Ped recommendation to wean at one year -- rebuttals? - Mothering Forums

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#1 of 10 Old 10-09-2011, 10:20 AM - Thread Starter
 
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The handout my pediatrician gives out regarding infant feeding at the 4-month appointment (yeah, I know -- strike one, they are already pushing solids) gives the following advice:

 

"Discontinue breast- and bottle-feeding by 12 months of age. A study by Dr. W. S. Agras found that delayed weaning was associated with more obesity."

 

In doing a quick google search, I am finding this exact sentence on pediatrician websites all over the U.S. (I was looking for the study because I'm pretty sure it was done on bottle-fed babies and they extrapolated to include breastfed babies in the recommendation). Do most pediatricians tell breastfeeding mothers to wean at one year because of concerns about obesity? Because to me that seems, not to put too fine a point on it, nuts. And totally wrong. WHO still recommends breastfeeding until age 2 , and I printed out their materials on complementary feeding.  Does anyone have any links to studies or reputable online sources that refute this recommendation? I understand what they are trying to do -- help prevent obesity in kids, which is admirable -- but I think this is bad advice and even though I wouldn't follow it, I hate that they are telling this to other mothers who might do so without looking into the issue any further.


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#2 of 10 Old 10-09-2011, 05:01 PM
 
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That pediatrician is going completely against the American Academy of Pediatricians, the World Health Organization and the Healthy People 2020 Initiative recommendations to continue breastfeeding through one year or as is mutually desired by the mother and child. 

 

http://pediatrics.aappublications.org/content/113/2/e81.full.pdf  This article by the AAP should give you some good ammunition to use... right before you fire your pediatrician.  Best wishes on finding a new - more up-to-date pedi who knows what is best for your baby. 

 

BTW.. you really don't need any rebuttal other than "it's my baby."

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#3 of 10 Old 10-09-2011, 05:22 PM
 
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If you Google breastfeeding + obesity the first hit should take you to Google Scholar where there are a number of articles. The evidence is not conclusive yet but there is a growing body of research which suggests that breastfeeding is protective against obesity.


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#4 of 10 Old 10-09-2011, 05:31 PM
 
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This is probably the study they are referring to:

http://www.ncbi.nlm.nih.gov/pubmed/2329430

Can only access the abstract here, would be interesting to see the full text.

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#5 of 10 Old 10-09-2011, 05:47 PM
 
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http://www.jpeds.com/article/S0022-3476(04)00223-9/abstract

I think this is the article, I was able to download the pdf file no problem. if this IS the article your ped is referencing s/he is somewhat off the mark with regards to conclusions. There were only 216 children in the study, and the main point that came away with was that overweight in children is, most influenced by parental overweight and a tendency to reactin highly emotional ways. The final, point about the bf connection is that more research needs to be done to determine of the relationship ous casual or not.

hope that helps!

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#6 of 10 Old 10-10-2011, 06:47 PM
 
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I would suggest also posting in the lactivism section as i have seen some very knowledgable mamas over there! Good for you for educating your dr..too bad u need to!
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#7 of 10 Old 10-10-2011, 07:30 PM
 
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Hi cannot help with studies - although im certain that i have heard breastfeeding can help lower the risk of obesity in adulthood  - just wanted to share that i have a 13 month old and we were just at the Docs this week.  I am obese, my husband is obese, and our son weighs 34 lbs ...at 13  months  - that is fairly pudgy!  he is 33 " tall - so its sort of commensurate - but Doc never said to stop breastfeeding at all - asked how much juice he was getting (none)  and we talked at length about his diet - we also dont eat any dairy....so there was really nothing to change.  I definitely think weaning at a year is bad advice - for both bottle and breastfeeders!   I think babies that age still need to suck on something!  Good luck changing his mind  (if that was what you were going for!)


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#8 of 10 Old 10-10-2011, 07:55 PM
 
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I was just reading the law in florida about freedom to breastfeed, and it actually mentions the health benefits, including lowered risk of obesity. Might be worth looking at the one for your state to see if it too mentions ir.
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#9 of 10 Old 10-11-2011, 11:43 AM
 
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This is from the American Academy of Pediatric Position Statement on Breastfeeding

 

There is no upper limit to the duration of breastfeeding and no evidence of psychologic or developmental harm from breastfeeding into the third year of life or longer.197

 

http://aappolicy.aappublications.org/cgi/content/full/pediatrics;115/2/496#SEC6

 

There is no reason a child needs to see a peditrician. When you fire your peditrician consider family practice doctors, NPs, and PAs.

 

 


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#10 of 10 Old 10-14-2011, 02:10 PM - Thread Starter
 
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Thanks all for the responses. I wasn't concerned so much because of myself -- I will always do what I think is right regardless -- but because they are giving out incorrect and outdated info to other parents. I did some research and dug up the study they referenced and some subsequent ones. From an email I sent to my friend who is currently doing his pediatrics residency:

 

The study relied upon is over 20 years old and has been contradicted by a number of more recent studies. here is the link -- you can get access to the whole study, I cannot (being a lay person, lol): http://www.jpeds.com/article/S0022-3476%2805%2982677-0/abstract. And here we are back at pediatricians are not adequately educated about and do not adequately support breastfeeding. They are  using an out of date study to tell mothers to stop breastfeeding at 12 months (and the fact that I'm probably the only mom who comes to them who would actually be doing so is beside the point). Gah! Besides which, the study they are citing says that breastfeeding beyond 5 months is associated with obesity at 6 years of age, which is OBVIOUSLY the result of some confounder in their study or a too-small sample size, because the bulk of the literature shows either no effect or a small protective effect regardless of duration.  See, e.g., these two links:http://www.pediatricsdigest.mobi/content/113/2/e81.full; and http://www.nature.com/ijo/journal/v28/n10/full/0802758a.html. Now, I don't know the relative prestige of the various journals where all this work has been published, but the two above cite several of the relevant studies and this Agras character is the only one who has ever found a positive correlation between extended breastfeeding and obesity. I mean, seriously, given the relative wealth, education level, and privilege of mothers who breastfeed past 6 months these days, I'd be willing to bet that the correlation runs the other way but that either way, breastfeeding is less important than early childhood nutrition and activity level in predicting obesity.

Anyway, I would like to know more about how the study was done but it's not available for free online. My guess is that, based on the date of the study, the women who were breastfeeding their children at the time the data was collected were disproportionately poor, and that is what accounts for the study results. WIC started in 1974, but was only serving 26,000 mothers with infants at its inception. The study was submitted for publication in 1989, and the children in it were followed until age 6. So the data are likely from the late 70s or very early 80s, when many women who breastfed may well have been doing it because they could not afford formula.

 

even looking at the abstract a second time, the other factors they found that correlated with adiposity at age 6 were adiposity at birth and parental education level (low), so it is crystal clear to me that: (1) we are talking about a correlation that was more linked to poverty than to breastfeeding; and (2) what the data on breastfeeding and childhood obesity really show is that, as I said yesterday, any potential protective effect of breastfeeding against obesity can be cancelled out by poor nutrition later in childhood (e.g., some studies have found that the protective effect only applies to white children, but not to African Americans or Latinos, which suggests that childhood obesity can in part be attributed to cultural differences in child feeding OR that the protective effect only applies to exclusively breastfed children (who tend to be white)).

 

[end quote]

 

The other thing I should mention is that they are not singling out breastfeeding -- what the handout said was to wean from bottle and breast at 12 months. It seems entirely possible to me that they are trying to tell bottle feeding mothers to wean their babies from the bottle at that age because some other stuff I read indicated that kids who take bottles as toddlers drink more milk than those who don't and that's an easy way to cut excess calories. And that they only included breastfeeding in their sentence to seem evenhanded. I strongly doubt that they see very many babies still BF beyond the 1 year mark anyway.

 

It's definitely not anything I would switch peds over -- I chose this one because he is very laid back and not heavy handed about things like some others I have been to in the past. I honestly think they are trying to help prevent childhood obesity (the ped's father works with him, running a weight management clinic for kids) and that's great, but they are just misinformed on this specific issue. I just want to present the research and have them take that sentence off their handouts, that's all. (Well, and the part about starting solids at 4 months. But that's a separate story).


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