So what do they feed kids in other countries, anyway?
January 21, 2009 11:38 AM   Subscribe

Infant feeding: Having just had my third baby, I'm struck once again by the rigidity of North American guidelines on feeding wee ones. I'm curious as to what is done in other countries and cultures, and what we did in the past. Resources?

For example, the 'rules' here suggest breastfeeding ONLY until at least six months, and then introducing foods one at a time, starting with the cereals and so on. Health care workers react with unmitigated horror if you suggest doing anything different - and I typically find that with my kids, introduction of solids has to happen earlier.

So does anyone know of any studies on what's done in other countries and cultures? Can anyone living abroad tell me what the guidelines are in your area? What did we do in the past? What about your experiences?
posted by Zinger to Human Relations (29 answers total) 10 users marked this as a favorite
My American Pediatrician let me start solids at 4 months. She spits them out and looks horrified, but I am allowed to smear them near her mouth...

He does have me do one thing at a time - only because then if she has an allergic reaction to something, you know that it was to the new thing.
posted by artychoke at 11:55 AM on January 21, 2009

Our ped said "you'll know when to start solids when you feel guilty eating in front of them" - she would follow us with her eyes and make mouth movements and generally make us feel bad [the baby, not the pediatrician].
posted by true at 12:00 PM on January 21, 2009 [11 favorites]

I believe that the AAP guidelines moved breastmilk ONLY to 6 months just in the last... decade or so? Before that it was 4-6 months.
posted by gaspode at 12:12 PM on January 21, 2009

This isn't really about breastfeeding, but: My Welsh grandmother used to swaddle me in blankets and put me outside in the mountain winters for a few hours. This practice is known as "hardening" to older, rural Brits, and "reasons to call child services" among Americans. The point is to make children hardy, tolerant to chilly weather, and hale. I can't say I'm any less of a baby now that it's 8 degrees in New York City today, but I'm strong as an ox.

I also used to nanny for a Korean family, and the grandmother would get hysterical if I gave the infant boy too many bananas because she was afraid too much fruit would make the baby less manly. Apparently I was supposed to give the baby meat at *every meal* to combat any sign of girliness. Granted, the woman was batshitinsane, so this might be less of a cultural difference and more of a, um, psychological divide.
posted by zoomorphic at 12:13 PM on January 21, 2009 [4 favorites]

Historian Jill Lepore's article in The New Yorker should answer some of your questions.
posted by Carol Anne at 12:14 PM on January 21, 2009

Health care workers react with unmitigated horror if you suggest doing anything different - and I typically find that with my kids, introduction of solids has to happen earlier.

My pediatrician (Pennsylvania) let us introduce solids starting at 4 months also.
posted by leahwrenn at 12:17 PM on January 21, 2009

Well, the World Health Organization is pretty solid on the "exclusive breastfeeding for first six months" deal. However, a lot of their policy is aimed at the developing world, where water (for mixing formula or preparing food) is often not safe.

From my experience as a nanny:

- A Japanese-Brazilian family fed their infant son a sort of runny oatmeal mixed with breast milk starting at about 4 months, because he just couldn't get full enough on breast milk alone. They incorporated other foods (mainly fruits and vegetables) into that mix starting at about 5 months. By 6 months, he was eating finger-food and even some finely mashed table food. A tall, skinny, hungry baby.

- A Turkish-Slovakian family fed their infant daughter breastmilk for maybe a month, then only formula until about 5 months, when they introduced Gerber-type baby cereal, then yogurt soon thereafter. They were a little more cautious on the solids, but by 7 months she was eating pretty much whatever they were, unspiced and finely mashed.

Both kids are healthy, beautiful, and smart.

After three kids, though, I think you're the expert on what the fruit of your loins can handle. The judgment regarding breastfeeding vs. formula vs. solids is so pervasive and destructive. I have co-workers who pretend to pump at work to avoid judgment. Jeez. Just feed 'em and enjoy tickling their chubby baby thighs.

Now my ovaries are hurting

posted by charmcityblues at 12:20 PM on January 21, 2009

This AskMe thread about baby-food recipes has some interesting discussion on that front.
posted by swift at 12:34 PM on January 21, 2009

Just wanted to point out that "in the past" infant mortality was 30-50%. Not the best place to be looking for good child-rearing practices.
posted by Riemann at 12:36 PM on January 21, 2009

More cultural chatfilter: my mom's extended family is Southern, and my mother and aunts quit breastfeeding after the first month. My mom claims (very defensively) that her sisters and cousins pressured her to give up breastfeeding so family members could give babies bottles. Also, Southerners tend to be traditional and a little prim about bodily functions, so my mom would have to find an empty room to breastfeed; she couldn't just throw a blanket over her shoulder and keep talking. My friend's mother from Alabama corroborated this practice.

My American Pediatrician let me start solids at 4 months. She spits them out and looks horrified, but I am allowed to smear them near her mouth... You might want to get a new pediatrician.
posted by zoomorphic at 12:42 PM on January 21, 2009 [1 favorite]

Denmark and Sweden say breast-feed pretty please if you can for at least six months, but solids can start at four months (in conjunction with breastfeeding) if baby wants it and most seem to really want it - at least taste and make a great mess.

Allowed 4-month foods are listed very clearly by pediatrician and the no-no foods as well (I can't remember all of them now but I recall no eggs until 1 year, no honey until 1 year). I recall first food suggestions being stuff like mashed potato and carrot puré, bananapuré, blueberrypuré, peachepuré, pearpuré, mangopuré, broccolipuré, gruel from corn, flavoured porridges based on rice or oats and with a tiny amount of wheat in it. (tiny amount being key here, you don't want too much wheat in a 4-month old)
At 5-6 months the wheat, buckwheat, full oats and real rice come in and meat in form of turkey & pork. At eight months red meat & fishes etc. Couldn't find any english language listings, but it's the norm to start some solids here at four months and all mom's seem to know which kinds of foods the child can't handle at what age - you can check a sample of products here for 4-month olds and see that there are plenty of things to choose from, all mashed up into gummable non-chewy stuff of course.
posted by dabitch at 12:49 PM on January 21, 2009

Two Dutch-German-Post-New-Age kids on breastfeeding and solid food initiation, according to their dad, who remembers pretty darn well:

#1. Girl (now 19, used to be carnivore incarnate, now a healthy vegetarian). She choose to go on with breastfeeding well until after she got interested in solid food (see also here . Self-link, but adds to the story). Solid food starting point as per her suddenly awakening interest in what we had on our plates (like true says): c. 5 months.
Breast off: initially one year, then we were in Southern France on vacation and she was thirsty all the time and hated cow's milk, so back to breast.
Finally off after 14 months or so. When she, around that age, found her old pacifier (which she hadn't used after week 2) in a heap of rubble, she had (for reasons unexplained) a laughing fit that lasted over a minute.

#2 Boy (now 16, used to be a picky eater, isn't any more). Got sporadically interested in solid food at 3 months age, but not seriously at all into it until c. 5 months.
Bit my wife when 8 months old and grinned devilish (ouch, I guess) and that was the end of breastfeeding. But he was the one with the pacifier. For ages.

Bottom line: kids will know. Don't know this for them. On the other hand, don't begin all too early with solids, 'cause their stomachs can't cope before a certain age (they say).

Guidelines: helpful for you to know that you're not totally off the mark (like, ten years or so), otherwise often just not so very hot. Small kids have little to think of besides food, they're the experts.

Pediatricians: there are bound to be nice ones and competent ones out there, but I haven't met any.
posted by Namlit at 12:51 PM on January 21, 2009 [1 favorite]

Sorry my puré list got a little long there, I just wanted to list all the ones I remember as safe at that age since there are protein strains babies kidneys can nog break (hence the eggs verboten until 1 years old thing), and there is a reason broccoli comes before wheat.

Honestly your pediatrician should be giving real advice on what food an infant can handle at what age, like the list I got (since s/he knows when the kidneys and other tummy parts can handle it) not tell you to just nurse. I nursed all the time but my baby was a hungry little monster who ate hommous at three months (and I'm not even sure that was considered OK, but she's still alive).
posted by dabitch at 12:55 PM on January 21, 2009

I'm very interested in this topic, but more of the historical/non-western cultures angle. While it's not an academic source, you might find this blog post from my favourite babyfood site interesting. I have no idea of the accuracy of the information without sources, but I enjoyed reading it all the same.
posted by Joh at 1:00 PM on January 21, 2009

Oops, I just re-read and there are sources in my linked article! Sorry.
posted by Joh at 1:02 PM on January 21, 2009

Further on the American "rules": "There is a difference of opinion among [American Academy of Pediatrics] on this matter. The Section on Breastfeeding supports exclusive breastfeeding for about six months. The Committee on Nutrition supports the introduction of complementary foods between four and six months of age where safe and nutritious complementary foods are available." (Your Baby's First Year, published by the American Academy of Pediatrics.)

Personal Experience in Brazil: I have seen our pediatrician tailor the start of solids to the baby. One friend was told at four months to start cereal. Another was told cereal at six months. With Wallababy, we started around six months with fruit. She actually wanted to wait a little longer because of our family history of allergies but we needed to start solids before we left on a two-month trip. So he started on fruit, which a lot of Americans have been really surprised at. They worry that kids who start with fruit will develop a sweet tooth and never want anything else. It hasn't seemed to be the case--he just finished up a dinner of lentils and rice, which he gobbled down!

The fruit was introduced one at a time, no citrus fruit or strawberries yet. After that it was a "soup" of zucchini, coyote squash, potato and carrots, I think. The next month chickpeas, lentils and something else were added to the soup. He could have egg yolk then, too. Finally it was time for meat, adding a different one to the soup every week: chicken, beef and fish. At his eleven-month check-up last week, she declared him ready to eat like an adult.

(I can't say we followed the diet exactly because we spent two months on the road in the U.S. and fed him prepared baby food almost exclusively.)

Other people in my life here have strong ideas of what I should and shouldn't be feeding him. They ask, for example, why I don't give him juice or tea and are sometimes surprised by his consumption of "finger foods".

As a North American living here, I've tried to strike a balance between the two cultures. I know that a lot of what the American docs say is just tradition, as is what the Brazilian docs say. I do a lot of research online and try to go with science and Wallababy's preferences as much as possible. Oh, and he's still nursing, which the pediatrician is happy about but I'm hoping to wean him soon. We'll soon find out what she thinks about that!
posted by wallaby at 1:19 PM on January 21, 2009

The American model provides the path of least litigation. Our guideline with our daughter was breast milk as much as possible under the (possibly incorrect) correlation of higher IQ - given that she has Down syndrome, it was a "why not? It can't hurt and if it helps, we'll take what we can get."

My son ate like a machine and I doubt that any woman has the capacity to have satiated him. Seriously. You know the sucker bet about drinking a gallon of milk in one go? Yeah, scaled up by body mass, he was doing more than that. We introduced solid foods earlier than is recommended because he was hungry and breast milk was not enough. That is what I believe is the best indicator of when to switch over.
posted by plinth at 1:22 PM on January 21, 2009

I'll start by saying I know this stuff because of my 10 month-old nephew. I'm (or rather we) are in Portugal.

Breastfeeding: there is *big* pressure on women to breastfeed, and they don't seem to be told that in most cases, breastfeeding is hard or even downright painful for the first couple of months. I had my "sister" (my best friend, actually, we're not blood sisters) crying, or more like sobbing on my shoulder because she was in pain and the baby wouldn't stop crying because he wanted more milk than she produced. She felt, even though it wasn't rational at all even to her, that she was being a "bad mother" because of this. Eventually, breastfeeding became easier and she still does it now - it was exclusive until 6 months. Women here breastfeed pretty much anywhere... They throw a blanket/cloth over their shoulder and off they go. Some don't use anything at all. Maternity leave is 4 months right now, and during the child's first year you get 2 hours off work everyday to tend to your child. Either the mother or the father can take this leave.

At 6 months, he started getting soup (no salt) and fruit (no citrus or berries). And now when you eat next to him, he does make you feel guilty. He'll start solids soon.

As for before, well, people in my generation (born in the 70's) were mostly bottle fed. It seems when formula arrived, people just switched to it and forgot about painful breastfeeding. In fact, I think today's *you must breastfeed* policy has a lot to do with doctors feeling quite a bit guilty over the bad advice they dispensed years ago. We started soup/fruit at 3 months because maternity leave was 3 months back then. Other than that, it was pretty much the same. Oh, except I was fed wonderful things like cow's brain, and since Mad Cow outbreaks, it's no longer done.
posted by neblina_matinal at 1:44 PM on January 21, 2009

In my nutrition class (USA, 2 months ago) we were taught that it's ok to start introducing solid foods when the baby loses its spit-out reflex (it had a better name than that, I think...). I've never had a baby, but what we were told is that babies instinctively push things out of their mouth until about 4-6 months, but that once they stop doing that you're ok to introduce solid foods.

I think the other concern is that babies get enough nutrition. They need lots of fat, lots of iron, lots of things that are in breast milk but not necessarily in cheerios. As someone said upthread, you have to introduce new foods one by one so you can tell if baby is allergic to something, but this makes it difficult to feed a balanced diet. Luckily, breastmilk is nutritionally complete for infants, and it doesn't cause allergies.
posted by vytae at 2:42 PM on January 21, 2009

vytae speaks of tongue thrust. And yeah, apparently most babies don't lose it until about 5-6months so feeding solids is a bit of a challenge, though it can be done.
posted by otherwordlyglow at 2:53 PM on January 21, 2009

my (American) baby had no interest in solids at 4 months of age - we started with rice cereal at 6 months, which he was barely interested in. Now at ten months, he often eats bits of what we eat, supplemented by bottles of breast milk and formula. Tonight he ate pureed peas and rice, and organic baby food (chicken and pasta.) He's never been a very hungry guy compared to my friends' babies.
posted by pinky at 4:58 PM on January 21, 2009

Best answer: I have read a lot on this and don't really know where to start. Scattershot links:

Interesting: Iceland's terrible infant mortality. Mothers and Medicine: A Social History of Infant Feeding 1890-1950, great read. Breasts, Bottles, and Babies, not as pleasantly written and rather lengthy but full of interesting tidbits; notable: popularity among a variety of cultures and periods of giving newborns non-milk feeds for a short period; these included preparations with honey and wine. A useful blog; see especially this article about baby food myths. Why baby knows best when it comes to food. I bookmarked this as a good example of fearmongering babyfood bullshit. About the relative lousiness of commercial foods. Common sense from Dr Jack Newman. Yahoo! Answers via India provides some insight: Can I give ragi to 4mo? ...Give sooji. And, pre-chewing food apparently occurs among many groups in this country and elsewhere.

I have a small collection of outdated baby-care manuals going back to the 40s; one common thread: infant feeding advice has not been laissez-faire anytime recently. The instructions are always dogmatic and rigid. And weird. The 1940s Australian "Our Babies" thinks you start weaning late, at 9mo, and baby is wholly off the breast early, by 11mo. Early editions of Dr Spock mention orange and tomato juice for newborns and offer a number of formula-making tables clearly influenced by the Rotch percentage method.

"Cereal" is junk -- cheap starch, heavily refined -- but it has been important to doctors since the development of Pablum. Vitamin-fortified paps were lifesaving in the day when formula was cow's milk watered down at home -- which see the recommendation for juices for newborns; the vitamin C was critical -- and pediatricians never weaned themselves from pushing it.

Personally, I did nil by mouth save breastmilk from the tap until a week shy of 6mo, when baby burst into tears over not getting my sandwich. I offered steamed veg -- lots of asparagus spears, easy to hold and gnaw, and things like toast with a yoghourt 'dip,' hummus and other bean spreads, etc. Pesto and salsa and curries by 7mo. No spoon-feeding. And no extensive conversations with the doctor on this; at an appointment around 8mo he asked "What's she eating?" and I said "Well...what isn't she eating, you mean," and he said "Excellent," and that was the end of it. This is in semi-rural Canada.

If nursing is painful get help with the latch...
posted by kmennie at 5:14 PM on January 21, 2009 [12 favorites]

My son ate like a machine and I doubt that any woman has the capacity to have satiated him.

My one niece was the same way. No amount of breast milk satisfied her. By 2 months, we had to supplement with formula. Right after that it was formula mixed with some rice cereal. She tore through every drop and morsel. Still does.

She's a perfectly lovely, tall, slender child. She just needed solids earlier.
posted by 26.2 at 11:03 PM on January 21, 2009

I think the strength of the breast-only chant from health care pros is to counter the strength of the chant about introducing solids that can come from friends and family. Some of that advice is OK, but some of it is frankly insane. (flour and water gruel for newborns, mixed into bottles) Aside from the reality that a baby consuming solids will usually sleep a bit longer through the night than a breastfed baby, I think that grandmothers in particular can feel a little left out by the closeness in breastfeeding. Again, my friends might have had the bad luck to all have really disfunctional birth families and in-laws, but the pressure they've had to introduce solids earlier than they would have preferred on the part of their mothers and MILs is pretty strong. Grandma and aunties can't wait to feed the babies, you see.

I thought the guidelines had more to do with what a child can actually digest at particular ages, and the danger of developing allergies in an immature system? If eating styrofoam makes you feel full, you'll eat less food from which you can actually pull nourishment.

That being said, if you're feeding a child, you'll know yourself when they're ready.

Solids seem to be introduced here at just around three/four months - cereals, mostly.
posted by Grrlscout at 12:41 AM on January 22, 2009

Just wanted to point out that "in the past" infant mortality was 30-50%.

Really? You have a citation for that?

Table 5.1 in R Woods, 'Infant Mortality in Britain: A Survey of Current Knowledge on Historical Trends and Variations' in Infant and child mortality in the past, eds A Bideau, B Desjardins, and H P Brignoli. Oxford, England, Clarendon Press, 1997. p76 shows estimated infant mortality rates in England between 1550 and 1950 peaking at 200 deaths per thousand (250 in a higher estimate). They generally fluctuate between 160-200 per thousand over that period, with a slow decline to the turn of the twentieth century.u They then start dropping rapidly in the 20th century, falling below 50 by 1951. The years 1901 to to 1910, alone, saw the mortality rate fall from 151 to 106 per thousand.
Figures for the US in its early years are considered less reliable but are generally comparable (see G Alter ' Infant and Child Mortality in the United States and Canada' in Bideau, Desjardins and Brignoli Op Cit)
posted by tallus at 4:19 AM on January 22, 2009

Interesting: Iceland's terrible infant mortality.
LOL! Yeah, everyone's IMR was 'terrible' in 1900. Their current rate of 3.27 is quite impressive. And IMR is a good indicator of the quality of health care in a country, not parenting as someone else suggested.

In so-called 'Central Europe' there are some differences.. solids are introduced at around 6 months. When the baby is still hungry despite max breast feeding it's considered time. First solids are cooked vegetables (potatoes, carrots) vs. rice cereal in the states. Breast feeding recommendations follow the WHO recommendations, exclusive ideally up to 6 months and then continuing to breast feed until age 2 or beyond.
posted by sero_venientibus_ossa at 12:00 PM on January 22, 2009

Agree with charmcityblues. If this is your third child, you should know by now to follow your gut about whatever you want to do with your baby. :)
posted by FergieBelle at 4:36 PM on January 22, 2009

Response by poster: Thanks for all the great links and discussion. My children have all been 'solid' (ie, not fat but higher birth weight) kids (8 lbs 7, 9 lbs 12, and now 9 lbs 1), and have had voracious appetites in the first six months, so I've always had to supplement with formula and introduce solids early. As the first two, now four and two are slim and chock full of energy with good but not over the top appetites, I figure I did okay.

I do wonder though, how much further along children are developmentally, if at all, if they have larger birth weights and whether modern feeding charts and measures have looked at this at all. I know I'm not the only one having larger kids.

Again though, thanks everyone!
posted by Zinger at 10:11 AM on January 23, 2009

Just to throw a wrench into things; my wife couldn't breast feed our twins after a fairly short period of time1 and so we switched to formula before moving to solid foods (all homemade; the one time I gave one of 'em Gerber in a pinch, he made such a face of disgust before spitting it out that I gave him another one to get it on video.) And now, at age three, they're both healthy as horses (always have been) and tall, my boy being very broad and my daughter being very slender (but both very muscled.) Heck, my daughter is in the 50th percentile for height...for a SIX YEAR OLD.

We've always credited their health to getting them colostrum in the beginning, making the baby food ourselves, keeping their foods healthy as they got older, giving them ample exercise opportunities every day and keeping regular sleeping scheduled. But then, you never really know what it is that's working, you just keep on doing it if it is, and change it if it isn't.

1 if someone is reading this and thinking about making a fuss over how terrible we are for giving them formula and how she could have breast fed if she had just "tried hard enough" or whatever, go tell your cat or your maid or something, they'll care more.
posted by davejay at 1:38 AM on May 31, 2009

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