Sunday, October 18, 2009

The Gill Rapley method & Baby-led weaning

About two months ago I met and befriended a very interesting dutch woman. She and her family moved to Aruba and she became Pro Lechi Mama Aruba's newest board member. One night as we were driving together, heading toward our mother-to-mother support group, she was telling me about something I had never heard of before... the Rapley method. At first I didn't quite grasp it, but as she explained it more extensively I got it. And then, recall our daughters' play date together last month? Well, at that same play date, I saw the implementing of the Rapley method. My eyes grew wide with astonishment and amazement at an eight-month-old with barely a few teeth feeding himself and chomping down on avocado and watermelon cubes. Where's the puree? Where's the plate? Where's the little infant feeding spoon that I had in an array of colors at my home?? He sat in his adorable modern wooden high chair with his cloth diaper turned bib around his neck, and he so graciously picked up the dices of food and fed himself leaving only two pieces fallen on the ground next to him.

I set out to look up this Rapley method that Noortje raved about. Noortje is a wonderful mother who looks up and does extensive reading and research into parenting strategies and what is fact against what is fiction. So when she told me about this new found method, I set out to look it up and help inform mothers about its benefits.

Gill Rapley is the world authority on baby-led weaning. She worked as a health visitor for 20 years and has also been a midwife and breastfeeding counselor. She came up with an approach called Baby-led weaning, which basically entails, watching out for cues that your 6+ month-old baby is ready for solids. Not just puree "solids" but, solids diced up in cubes the size of a baby's fist, big enough to grasp and chew on. When people hear about a baby getting "big chunks" to eat, it sends a practically automatic panic-response to their brain which then signals them to tell you in a harsh tone "What are you doing?! The baby is going to choke!!" However, this method of infant feeding is actually more beneficial to the infant than if they were spoon-fed puree gulping babies. Why? Well, at the Rapley website there is an almost over-abundance of current up-to-date information on why this approach is far superior and should be the norm of follow-up infant feeding at 6+ months. Reading this for the first time, you may be wondering, ok, well how do I do this? What is involved? Are there guidelines? Yes there are! The below mentioned were taken from the webiste.

Rationale for a baby-led approach to the introduction of solid foods
1. Breastfeeding as the basis for self-feeding
Exclusive breastfeeding is recommended for the first six months of life. Breastfeeding is the ideal preparation for self-feeding with solid foods. Breastfeeding babies feed at their own pace – indeed, it is impossible to force them to do anything else! They also balance their own intake of food and fluid by choosing how long each feed should last. And, because breastmilk changes in flavour according to the mother’s diet, breastfeeding prepares the baby for other tastes.
Normal, healthy breastfed babies appear to be quite capable, with the right sort of support from their parents, of managing their own introduction to solid foods. However, although it is the self-feeding which characterizes breastfeeding that underpins the theory of baby-led weaning (BLW), many parents whose babies were bottle-fed have found that this method works equally well for them. The only significant difference is the need to ensure that the baby is offered drinks other than milk.
2. Understanding the baby’s motivation
This approach to the introduction of solids offers a baby the opportunity to discover what other foods have to offer as part of finding out about the world around him. It utilises his desire to explore and experiment, and to mimic the activities of others. Allowing the baby to set the pace of each meal, and maintaining an emphasis on play and exploration rather than on eating, enables the transition to solid foods to take place as naturally as possible. This is because it would appear that what motivates babies to make this transition is curiosity, not hunger.
There is no reason for mealtimes to coincide with the baby’s milk feeds. Indeed, thinking of (milk) feeding and the introduction to solid foods as two separate activities will allow a more relaxed approach and make the experience more enjoyable for both parents and child.
3. Won’t he choke?
Many parents worry about babies choking. However, there is good reason to believe that babies are at less risk of choking if they are in control of what goes into their mouth than if they are spoon fed. This is because babies are not capable of intentionally moving food to the back of their throats until after they have developed the ability to chew. And they do not develop the ability to chew until after they have developed the ability to reach out and grab things. The ability to pick up very small things develops later still. Thus, a very young baby cannot easily put himself at risk because he cannot get small pieces of food into his mouth. Spoon feeding, by contrast, encourages the baby to suck the food straight to the back of his mouth, potentially making choking more likely. It appears that a baby’s general development keeps pace with the development of his ability to manage food in his mouth, and to digest it. A baby who is struggling to get food into his mouth is probably not quite ready to eat it. It is important to resist the temptation to ‘help’ the baby in these circumstances since his own developmental abilities are what ensure that the transition to solid foods takes place at the right pace for him, while keeping the risk of choking to a minimum.
Tipping a baby backwards or lying him down to feed him solid foods is dangerous. A baby who is handling food should always be supported in an upright position. This ensures that food that he is not yet able to swallow, or does not wish to swallow, will fall forward out of his mouth.
Adopting a baby-led approach doesn’t mean abandoning all the common sense rules of safety. While it is very unlikely that a young baby would succeed in picking up a peanut, for example, accidents can and will happen on rare occasions – however the baby is fed. The normal rules of safety while eating and playing should there be adhered to when the transition to solid foods is baby-led.
4. Ensuring good nutrition
Babies who are allowed to feed themselves seem to accept a wide range of foods. This is probably because they have more than just the flavour of the food to focus on – they are experiencing texture, colour, size and shape as well. In addition, giving babies foods separately, or in a way which enables them to separate them for themselves, enables them to learn about a range of different flavours and textures. And allowing them to leave anything they appear not to like will encourage them to be prepared to try new things. General principles of good nutrition for children apply equally to young babies who are managing their own introduction to solid foods. Thus, ‘fast foods’ and foods with added sugar and salt should be avoided. However, once a baby is over six months old there is no need (unless there is a family history of allergy or a known or suspected digestive disorder) to otherwise restrict the foods that the baby can be offered. Fruit and vegetables are ideal, with harder foods cooked lightly so that they are soft enough to be chewed. At first, meat is best offered as a large piece, to be explored and sucked; once the baby can manage to pick up and release fistfuls of food, minced meat works well. (Note: Babies do not need teeth to bite and chew – gums do very well!)

There is no need to cut food into mouth-sized pieces. Indeed, this will make it difficult for a young baby to handle. A good guide to the size and shape needed is the size of the baby’s fist, with one important extra factor to bear in mind: Young babies cannot open their fist on purpose to release things. This means that they do best with food that is chip-shaped or has a built-in ‘handle’ (like the stalk of a piece of broccoli). They can then chew the bit that is sticking out of their fist and drop the rest later – usually while reaching for the next interesting looking piece. As their skills improve, less food will be dropped.
5. What about drinks?
The fat content of breastmilk increases during a feed. A breastfed baby recognizes this change and uses it to control his fluid intake. If he wants a drink, he will tend to feed for a short time, perhaps from both breasts, whereas if he is hungry he will feed for longer. This is why breastfed babies who are allowed to feed whenever they want for as long as they want do not need any other drinks, even in hot weather. This principle can work throughout the period of transition to family foods if the baby continues to be allowed to breastfeed ‘on demand’. A cup of water can be offered with meals as part of the opportunity for exploration but there is no need to be concerned if he doesn’t want to drink any. Babies who are formula-fed need a slightly different approach, since formula has the same consistency throughout the feed and is therefore less thirst-quenching. Offering water at regular intervals once the baby is eating small quantities of food is all that is needed to ensure a sufficient fluid intake. Continuing to give milk feeds ‘on demand’ during the weaning period will have the added advantage of allowing the baby to decide how and when to cut down his milk intake. As he eats more at shared mealtimes, so he will ‘forget’ to ask for some of his milk feeds, or will take less at each feed. There is no need for his mother to make these decisions for him.

Many mothers that are reading this blog may already have read or heard or even done all of this. Why I'm writing it is because, in Aruba, there is a silent fear of a baby becoming malnourished if he isn't fed solids at the eve of his 6th month. This belief is perpetuated by stories of mothers who were arrested for refusing to give their babies nothing but breast milk which resulted in the child becoming severely malnourished. ( as the story goes, the "baby" that became malnourished was not actually a baby but a toddler of 2 years). Many Aruban mothers are paralyzed into believing that a 6-month or a 7-month-old baby must be eating solids already. I've heard horrific ( to me, but not to the mom) stories about 6 week-old babies being given soup, and 3-month-old babies being given bread and baby food. I'm horrified when mothers listen and blindly trust their pediatrician's advice to give their 4-month-old fruit puree ( a 4-month-old that suffers from horrible reflux).Mothers in Aruba must be told that a baby, especially a breastfed baby, does not consume solids at 6+ months because there is a sudden deficiency in breast milk. Actually, a breastfed baby's primary source of nourishment throughout their first year should be breast milk. Mothers who are hell bent on arbitrarily sticking to the American Academy of Pediatrics and many other sources' recommendation on when to start with complementary foods are setting themselves up for a big head-ache and a big mess. I've read and heard of countless mothers who listened and followed their  baby's cues on when they were ready to start solids. Some babies were even exclusively breastfed for 11 months inconsequentially. The baby did not become undernourished, or lacking in anything, the baby simply wasn't developmentally ready for solids. 

I don't think there's anything wrong with listening to advice, but I'm a big believer in, if what you say sounds questionable, especially against my mothering-instincts, you better believe I'm gonna look it up and do some thorough research, and if what you say goes contrary to what I found, you better expect a hard copy of all the information I found.  Is this attitude wrong? Is this attitude disrespectful? Absolutely not. Mothers don't have to speak in a rude manner when addressing such topics with the baby's health care provider, but a mother must be firm, or else she'll be easily pushed and forced into believing that the practices that are "the norm these days, are the most beneficial". 

Aruban Mamas..breastfeeding or not... enjoy and decide accordingly...

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