Wednesday, November 30, 2011

Oh No, She Didn't! The "Time to Stop Suckling" post in Slate

As any blogger will tell you, when you can't think of anything to blog about, find a news story related to your blogging topic, and comment away. Not that I'm doing that or anything (looks around sheepishly).

But there's been some comment by The Feminist Breeder and others on their Facebook pages/blogs about a certain piece of advice given by Slate's Dear Prudence to a lady disconcerted by her sister-in-law breastfeeding her five-year-old son at the table at Grandpa's 80th birthday bash. Cue the usual bingocard lactivist outrage about how this just shows how meeeeaaaan the world is breastfeeding mothers. Lots of the usual comments on TFB's Facebook page about how the global average age of weaning is four years (oh no it isn't), except that for some reason the bidding has now gone up to five years.

To be honest, though, I think the age is less an issue than the boundaries, and the fact that a schoolboy is still using his mother's body like a drinks bar. If one is going to nurse a child at such an advanced age, I think it's time to make it a discreet, private thing. This is not achieved by whipping your boob out in front of a family gathering. I can't think of a single reason why a child that age would need to nurse rightthisverysecond at a party (why can't he just get a glass of water?); even if he needs the milk for nutritional reasons due to allergies (an odd claim since many cultures do not drink cow's milk), presumably that can wait too.

There are social implications here; the outside world is not going to be kind to this child. Sooner or later he will realize that other kids his age don't nurse and will stop asking, but the problem is that by that point he will probably already have become a target of teasing and ridicule. I don't think the mother in question is thinking of her son's welfare at all; I think she is thinking of herself and her identity as the One Crunchy Mum To Rule Them All. Getting critical comments is, I suspect, all part of the agenda (perhaps she failed to get any when feeding her son in public as a baby and is nursing--haha--a little secret disappointment?) There is a certain type of mother who thrives on feeling that her mothering choices make her a persecuted minority.

Saturday, November 19, 2011

Bullshitometer: Baby led weaning/Gill Rapley

Baby led weaning, a term invented by British health visitor Gill Rapley, may not be "breastfeeding" as such, but it's so popular on breastfeeding-centered boards and blogs that it's worth a little scrutiny. Confusingly for North Americans, BLW is not about weaning from the breast; rather, it refers to a method of solid food introduction which consists (roughly) of forgoing the traditional spoonfeeding of purees, and instead giving the baby large-ish pieces of table food to self-feed... or chuck on the floor if they are so disposed, the idea being that this is about "following the baby's lead" in terms of what and how much solid food they eat. BLWers usually wait at least six months--sometimes later--before starting solids, and BLW is typically characterized by a much slower shift towards solids than the spoonfeeding approach, with babies not infrequently getting little in the way of solids until they approach a year old.

Because BLW has become quite fashionable, everyone seems to have started using the term and you will often hear people using it to describe what is more traditionally called "finger foods" ("We're doing some purees with a spoon, and also some BLW"). However, people who take BLW Very Very Seriously--I'm going to refer to them as the BLW purists--scoff at such approaches, saying that you can't do BLW by halves. The whole philosophy of bona fide BLW, you see, is based on the idea that babies should be entirely in charge of the feeding process; once you start doing any spoonfeeding, the whole weaning process becomes... like... not BLW. In this respect, the purists actually go even further than Rapley herself, who admits that a bit of spoonfeeding may be okay if you really have to. Gill Rapley's philosophy of BLW is set out in her book;  however, aficionados tend to say that this weaning method is as old as time itself ("What do you think people did before blenders?") and that by contrast, puree-based spoonfeeding is a new invention, necessitated by the invention of infant formula and pushed on parents by the babyfood industry, which has a vested interest in getting parents to give solids more and earlier than is natural for babies.

Finger foods are not the subject of this Bulshitometer post--everyone does finger foods and all pediatricians recommend them, including my parents' 1970-something Dr Spock book if I remember rightly. What I am scrutinizing is BLW as per the second definition, and the claims that have been made for it by Gill Rapley and her fans--namely, that there is a particular virtue in avoiding pureed/mashed foods and spoonfeeding, and that forgoing these things will lead to children with better eating habits, that parent-led feeding will make children more prone to obesity or pickiness, that children allowed to self-feed everything will gain better motor skills and instinctively avoid things they are allergic to, that pureed foods cause constipation, and that BLW is the "natural" way and represents the biological and historical norm for human babies.

Better eaters
Less obesity! Better eating habits! Children who eat vegetables without complaining! Rapley could hardly have come up with a more appealing laundry list of points with which to entice 21st century parents engaged in that very modern pursuit of worrying about food. Based on her 20-odd years as a health visitor, "Rapley believes that babies allowed to feed themselves tend to become less picky, develop better hand control more quickly and to avoid foods to which they are later found to be intolerant."

I'm sure she does believe all this. Similarly, people in the 17th century apparently believed that bloodletting cured all manner of ills and that fever could be cured by taking live pigeons to bed with you. All together now: "The plural of anecdote is not evidence."

Considering the fervor that BLW inspires in some of its devotees, it's striking how little evidence there is to support its claims--"little" as in basically "none." Rapley's book's claim that BLW will result in less picky eaters rests upon a single experiment conducted before WWII--a trial for which almost no data was ever presented and which can never be replicated for ethical reasons. Rapley also includes a study she conducted among a small group of babies which proved, not very excitingly, that if you present babies with a variety of table foods, by nine months they will be... eating a variety of table foods. So yes, if you want to skip the purees and go slower on solids, it's probably fine. But none of this provides any evidence for Rapley's other claims of less picky eaters or magic allergy avoidance.

The other "evidence" provided by the book consists largely of proud parents saying things like "I'm doing BLW with my nine-month-old and she's eating broccoli! See? BLW totes works!" No. Your child is eating green veggies with gusto because she is a baby. Come back when she's two and we'll talk. Two is generally when the food fussies kick in, probably for evolutionary reasons related to the fact that toddlers in neolithic societies were at real risk of being poisoned by unknown plants found in their environment. The BLW site's toddler forum is full of parents moaning that their two- and three-year-olds have suddenly started rejecting foods they used to eat with relish.

Other parents compare the fact that their BLW-ed younger child is a better eater than their traditionally weaned older child--a comparison which, on the individual level, tells us precisely nothing, given that in any pair of siblings, even those weaned in exactly the same way, one will typically be a better eater than the other simply because genes play a powerful role in our eating preferences.This is Bad Science 101--seriously, I could use exactly the same approach to "prove" the efficacy of homeopathy (or the live pigeon treatment, for that matter).

I mean, I do get that obesity and the dreaded "kiddie food" culture of bland junk foods are worries for parents; but these are problems that have become acute only in the last half-century, so it seems a bit odd to blame them on parent-led feeding of mashed foods, which has gone on for millennia (see below). Cross-culturally too, it's hard to see any patterns; as one poster notes here (with thinly disguised annoyance), French babies get bland mush on a spoon and cereal in their formula bottles, and still seem to end up better eaters than British and American children. So do Japanese kids, for that manner, in spite of their parents Doin It Rong in terms of first foods (spoon-fed gluey rice porridge, since you asked).

Better motor skills
Manipulating finger foods doubtless is indeed a way for babies to practice their fine motor skills, but in Rapley's claims that BLW results in better motor skills, I detect the whiff of a burning straw man; I don't think many people actually do wean babies on nothing but spoonfed mushes. Most parents have always given finger foods in addition to spoonfeeding, and it's hard to see how the benefits of finger food practice get magically erased as soon as you give the kid a bit of mashed potato on a spoon. As for the vague parental claims that their BLWed babies have better motor skills, see above comments about anecdotes vs evidence.

Purees cause constipation
There is no reason why pureed foods should cause constipation any more than non-pureed foods. A quick visit to Ask the Dietitian confirms that pureeing or even blenderizing foods leaves their fiber intact--although anyone who regularly consumes fruit smoothies can testify to their, ahem, bowel loosening effect without the need to go online. Perhaps Rapley is confusing pureeing with juicing, a very different process? Constipation is a common temporary effect of solids-introduction as the baby's gut tries to get used to new foods; if it is less noticeable with BLW, a simpler explanation is that if you are hardcore about the baby only eating what he/she can self-feed, it will probably take a while before they actually eat enough to have any effect on the digestive tract.

BLW is popularly considered to be more "natural" than feeding purees or mashes. Now..... trying to define what is "natural" for human beings is always a bit of a philosophical headache. However, it's not clear on what grounds BLW qualifies.

The whole "What Would Cavemama Do" approach to childrearing gets a bit daft, but for the sake of arguing.... Rapley's book states that prior to the 20th century, most babies didn't start solids till they were "eight or nine months old" (she gives no source for this alleged fact). It's surprisingly hard to find proper sources on solids introduction in pre-industrialized societies; from those which can be found, what kind of picture emerges? Well.... surprisingly, lots of mush, lots of parent-led feeding, and lots of starch, to be honest (see here, here, here and here, for example... if you don't want to wade through the last one, there is a summary here). Feeding babies foods that have been mashed in some way--between two rocks, your fingers or even your own jaws--has a long history, and no, you don't need a spoon or a blender (slummy mummies like me could have told you that already, though).

Do babies in "traditional" societies also self-feed? Probably: the casual nature of such culinary encounters is such that they probably aren't going to make it into an anthropologist's report, but given how grabby older babies are it would be surprising if this didn't happen. In other words, throughout human history, most babies most likely have received a mixture of parent-fed mushy things and larger pieces for self-feeding.... which, funnily enough, is pretty much what most parents in industrialized societies also end up doing.

What I can say is that I could not, in all my researches, come across any "traditional" societies that do solids-introduction the way Gill Rapley sets out (no parent-led feeding, baby only eats what baby self-feeds, blah blah). Not one. To be honest, I'm not even sure how Rapley-esque weaning would really work in a traditional society. For a start, I can't see women in a food-poor environment being cool with a baby throwing good food all over the floor in the name of play and exploration. They don't really do the whole "child-centered" thing in traditional societies.

Curiously, Rapley also mentions pre-chewing in her book, and says that she thinks it is fine; she does not, however, clarify how this differs from spoon-feeding (on which she blames for everything from gagging to pickiness to overeating).

Rapley's devotees insist that BLW is the most convenient way of giving solids. I am not sure I agree. I think the most convenient way, for most people, is to do some finger foods and some parent-led feeding, depending on the food, the situation and what seems to suit you and your child best (unless you end up with one of those kids who simply refuses to be spoonfed at all). After all, traditional weaning has always included finger foods; Rapley's innovation is largely to say that pureeing and spoonfeeding should be ruled out. Ruling stuff out rarely makes the whole childrearing thing easier.

For example, giving baby an apple chunk/loaded spoon to nibble at (so you can eat your dinner) is one of the first things you learn in Mum School... it makes sense, especially, in the evening, since both baby and clothes will soon be going in the wash anyway. But when you are in a restaurant, it may not be very convenient (or polite) to basically allow your child to throw food everywhere--make no mistake, self-feeding is messy, and while you don't have to spend time mashing or feeding, you will probably spend about as much time cleaning up, changing clothes and getting food out of the kid's hair. One hears of hardcore BLWers carting splash mats and portable highchairs around with them, leaving honking tips for waiters to make up for the blizzard of mess, or sticking to "child-friendly" restaurants, rather than subject young Sparkleigh to the dreaded sp00nfeeding of d00m. One has to ask, would it not be easier to just sit Junior on your lap and offer them something mushed up on a spoon or finger?

Similarly, if you have to get to the doctor's at 2pm, it makes more sense to quickly and neatly spoon kiddo a bit of food, and then DONE. Rather than hang around waiting while the child thoughtfully pushes avocado chunks around on a food tray, then change clothes and wipe down the floor/bumbo/baby, and then have to stop on the way to nurse again, because the kid didn't actually get more a mouthful of food inside them.

Because that is the other thing about true, purist BLW; if your baby really does only eat what he or she is able to self-feed, most likely he or she will take to solids as a pretty slow pace--in some cases very slow (on crunchy forums one is constantly reading about children who are 12, 15, 18 months old and still almost completely breastfed). This may or may not suit your agenda. I can see it being convenient, maybe, for a SAHM who loves breastfeeding. But if you are working, you will have to pump (and sterilize and set up pumps, and store and defrost) more milk... unless you are happy to give formula as well. And I strongly suspect that nightweaning, and moving away from nursing to sleep and constant comfort feeding are psychologically easier to see through if you are seeing your baby put away a certain consistent amount of solids every day, so that you are not constantly fighting the voice in the back of your head that says "But what if she's still HUNGRY??"

Then there is the conundrum of what to do with foods that beg to be spoonfed (preloading spoons for the baby to self-feed with doesn't always work). As one poster here put it, "If we're eating pasta or noodles or a roast dinner DD eats with her hands. If it's soup or yoghurt or mash I use a spoon. Common sense. A friend went to such great lengths to avoid a spoon it was comedy. Chunks of pear dipped in yoghurt (which got chucked on the floor), toast dipped in porridge, yum! It's just a spoon FFS!" Some BLW purists apparently try to facilitate self-feeding by circumcising bananas with scissors (Freud'd have a field day with that one), lovingly rolling slippery foods in crushed cheerios, or snipping them up with crinkle cutters.  All good fun, no doubt, but it's unclear how any of this is actually less work than just offering said food on a spoon. Anyway, I'm pretty sure cavemama didn't have crinkle-cutters.

Finally, I LOLed at Rapley's suggestion that parents should get round the whole salt issue by simply not using any salt in their own cooking. Are there parents who actually do this... for everything they cook? Remind me never to eat at their houses. A stir-fry, a curry, a pasta sauce simply will not taste as tasty without a certain minimal amount of salt. I like eating tasty food. Sorry.

The nutrition thing
Many babies take to self-feeding early and easily--indeed, these babies often reject spoon-feeding altogether and clearly it makes sense to just let them get on with it. But other babies, particularly those whose motor skills are slower to develop, will not be able to self-feed useful amounts of food until they are much older than six months; if you really do have this strict rule about Baby Must Only Eat What Baby Puts In Own Mouth, it could be a really long time before they are able to actually eat more than minuscule amounts of food (as evidenced by all those non-eating older babies and toddlers on BLW forums). However, as I discuss here, once babies get much past six months they do start to need more nutrients than they can realistically need from breastmilk. The "food before one is just for fun" thing is one aspect of BLW that I just can't agree with. The Maternal and Child Nutrition Journal has expressed similar views, by the way--suggesting that while many babies will do OK with self-feeding alone, some could be put at risk of micronutrient deficiency if their parents are hardcore about not doing any spoon-feeding. I personally feel that offering foods in different ways and being flexible is probably the best approach.

Bullshitometer verdict
I have a confession: I actually really, really like most of the ideas found in BLW. I like the idea of giving children table foods where possible, including spicy and unusual things; I agree that babies can generally start finger foods as early as six months; I particularly like the idea of using BLW as a motivation for improving the food that the family eats as a whole. I just think it's a shame that Rapley had to spoil some sensible ideas with silly claims about purees being constipating and parent-led weaning causing bad eating habits, none of which is backed up by any data.

I think BLW was in some ways a necessary corrective to bossy Gina Ford types lecturing people about introducing the "right" foods in the "right order" and the "right amounts," and baby food manufacturers going on about "stages," causing parents whose babies didn't respond well to this to feel a lot of stress. But it's not much of an improvement if we just exchange that for all the self-conscious agonizing seen among many posters on BLW boards (debating about whether using a mesh feeder is "real" BLW weaning, whether we are "allowed" to hold food up to their mouths or is that helping them too much, blah blah), with parents fretting that if they break any of the "rules" their children will end up obese, terrible eaters or what have you.

I hereby propose the Breastfeeding Without Bullshit Patented Bone Idle Can't Be Bothered Weaning Method, which consists of trying out lots of things (finger foods, cereal, puree, finger feeding, mesh feeder, feeding them with a spoon, handing them loaded spoons, giving them pieces to self-feed, holding up bits for them to take a bit out, whatever) and doing what you and your child enjoy most and find the least hassle. Because at the end of the day it isn't going to make any long-term difference anyway.

Finally: if any mother, online or in real life, spends her time banging on to other mothers about how her proposed weaning "system" (BLW, gourmet-meals-in-an-icecube-tray or whatever) is inherently superior and guaranteed to produce a marvelous eater, the laws of karma dictate that her baby will grow into one of those toddlers who refuses to eat anything except luminous orange macaroni cheese. You Have Been Warned.

Further reading
Weaning Made Easy by Rana Conway. I discovered this book after writing this post; Conway discusses some of the ideas talked about here, with a good run-down of some of the advantages and potential issues with puree-only or "pure" baby led weaning approach, and recommends a mixed and flexible approach to feeding as being the best suited to the majority of parents and babies.