might actually nap and not cry all day. We have tried everything. If you know of any studies please let me know. He is 18 weeks old.”

I totally understand Roxanne’s confusion, because there’s lots of conflicting advice on this topic. This is a question that I tackled in-depth in my book (due out in July!), but I wanted to offer some of this information on my blog as well.

Let’s start by getting our terminology straight.

Starting solids is just the beginning of a slow transition from an exclusive milk diet to a diet of table foods. In some countries, this is also called “weaning,” which is confusing since the same term means stopping milk feeding in the U.S. (i.e. weaning from breastfeeding, weaning from a bottle). “Complementary feeding” is often used in the research and public health worlds. This is an apt term, because the goal with feeding solids to babies is to complement breast milk or formula, which will continue to provide most of babies’ calories through at least the end of the first year.

Should you give your baby solid foods at 4 months, 6 months, or somewhere in between? The research on this question is complex.

Should you give your baby solid foods at 4 months, 6 months, or somewhere in between? The research on this question is complex.

What is the history of starting solids?

There is a common assumption that longer exclusive breastfeeding – and longer delay in starting solids foods – must be more natural, and hence, healthier. But looking at traditional human cultures, with no access to commercial baby food, modern pediatricians, or divisive Internet forums, can give us valuable perspective on what is “natural.” A survey of childbirth and breastfeeding practices in 186 non-industrial cultures reported that solid foods were routinely introduced before 6 months, a finding that surprised the author:

“Contrary to the expectation of a prolonged period of breast-milk as the sole source of infant nutrition, solid foods were introduced before one month of age in one-third of the cultures, at between one and six months in another third, and was postponed more than six months for only one-third.”1

A more recent cross-cultural analysis of 113 nonindustrial populations from around the world found that parenting introduced solid foods before 6 months in more than half, with 5-6 months being the most common time for introduction.2

Human diets and infant care practices vary tremendously around the world, so it’s impossible to say if starting solids at 4 months or 6 months is more natural. As to which is healthier – well, that’s where we need to look at the science.

What is the official advice about starting solid foods?

Public health and professional organizations fall into two camps when it comes to recommendations about solids foods: they either recommend starting between 4 and 6 months OR at 6 months. There are well-respected organizations on both sides. Continue reading

What To Do About Babies and Peanuts: New Study Finds Early Exposure Can Prevent Allergy

You’ve probably already seen headlines about a study showing that feeding children small amounts of peanut products in the first 5 years of life can prevent the development of peanut allergy. The study was conducted in the U.K., led by Gideon Lack of King’s College London, and was published this week in the New England Journal of Medicine (free full text available here).1

Why is this study important?

Photo by Sanja Gjenero

Photo by Sanja Gjenero

Food allergies are on the rise in Western countries, and peanut allergy is one of the scariest. In the U.S., more than 2% of children and their families are now living with a peanut allergy, representing a 5-fold increase in prevalence since 1997.2,3 And this allergy isn’t just an inconvenience; it’s now the biggest cause of anaphylaxis and death related to food allergy in the U.S.4 This is a huge concern to parents wondering when and how to introduce peanuts to their kids, but the advice on this matter has been really confusing over the last 15 years.

In 2000, the AAP recommended delaying the introduction of peanut and other commonly allergenic foods (i.e., wheat, eggs, fish, cow’s milk) until at least the first birthday and until age 3 for kids thought to be high-risk for allergy.5 While this advice may have seemed reasonable, it was never based on good evidence – just a best guess based on knowledge at the time.

Meanwhile, the incidence of food allergies continued to climb, and epidemiological evidence emerged that avoiding allergens might backfire. In 2008, the AAP issued new guidelines stating that there was no evidence that delaying introduction of solid foods, including common allergens, beyond 4 to 6 months of age would protect children from developing allergies.6 This document was intentionally vague, because at the time, there weren’t any studies to give more specific guidance on when to introduce what, in what amounts, etc. And this flip-flop in advice, which was also mirrored in many other countries, has left a lot of parents confused.

Gideon Lack and colleagues published a study in 2008 that found that the incidence of peanut allergy among Jewish children in the U.K. was 10-fold higher compared with those growing up in Israel.7 Comparing the mean age of introduction of peanut protein between the two countries, they found that babies in Israel were commonly introduced to peanut in their first year, while babies in the U.K. were not. This led them to their hypothesis that early exposure to peanut might help prevent the development of peanut allergy, and that’s what the current study tested.

How was this study conducted?

The researchers recruited babies between the ages of 4 and 11 months that were high risk for developing peanut allergy because they had severe eczema, egg allergy, or both. Continue reading

The Whole Truth About Infant Cereals: 7 Science-Based Tips

I recently received an email from a reader with a question about baby cereals:

“My wife and I are expecting a baby this October. We are planning to breastfeed but have lots of questions about introducing solid foods, particularly cereals. Do we have to feed the baby commercial baby cereals? I am concerned about all the extra crap that is put into commercial food, including unnecessary sugars and possible GMOs. Is there another product or whole food option that we could use to introduce grains to our baby instead of a commercial cereal product?”

~Brenda and Leah in San Diego, CA

Baby cereals have made a big swing in popularity over the last couple of generations. It wasn’t long ago that they were considered an essential first food, given to baby within the first months or even weeks of life. These days, in some circles, they’ve become a marker of lazy parenting, with conscientious parents choosing instead to prepare their own organic carrot purees or scrambling eggs with butter and breast milk. Cereals, meanwhile, get slammed in blog posts that call them over-processed, pointless, and even toxic. The movement towards more real foods for babies is definitely a good thing, but the scare-mongering about baby cereals is not. Brenda and Leah’s question is a great one, and it deserves an answer that is science-based, not sensationalized.

mother feeding her baby

1. You don’t have to feed a commercial baby cereal.

The reason infant cereals are typically recommended is that they are fortified with iron, and iron can become limiting during late infancy, particularly in breastfed babies. In early infancy, babies are mostly using stored iron that was transferred from mom during pregnancy, but by around 6 months, those stores run low, and they need to be getting some iron from solid foods. At this age, babies are growing and developing rapidly, and studies show that iron deficiency in infancy can cause developmental delays and lasting cognitive deficits.1–3 Breastfed babies are at greatest risk for iron deficiency,4,5 because breast milk is quite low in iron. (The iron in breast milk is efficiently absorbed, but there simply isn’t much of it.)

Commercial baby cereals are fortified with iron, effectively making it an easy way to deliver extra iron to lots of babies. In one study, among breastfed babies fed a fortified cereal daily, only 2.5% developed iron deficiency, compared with 14% of babies fed solids at their parents’ discretion.6 Infant formula is also fortified with iron, so babies that are formula-fed for at least half of their milk meals generally get enough iron that way.

However, there are other sources of iron that are actually better than fortified cereals. Meat, poultry, and fish all contain heme iron, which is more efficiently absorbed in the digestive tract than nonheme iron, the form found in plants like spinach and beans, as well as fortified cereals. Including a source of heme iron in a meal also increases the absorption of nonheme iron, so serving baby a little chicken with lentils actually increases the bioavailability of iron from the lentils. Baby cereals are often recommended as first foods, but this is based more on tradition and culture than on any scientific evidence. There is no reason why you can’t introduce those great heme sources of iron (meat, poultry, fish) as first foods, and in fact, this is now recommended by the AAP. If your baby is consuming 1-2 small servings of meat per day, plus other sources of non-heme iron, then there’s no reason that you have to supplement with an iron-fortified cereal. See more of my tips on ensuring that your baby gets enough iron in this post: 5 Practical Ways to Increase Iron in Your Baby’s Diet. Also, note that your pediatrician should test your baby for anemia around 12 months, so this will at least alert you if your baby is very deficient in iron.

Many babies and their parents also opt to skip spoon-feeding entirely, doing some version of Baby-Led Weaning. Cee simply wasn’t interested in being spoon-fed pureed foods, but she loved feeding herself soft finger foods. That meant that she ate very little infant cereal, except what I baked into muffins or pancakes (mostly to use up the box, but I figured she could also use the extra iron). This route can be fun and appropriate for babies that are ready to self-feed by around 6 months; others may need spoon-feeding and may love the interaction of feeding with a tuned-in caregiver.8 There are lots of options here, and the most important thing is to offer iron-rich foods (cereal or otherwise) and to follow your baby’s lead with texture and timing.

2. Commercial baby cereals may not be as bad as you think.

Here’s the Nutrition Facts label and ingredient list for Gerber’s oatmeal cereal (this one happens to be an organic product, but the conventional version is otherwise the same):

gerber oatmeal label

What’s in baby cereals? Take a look at the ingredient list. Continue reading

New Research on Gluten Introduction to Infants and Risk of Celiac Disease

If you’re worried about your child’s risk of celiac disease and wondering when to introduce gluten-containing foods, then you’ll want to know about two new studies published in the New England Journal of Medicine this week.

Gluten is delicious to most of us, but it can be devastating to those with celiac disease. Photo by Adrian van Leen

Gluten is delicious to most of us, but it can be devastating to those with celiac disease. Photo by Adrian van Leen

Celiac disease is an immune response to gluten, a protein found in wheat, barley, and rye. It causes inflammation and damage to the small intestine, and while it can be successfully managed with a gluten-free diet, it is a lifelong disease. (Celiac disease is distinct from non-celiac gluten sensitivity, which is a murky and controversial condition that may not be related to gluten at all.)

I reviewed the research on early infant feeding and risk of celiac disease on my blog about a year ago (Breastfeeding, Gluten Introduction, and Risk of Celiac Disease). I have since received lots of comments and messages from parents concerned about this, so I wanted to be sure to write about these important new studies.

These latest studies dramatically advance our understanding of this topic because they are randomized controlled trials. Both started with a group of babies already identified as being high-risk for celiac disease, randomly assigned them to different time of introduction of gluten, and then tracked their development of the disease. Previous studies were all observational, thus only able to identify associations between variables, and were limited by confounding factors and other sources of bias.

The first study was led by researchers in the Netherlands but included children born in 7 European countries and in Israel. 944 babies were identified as being high-risk for celiac based on a genetic predisposition (HLA genotype) and having a first-degree relative (parent or sibling) with celiac. The babies were randomized to two groups, and one group was given a small amount (100 mg) of gluten starting at 4 months of age, while the control group was given a placebo and instructed not to introduce gluten until 6 months, at which point parents in both groups were advised to gradually introduce gluten-containing foods. The incidence of celiac disease was tracked through 3 years of age, with all suspected cases confirmed with an intestinal biopsy. Overall, about 5% of the study participants developed celiac disease by age 3, and it made no difference whether gluten was introduced at 4 or 6 months. It also made no difference whether the babies were breastfed (exclusively or not) or currently breastfed at the time of gluten introduction.

The second study was conducted in Italy and had a similar design but instead compared gluten introduction at 6 vs. 12 months. Continue reading

What’s so important – and stressful – about family dinner?

A recent study about the stress of getting family meals on the table has been getting lots of attention from both the media and moms. A Slate piece, “Let’s Stop Idealizing the Home-Cooked Family Dinner,” posted Wednesday, has already garnered 3.5K comments on the article itself and more than 26K Facebook shares. This has obviously struck a nerve. While feeding a family is a big and often stressful job, some perspective about why we do it and what matters most about family meals might be helpful to families feeling the mealtime crunch.

The study itself, titled “The Joy of Cooking?”, was published in Contexts, a publication of the American Sociological Association geared to be accessible to the general public. The paper itself is a really interesting read and freely available online.

Researchers in the sociology and anthropology departments at North Carolina State University conducted the study. This was a qualitative study, which means that the data came in the form of stories, generated from interviews with real people. From the paper:

“Over the past year and a half, our research team conducted in-depth interviews with 150 black, white, and Latina mothers from all walks of life. We also spent over 250 hours conducting ethnographic observations with 12 working-class and poor families. We observed them in their homes as they prepared and ate meals, and tagged along on trips to the grocery store and to their children’s check-ups. Sitting around the kitchen table and getting a feel for these women’s lives, we came to appreciate the complexities involved in feeding a family.”

These kinds of methods are common in sociology and anthropology research, and they allow researchers to understand the many complex variables that contribute to how people feel and why they feel that way. However, we have to be careful about interpreting these studies beyond the individual stories that they provide. For example, this study wasn’t a random sample of moms, and it can’t give us quantitative information like the percentage of moms who find cooking to be an unbearable chore versus rewarding or enjoyable. It doesn’t allow us to look at correlations between family income and nights of home-cooked meals per week, for example.

Here’s what it can tell us: Continue reading

Amylase in Infancy: Can Babies Digest Starch?

Several readers have emailed me to ask about babies’ ability to digest starch. Here’s one:

“I have noticed you recommending cereals for babies several times.  I am sure that you are aware that many people look at feeding a baby grains before the age of one or even two as if you have offered your child strychnine. One of the reasons cited is that they supposedly do not have amylase to digest grains before that time. I have often wondered what exactly is happening to the cereal if it is not being digested, but the only statement I could find is something about it “rotting” in the gut.

I would love to get information from a scientific point of view on this topic.  Everything I have been able to find thus far has been very biased towards one point of view or another. Either “cereal is the perfect first food. Easy to digest and enriched with iron” from the infant cereal companies or “Cereal is junk.  No infant should ever eat grains. It is not natural or traditional and they can’t digest it” from online parenting sites.

I need a little clarity and common sense.”

~Hope

I love the skepticism in Hope’s email, and I can also empathize with her frustration about how difficult it is to find good information about a seemingly simple question: Can babies digest starch? If you search for the answer to this question online, you will run into dire warnings of the dangers of giving starch to babies. But these sites might set off your woo detector – as they should. So, after receiving multiple emails about this question as well as seeing it mentioned in discussions on the Science of Mom Facebook page, I figured it was time to put some evidence-based information about babies and starch digestion on the Internet.

Researching this question has given me an excuse to read some classic nutrition physiology papers harkening back to the 1960’s and 1970’s, and it’s brought back memories of years in the lab, exploring nutrient digestion and metabolism. And starch digestion in infancy, it turns out, is a really neat story.

Let’s start with some basics about carbohydrate digestion.

What is starch? How is it digested?

Starch is a type of complex carbohydrate. Made from lots of glucose molecules bonded together in long, branching chains, it is a plant’s way of storing glucose – product of photosynthesis and source of energy – in a stable form. We find starch in grains, root vegetables, winter squashes, beans, and some fruits, like bananas. Starch is an important storage depot for the plant, and it also makes for tasty staple foods for cultures around the world.

One little section of starch, containing 3 glucose molecules. Wikimedia Commons, public domain.

A chain of 3 glucose molecules, like a tiny section of starch.

Glucose is the major fuel for the cells of the body. When we eat starch, we have to break the bonds in those chains of glucose molecules, liberating them to be absorbed from the small intestine into our blood. Starch digestion begins in the mouth, where salivary amylase starts chopping up those large glucose chains. When this partially digested starch gets to the small intestine, amylase made and secreted by the pancreas jumps in to do more bond-breaking and is responsible for most of starch digestion in adults. A suite of enzymes produced by the cells lining the small intestine, including sucrase, isomaltase, maltase, and glucoamylase, work on the remaining short chains, finishing up the job and making glucose available for absorption.

Starch Digestion in Infants

Infants go through some incredible nutritional transitions in the first months of life. Prior to birth, their growth and development is fueled almost entirely by glucose from mom, absorbed across the placenta. After birth, they have to abruptly transition to an exclusive milk diet, which is high in fat and lactose, still a relatively simple sugar. As they start solid foods, babies have to adapt to a much more complex and varied diet. Around the world, starch is a major source of energy in the diets of children and adults alike. But when infants are first introduced to starchy foods – often in the form of cereals and porridges – starch is a novel nutrient to their digestive tract. They need to turn it into glucose, but are they equipped to do this? Continue reading

Breastfeeding, Gluten Introduction, and Risk of Celiac Disease

A study published yesterday in the journal Pediatrics suggests that later introduction of gluten and breastfeeding beyond 12 months both increase the risk of a child developing celiac disease. These new findings add to the already muddy waters of our current understanding of the role of infant feeding in celiac disease.

Photo by Shree Krishna Dhital, via Wikimedia Commons

Celiac disease is an immune response to gluten, a protein found in wheat, barley, and rye. Celiac is characterized by inflammation and damage to the small intestine, leading to symptoms such as diarrhea and digestive pain. In the U.S., celiac disease is present in about 1 in 141 people, although many of these cases go undiagnosed. Infants that develop celiac disease often have poor growth or weight loss, because intestinal damage compromises nutrient absorption. They also may have chronic diarrhea and a swollen, painful belly.

Celiac can usually be treated with a gluten-free diet, but there isn’t a cure for the disease. Multiple genetic markers have been identified for celiac disease, but many genetically susceptible individuals tolerate gluten and never develop symptoms, leading to speculation about other risk factors, including early childhood nutrition.

This latest study was a large, prospective survey of infant feeding practices and development of celiac disease in Norwegian children. Parents were asked when they first introduced gluten and how long they breastfed their babies. Children that developed celiac disease were tracked through Norway’s national medical system. The study included 324 children with diagnosed celiac disease and 81,843 without celiac. The researchers then looked for patterns in the data that might help to explain why some children developed celiac disease and others did not.

There were two major findings to emerge from this study:

  1. Children that had not yet tried gluten by 6 months of age were more likely to develop celiac disease.
  2. Breastfeeding at the time of introduction to gluten did NOT appear to be protective. In fact, breastfeeding for longer than 12 months was associated with an increased risk, although it was borderline significant (P=0.046).

Both of these findings are contradictory to current infant feeding advice in the U.S. The AAP’s Section on Breastfeeding recommends exclusive breastfeeding for about 6 months before introducing solid foods, followed by “continuation of breastfeeding for 1 year or longer as mutually desired by mother and infant.” The same AAP policy goes on to say, “There is a reduction of 52% in the risk of developing celiac disease in infants who were breastfed at the time of gluten exposure.” But this Norwegian study effectively found that following the current advice of the AAP seems to increase a baby’s risk of celiac, not decrease it.

Obviously, we need more information here. And as usual, one study isn’t enough to give us the full picture of what we know and don’t know about this topic.

To understand the evolving hypotheses around celiac disease and infant feeding, we need to go back to Sweden in the mid-1980’s, when the rates of celiac disease in young kids suddenly quadrupled from an incidence of 1 in 1000 births to 4 in 1000 births over just a few years. It was an epidemic, and it appeared to be isolated to Sweden; neighboring countries weren’t affected. What’s more, celiac was showing up in really young kids. The median age of diagnosis during the epidemic was just about a year old. In 1995, celiac disease in Sweden plummeted back to pre-epidemic levels, and the median age of diagnosis increased to 4 years of age. Continue reading

What’s Your Feeding Style? (Fearless Feeding Review and Giveaway)

Do you have a feeding philosophy? What’s your feeding style?

These are not the most common topics in parenting discussions. We’re often too busy talking breast and bottle, baby led weaning or purees, organic or conventional, and how to get our kids to eat more vegetables. But the question of feeding style, I believe, matters more to children than any of these oft-discussed topics.

I am really pleased to have a new book on my shelf that covers the HOW and WHY of feeding children just as well as it covers WHAT to feed: Fearless Feeding: How to Raise Healthy Eaters from High Chair to High School, by Jill Castle and Maryann Jacobsen. Both authors are registered dieticians, mothers, and bloggers. They take a long-term view on feeding – that we shouldn’t just be concerned with what our kids are eating today, but also about teaching kids to eat well for a lifetime.

9781118308592_Castle.inddFeeding style is one of the first topics in Fearless Feeding, so if you’re not sure how to describe your own feeding style, here’s your chance to give it some thought. Castle and Jacobsen discuss 4 feeding styles, analogous to parenting styles that may be familiar to you: Continue reading