Ms Louise Reynolds:

Let us go back one step from weaning, to breastfeeding. Without doubt, the evidence shows that breast-feeding is the best option for babies. Traditionally in Ireland, we have not had a culture of breastfeeding. It is now becoming more well established. The latest figures are that 58% of mothers are breastfeeding in hospital, so they will initiate breastfeeding. That drops quite dramatically when the mum goes home. Problems can arise in the first couple of weeks and support may be needed but the supports are not there. There will be one visit from a public health nurse but there are no daily visits to help. Unless somebody has a mum, a sister or a friend who has breastfed, very often women can drop breastfeeding at that stage. We know that at three months, the number of mothers still breastfeeding are down to 36%. The target is to try to get that number up to 40% at three months. That is the first issue. We know that is the culture in Ireland compared with Scandinavian countries, where the initiation rate of breast-feeding is 98%. There is a significant distance way to go. That is something that is really important. We know that infants who are breastfed for six months or longer have a 50% less chance of being overweight or obese at the age of nine years. The evidence has shown that outcome when these children are followed. That is not only because of social class. We know that breastfeeding mothers tend to be educated to a higher level and also tend to be from a higher socio-economic group, however, we need everyone to be supported in breastfeeding. That is really important. Breastfeeding comes first and then weaning. Traditionally, I would imagine that all present were weaned at three months of age as that was what was done. One now has grandparents suggesting that such children be given something to eat because they are hungry or are crying. Following on from that, the advice was to start feeding the child at four months, but now the WHO has pushed weaning out to six months. This is due to the maturation of the baby's immune system. The baby's immune system is poorly developed when the baby is born. The reason that a baby is born at nine months is that the baby's head size can fit through the birth canal but there is a great deal of maturation that still needs to go on once the baby is born. That is why breastfeeding is the perfect food for babies. Exclusively breastfeeding up until the age of six months is now advocated and beyond that, the introduction of complementary foods.

It can get confusing because the information on some packaging of baby foods will say the product is suitable for babies from four months. The guidelines from the WHO first said that breastfed infants should be weaned at six months, but formula-fed infants were being weaned at four months. That caused a lot of confusion.

The advice now is to reduce the risk of allergy, because babies who are weaned too early tend to be at a greater risk of allergy and are at a greater risk of being overweight and of obesity because they tend to be overfed. Another issue is that breastfed babies stop feeding when they are full. One has no idea how much they have had. That may cause a bit of anxiety for the mother because she is worrying whether the baby has had enough but that allows the baby to develop his or her own sense of satiety, with the baby tuning in to when he or she is full. They are developing their own signals of feeling full. If a baby is on formula, one is anxious that the baby finishes the bottle. The baby may be full but the mum is feeling anxious because the baby has not drained the bottle. There are lots of cues and a lot more going on, which is really important.

We need to get more mums to breastfeed, but I know it is difficult. When I look back on my own experience, it was the support of friends and the knowledge that I was doing the right thing that helped me to stick with it during the first couple of weeks. After that, it can be plain sailing. It is during the first few weeks that support for breastfeeding mothers is critical. If we could get the breastfeeding rates up, it would be phenomenal for children's health and for mothers' health as well, because it protects against breast cancers and various types of ovarian cancers. There are lots of benefits to the mum from breastfeeding. I agree that breastfeeding and early weaning are critical issues.

Dieticians are trained and know the evidence base behind it. It is not based on an idea or a feeling but on scientific evidence. As for any access to dietetic support, public health nurses are trained and have some contact with dieticians in the community. The issue is to get support for mums and that is really important.