Friday
Oct092009
Nestle Answers: Introducing solids - maybe, kind of, sort of at 6 months
Friday, October 9, 2009
This is one of a series of posts that features Nestle’s answers to my questions that came out of the Nestle Family event. To access the other questions and answers, go to follow-up questions for Nestle and click on the questions you are interested in. Answers will be posted as they are received and analyzed.
You indicate that “Nestle complementary foods are not marketed or presented as breast-milk substitutes” and that you support the May 2001 WHA Resolution that changed the recommended duration of exclusive breastfeeding from 4-6 months to 6 months. Given your support in this regard does this mean that you do not market any food/drink products at all for the use by infants under 6 months of age in any country and that none of your labels for cereal or baby food indicates that it can be used starting at 4 months?
Nestlé fully supports the May 2001 WHA Resolution 54.2 which changed the recommended duration of exclusive breastfeeding from 4 – 6 month to 6 months, thereafter introducing complementary foods while recommending continued breast feeding for as long as possible. Thus we implement this resolution in the same way as we implement the WHO Code and we have completed label changes on complementary foods to follow the 6-months recommendation. In addition, in developing countries Nestlé applies the WHO Code not only to starter formula (0-6 months of age) but also to follow-on formula (6-12 months). It is the only major manufacturer to do so.
I asked about labels. I didn't ask about websites. While I don't have time tonight to run out to all of our local stores to check the labels on the products, a few clicks of the mouse demonstrated that if Nestle does "fully supports the May 2001 WHA Resolution 54.2 which changed the recommended duration of exclusive breastfeeding from 4 – 6 month to 6 months", it obviously forgot to tell its Web staff. I went to three Nestle baby websites and found suspicious content and recommendations on all three.
I figured I would start my journey in the United States. I went to Gerber's (owned by Nestle) website to get information on its baby food products and on introducing solids. While all of the labels in the product pictures are too small to be able to see what is marked on them, there was some interesting information on introducing solids.
In response to the question "When should I start my baby on solid foods", Nestle doesn't say to wait until at least six months. Instead, it says "around the middle of your baby's first year". Around the middle could mean a bit before six months or a bit after six months. Depending on how the individual person interprets "around" that could mean between 4 months and 8 months.
Nestle mentions the baby should reach the Supported Sitter developmental stage. There is no information provided on when that might be. Also other leading sources on when you should introduce solids indicate that the baby should be able to sit well without support (i.e. sits independently) .
Instead of clearly and unequivocally saying that the baby must be at least 6 months old and have met certain developmental milestones, Nestle has chosen to just eliminate the information on the age at which solids should be introduced.
This one was even more overt. Nestle Canada has age-based pages that indicate what the baby should be doing and eating at different stages. On the page for 4 to 5 months old, Nestle is heavily pushing solids using both visuals (the baby being spoon fed and the box of cereal) and text (the links on introducing cereal and introducing solids).
There are 47 products listed in the Stage 1 (Stufe 1) category that is listed as 4 months and up. Those products, a few of which can be seen in the screen capture from the 4 months and up product page, include
These products include ingredients like berries, honey and tomatoes that are not supposed to be introduced until much later due to being allergens, botulism risk, etc. The labels on the products listed on the website clearly have the same 4 months and up label that is listed on the website itself.
Perhaps Nestle has now updated all of its product labels in store to say six months plus (but I can't be sure of that and highly doubt it). But even if they have, these other actions regarding Web content, handbooks, and other materials suggest that Nestle is using other ways of continuing to perpetuate the myth that solids should be introduced before six months of age. In fact, like the boycott that so few Americans are aware of, you will probably find that few Americans (Germans, Canadians, etc.) are aware of the updated recommendation and Nestle would like to keep it that way.
Question
You indicate that “Nestle complementary foods are not marketed or presented as breast-milk substitutes” and that you support the May 2001 WHA Resolution that changed the recommended duration of exclusive breastfeeding from 4-6 months to 6 months. Given your support in this regard does this mean that you do not market any food/drink products at all for the use by infants under 6 months of age in any country and that none of your labels for cereal or baby food indicates that it can be used starting at 4 months?
Nestle's Answer
Nestlé fully supports the May 2001 WHA Resolution 54.2 which changed the recommended duration of exclusive breastfeeding from 4 – 6 month to 6 months, thereafter introducing complementary foods while recommending continued breast feeding for as long as possible. Thus we implement this resolution in the same way as we implement the WHO Code and we have completed label changes on complementary foods to follow the 6-months recommendation. In addition, in developing countries Nestlé applies the WHO Code not only to starter formula (0-6 months of age) but also to follow-on formula (6-12 months). It is the only major manufacturer to do so.
My Response
I asked about labels. I didn't ask about websites. While I don't have time tonight to run out to all of our local stores to check the labels on the products, a few clicks of the mouse demonstrated that if Nestle does "fully supports the May 2001 WHA Resolution 54.2 which changed the recommended duration of exclusive breastfeeding from 4 – 6 month to 6 months", it obviously forgot to tell its Web staff. I went to three Nestle baby websites and found suspicious content and recommendations on all three.
Gerber USA
I figured I would start my journey in the United States. I went to Gerber's (owned by Nestle) website to get information on its baby food products and on introducing solids. While all of the labels in the product pictures are too small to be able to see what is marked on them, there was some interesting information on introducing solids.
In response to the question "When should I start my baby on solid foods", Nestle doesn't say to wait until at least six months. Instead, it says "around the middle of your baby's first year". Around the middle could mean a bit before six months or a bit after six months. Depending on how the individual person interprets "around" that could mean between 4 months and 8 months.Nestle mentions the baby should reach the Supported Sitter developmental stage. There is no information provided on when that might be. Also other leading sources on when you should introduce solids indicate that the baby should be able to sit well without support (i.e. sits independently) .Instead of clearly and unequivocally saying that the baby must be at least 6 months old and have met certain developmental milestones, Nestle has chosen to just eliminate the information on the age at which solids should be introduced.
Nestle Canada
This one was even more overt. Nestle Canada has age-based pages that indicate what the baby should be doing and eating at different stages. On the page for 4 to 5 months old, Nestle is heavily pushing solids using both visuals (the baby being spoon fed and the box of cereal) and text (the links on introducing cereal and introducing solids).
When you actually click on the links on introducing cereal and introducing so
lids, some of those pages tell you that you should wait until six months. But if that is the case, what on earth is this information doing on the 4 to 5 months page to begin with? And shouldn't they move them from the 4 to 5 month section (where it is linked from and as appears in the breadcrumb) to the 6 to 7 month section?
Also, on its product page for baby cereals Nestle Canada conveniently doesn't mention an age to start its Stage 1 cereals, but its Stage 2 cereals are listed as being for 6 months and up. Wouldn't Stage 1 logically come before Stage 2 and therefore be before six months?
Nestle Germany
There are 47 products listed in the Stage 1 (Stufe 1) category that is listed as 4 months and up. Those products, a few of which can be seen in the screen capture from the 4 months and up product page, include
- vegetables
- fruit
- meals of mixed vegetables and meats (including spaghetti bolognese)
- cereals
- juices and teas
These products include ingredients like berries, honey and tomatoes that are not supposed to be introduced until much later due to being allergens, botulism risk, etc. The labels on the products listed on the website clearly have the same 4 months and up label that is listed on the website itself.
The AAP recommendation
On page 54 of IBFAN's monitoring report, or the second page of the section on Nestle's Code violations, IBFAN provides the following interesting information [emphasis mine]:
In April 2003 the company [Nestle] announced that it had "completed label changes on complementary foods to follow the six-month recommendation". During their general monitoring, IBFAN observers have checked the age recommendations of all companies and provide evidence that the change promised by Nestlé finally occurred in many countries but not in all. See Section 2 for continuing violations.
It is hoped that Nestlé will abandon its double standard and apply the change in all countries, reflecting the universality of the Code and subsequent Resolutions. Other companies would have to follow suit if Nestlé continues a decisive leadership role.
However, at the end of 2003, Nestlé gave a large grant to the American Academy of Pediatrics (AAP) to pay for the cost of sending the AAP 2004 Pediatric Nutrition Handbook for free to over 50,000 doctors. The Handbook reverses AAP's 2000 endorsement of "six months exclusive breastfeeding" by going back to the old “4 to 6 months.” The Handbook mentions “4 to 6 months” several times but has only one footnote to say that the AAP Section on Breastfeeding favours the 6-month recommendation. Double standards once again?
I'll let you draw your own conclusions.
Supportive on the surface only?
Perhaps Nestle has now updated all of its product labels in store to say six months plus (but I can't be sure of that and highly doubt it). But even if they have, these other actions regarding Web content, handbooks, and other materials suggest that Nestle is using other ways of continuing to perpetuate the myth that solids should be introduced before six months of age. In fact, like the boycott that so few Americans are aware of, you will probably find that few Americans (Germans, Canadians, etc.) are aware of the updated recommendation and Nestle would like to keep it that way.
Reader Comments (62)
QUOTE - Studies on celiac have shown benefits to introducing tastes of gluten earlier END QUOTE
I've read a couple of studies showing this - however none of those that I found closely examined feeding method ie excl breastfed/part breastfed/artificially fed. As Gliadin (the problem part of gluten) passes into breastmilk if the mother consumes - wouldn't an exclusively breastfed baby be exposed to it pre 6mths even without solids?
Do you have any links please to the studies that: ""indicate that 4 months of exclusive breastfeeding may be enough to provide maximum allergy protection"" - I have only ever found minimum of 4mths rather than that provides maximum iyswim, would be interesting to read.
QUOTE - I have heard that this is a matter of debate in the WHO as well. END QUOTE
I find this confusing as allergies are not the only reason for the guideline are they? Surely that's more a piece of the jigsaw than the whole picture? We know for example that the gut doesn't close at exactly 4mths in the vast majority of babies - so what about (as a random example) say SIDS figures? 4-6 months is high risk in relation to SIDS that we know exclusive breastfeeding lowers the rate of. Or obesity, or various cancers which shorter duration are linked to increased risk of or, or, or (insert any of the other reasons for breastfeeding here)
Charlotte:
Here's one:
http://pediatrics.aappublications.org/cgi/content/abstract/121/1/e44
Here's another that supports what you said, that for allergies alone 4-6 months might be best, but not when other considerations are taken into account.
http://www.ncbi.nlm.nih.gov/pubmed/19685855?ordinalpos=1&itool=EntrezSystem2.PEntrez.Pubmed.Pubmed_ResultsPanel.Pubmed_DiscoveryPanel.Pubmed_Discovery_RA&linkpos=2&log$=relatedreviews&logdbfrom=pubmed
The Israeli guidelines recommended only 1-2 tablespoons of food/day from four to six months, and they don't insist on starting so early, they just say it's not harmful and there is an advantage to preventing celiac when the baby is still breastfed. If you wait six full months to introduce the gluten, there is a greater chance the baby will have weaned.
There is a real danger of compromising milk supply and overfeeding when starting too early. On the other hand, some mothers might nurse longer if they had "permission" to start offering tastes before months. They might do this instead of supplementing. Another consideration is for mothers whose milk supply drops at 4-5 months. Dr. Jack Newman says this is very common. If the usual methods for increasing supply don't work, he prefers solids to formula supplements.
Yet another consideration is that the stricter the guidelines, the more formula that is sold. Formula-fed babies should perhaps be eating solids by four months, as every nutrient in formula can be found in solids. Dr. Newman says they don't need formula at all after six months, as long as they are eating a variety of solids.
In Israel exclusive breastfeeding is exceedingly rare as 70% of babies receive a bottle of formula in the hospital and another large group do so in the early weeks. Here, I'd much rather the focus be on exclusive breastfeeding in the early weeks and months.
Regarding the first link - the AAP one; it doesn't appear to distinguish between feeding method? It looks to include fed any method? As an AF baby doesn't have a gut full off good bacteria that is at risk from solids - I think the outcome is bound to be different? Also the study states in it's conclusion: For eczema, the results were conflicting, and a protective effect of a delayed introduction of solids cannot be excluded.
The second reads: When all aspects of health are taken into account, the recommended duration of exclusive breastfeeding and age of introduction of solids were confirmed to be 6 months, but no later.
Again I would like to see the papers studied for review, as finding any which clearly study babies exclusively breastfed for 6mths seem very few and far between (if any?!). The criteria included in "breastfed" is usually that they have had some breastmilk - could be a day! But this has to skew data...
QUOTE The Israeli guidelines say it’s not harmful and there is an advantage to preventing celiac when the baby is still breastfed. If you wait six full months to introduce the gluten, there is a greater chance the baby will have weaned. END QUOTE
I'm a bit confused by what you mean - a breastfed baby who has a mum consuming gluten, would be exposed from birth! I can see the logic for formula fed infants who have zero exposure, but don't understand how this relates to breastfed.
Whether it's formula or solids - either introduced before gut closure IMPO pose a risk due to the changes they provoke within the gut.
Neither paper seemed to mention Celiac specifically...they talk about food allergies and food sensitization, but Celiac is an auto-immune disease that creates an intolerance. In my mind this is different.
My husband was just diagnosed with Celiac and we have an 8 month old who was just weaned due to medical issues on my part. While my son was exposed to gluten through my breastmilk, our pediatrician has advised treating gluten like a common allergy food (say, strawberries or nuts) and not introducing any as solids into his diet until he is at least a year old (that is when babies' immune systems are more developed, I believe). The current AAP guidelines even say no wheat until 12 months, regardless of whether a parent actually has Celiac or not, and I don't see either of these papers suggesting anything different.
This discussion of the most recent research on the introduction of solids is interesting. I will look into it for other possible future posts. However, I don't think it is directly relevant to the key point of this post, which is that Nestle says one thing and does another.
Nestle's answer said:
"Nestlé fully supports the May 2001 WHA Resolution 54.2 which changed the recommended duration of exclusive breastfeeding from 4 – 6 month to 6 months, thereafter introducing complementary foods while recommending continued breast feeding for as long as possible."
However, its websites around the world either specifically recommend a ton of foods to introduce at 4 months, provide contradictory information (say 6 months in one place, 4 to 5 months in another) or just leave out the age recommendation altogether and focus on milestones which might not be the right milestones to be focusing on.
My issue is that Nestle is saying one thing and doing another.
My son didn't have anything but breast milk until he was nine months old. I knew to wait until six months, and he need more than breast milk and was thriving, but at nine month I thought it was time to give into his curiosity and start some "solids."
Just wanted to share an interesting article regarding infant feeding in the US... the results are pretty shocking! According to this study, part of the CDC's Infant Feeding Practices Study II, 21% of mothers (article refers to mothers not parents) introduced solids BEFORE 4 months. Scary stats regarding other unhealthy infant feeding practices are also cited. The study also found that the prevalence of these unhealthy feeding practices was higher among those mothers with lower levels of education. (I wonder if this is also related to access to health care as well as educational level.)
The full article can be found here: http://pediatrics.aappublications.org/cgi/content/full/122/Supplement_2/S91
So, although many who have commented here have indicated that they personally would not be affected by product labelling and/or other educational information that suggests beginning solids before 6 months, clearly many, many parents in the States are not aware of the 6 month recommendation (or the importance of it) and may therefore be more likely to listen to "suggestions" from infant food manufacturers like Nestle.
QUOTE: The study also found that the prevalence of these unhealthy feeding practices was higher among those mothers with lower levels of education. (I wonder if this is also related to access to health care as well as educational level.) END QUOTE
I don't think so on the last point as the data is the same for the UK and we all have the same access to health visitors, doctors etc.
QUOTE: clearly many, many parents in the States are not aware of the 6 month recommendation (or the importance of it) and may therefore be more likely to listen to “suggestions” from infant food manufacturers like Nestle.
I think it comes down to not understanding the importance - here in the UK most mums I speak to are aware of the guideline, but have a reason why there's was the hungry/advanced/non sleeping/refluxy/now gaining enough weight/gaining too much weight etc etc (delete as appropriate) baby that is the exception. Plus of course lots of family, friends and non evidence based parenting forums (a HUGE parental influence) all are full of people with stories of how early they had to do solids and comments such as "the guidelines are only for breastfed babies" or "my health visitor says the guidelines only apply to the third world" or "guidelines aren't worth the paper as they change every two minutes, mummy knows best" etc etc etc (I could fill a page on why the guidelines should be ignored according to forums!)
Sit this alongside the masses of health visitors who still suggest solids for infants below 6 mths (as per your paediatricians) and it's no wonder parents aren't listening.
What in my opinion the labelling does, is serve to normalise that enough infants need solids pre 6 months to put it on their jars. Parents think that if it could harm their baby to give solids at 4 mths - the manufacturers wouldn't be allowed to put from 4mths on the label! If the labels all said 6mths plus, I think the number of parents that would buy them for younger infants would certainly plummet. Even those who thought "but it's only carrot" are likely to on the whole presume there was a reason it said 6mths plus and think twice about buying it.
Calculate this drop in sales in terms of profit - and you have the reason baby food companies are going to be as reluctant as possible to change the age suitability. I honestly think it will only happen when it becomes a legal requirement (or they are in a position of being forced)
I'm a college graduate and a mother of 3 and it's only in reading this thread that I've realized the recommendation for "6 months of exclusive breastfeeding" means no solids. I seriously always thought it just referred to not supplementing with formula. I did not give my younger two any formula but they both started cereal at 4 months on the recommendation of two different pediatricians. I was told to start them on cereal then because their iron tested low.
[...] First, they have clearly not delivered on that promise as demonstrated in my post on Nestle’s misleading or downright wrong information on when to introduce solids. [...]
[...] asked Nestle whether it markets any complementary foods (i.e. baby food, cereals, etc.) for babies u.... Nestle answered that: Nestlé fully supports the May 2001 WHA Resolution 54.2 which changed the [...]
Well, we can, can't we? None of my kiddos have ever seen a ped, only our family doc. Ped's are specialists. We wouldn't go see a cardiologist for an annual checkup, so why should babies go to peds for their well-baby exams?
Another option is to stay out of the doctor's office altogether, unless your baby gets sick. My third baby will have her first visit for her 1-yr checkup. I see what you mean, but the fact is that no one is MAKING moms take their baby to the doc. For us, we have chosen to educate ourselves as much as we can, and we simply ignore out-of-date advice. Actually, if my doc was offering out-of-date advice, I would start searching for a new doc.