Results

SAMPLE CHARACTERISTICS

The sample was similar to the postal code areas from which it was drawn, and similar to the Greater Glasgow Health Board area, in terms of social class (table 1) and infant feeding practice (45% breastfeeding at the end of the first week v43% from the postal codes sampled). The breastfeeding rate observed was similar to that found for Scotland in the 1990 OPCS infant feeding survey (fig 1).2

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Figure 1

Breastfeeding rates compared with the OPCS 1990 infant feeding report.2 Blank, Glasgow longitudinal infant growth study; Shaded, OPCS data for Scotland 1990; Filled, OPCS data for the UK 1990.

TIMING OF WEANING

Median age of introduction of solid food was 11 weeks (range 4–35 weeks). Only 7% of the sample had not introduced solids by 4 months old (the recommended time of weaning). This was similar to that reported for Scotland and the UK2 in the 1990 OPCS infant feeding survey (fig 2).

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Figure 2

Percentage of mothers who had introduced solid food by age of infant compared with OPCS 1990 infant feeding report.2 Blank, Glasgow longitudinal infant growth study; Shaded, OPCS data for Scotland 1990; Filled, OPCS data for the UK 1990.

There was no significant difference in timing of weaning between boys and girls. Younger mothers tended to introduce solids earlier (table2). Weaning was later in those of higher socioeconomic status (χ² test for proportion weaned before 10 weeks and on or after 10 weeks, p < 0.01) and in mothers who had higher or further education (Mann-Whitney test, p < 0.05). Nine per cent of mothers in social class I and II, and 31% in social class III and below had introduced solids by 10 weeks. Breast fed infants were weaned later than formula fed infants (median 12 v 11 weeks, Mann-Whitney test p < 0.001). Eight per cent of mothers who breast fed weaned by 10 weeks compared with 33% of mothers who formula fed. The infant’s weight at 1 month was also related to timing of weaning: heavier infants were weaned earlier. Weight at 1 month was negatively correlated with age at introduction of solids (multiple regression; p < 0.05).

Of the 127 mothers in the sample, 98 completed an additional questionnaire on attitudes to and information on weaning. There was evidence of an association between the provision of formal advice and timing of weaning. Of 65 mothers who sought or received formal advice, only nine introduced solids before 10 weeks compared with 12 of 33 mothers who had not received formal advice.

FIRST WEANING FOODS

Commercially prepared cereals were the most commonly used first weaning foods, used by 102/127 mothers (82%). This consisted of baby rice (66%), baby cereal (9%), and rusks (5%). Only six infants (5%) were given fruit or vegetable purees as their first weaning food. The remaining 14% were introduced to solid food with other commercial baby foods.

USE OF COW’S MILK AND REDUCED FAT MILK AS A MAIN DRINK

By 6 months of age, two infants (2%) were given cow’s milk as their main drink. This increased to 22 (17%) at 9 months, and 55 (45%) by the end of the first year. These proportions were smaller than those found by the OPCS infant feeding survey2 where 36% had used cow’s milk as a main drink by 9 months. Semiskimmed or skimmed milk was used as a main drink in five (4%) of the Glasgow sample by 1 year.

ATTITUDES TO WEANING AND SOURCES OF INFORMATION

Ninety eight mothers were asked for their attitudes to weaning and on sources of information; they could give more than one answer to each question.

The two reasons most often reported as to why mothers weaned their child were (1) the perception that the infant was “not satisfied with milk feeds and was hungry” (73 of 98 mothers), (2) “because the baby was not sleeping through the night” (20 mothers).

Knowledge as to when to wean and what foods to use were obtained by 53 of the 98 mothers from previous experience, 43 from books and leaflets, 31 acted on advice from the health visitor or doctor, and 15 obtained advice from family or friends. When asked if any formal advice was received from health professionals, 65 of 98 mothers reported having some type of formal information. In most cases (54 of 65) this was from the health visitor or doctor and in 21 of 65 this was from books or leaflets.

Mothers were asked which factor had the greatest influence on their decision to introduce solids and their choice of solid foods; advice from the health visitor or doctor was not the main influence reported. Only 28 of 98 mothers reported that the health visitor or doctor had the greatest influence on when to wean their baby and, as noted above, the perception that weaning was necessary to “satisfy” the infant was dominant.

Discussion

The results confirm widespread non-compliance with current UK recommendations1 in relation to timing of weaning, use of cow’s milk as a main drink, use of reduced fat milk as main drinks, and first weaning foods.

Breastfeeding rates in Glasgow are low.8 Timing of weaning was earlier than recommended1 but similar to UK data on infant weaning practice.2 Compliance with recommendations in relation to cow’s milk was marginally better than UK data.2 In summary, these results suggest that low levels of compliance with UK recommendations were not the result of factors specific to the sample, or to Glasgow.

The public health implications of non-compliance on such a scale remain unclear.3 4 The most serious discrepancy between actual practice and recommendations is in timing of weaning. Early introduction of solids has been discouraged because it is believed to encourage excessive weight gain, increase the risk of infection, and increase the risk of allergic disease.1 There is a consensus that early weaning is hazardous and should be avoided.1 However, Forsyth et al showed that early introduction of solids might be less harmful than was previously thought, and they suggested a more flexible approach to recommendations on weaning practice.4

Around two thirds of mothers received formal advice about weaning practice, but most reported that other factors influenced their decision on weaning. In particular, 74% reported a perception that infants were hungry, and 20% reported infant sleep disturbance. Previous studies have reported that infant body size influences timing of weaning, independent of other factors,2 4 implying that timing of weaning is matched to the physiological needs of the infant, at least in part. Other factors that influenced timing of weaning in the present study were those already described2: mothers who used formula feeding, those who were younger, and those in lower social classes, tended to wean their infants earlier. The observations that mothers who did not receive formal information on weaning, who formula fed, and those of lower social class and educational attainment tended to wean their infants earlier, suggests that weaning practice can be influenced by education.

The importance of non-compliance with current recommendations in relation to cow’s milk feeding, use of reduced fat milks, and first weaning foods is difficult to assess, and such an assessment is beyond the scope of this study. Recommendations on the use of cow’s milk in infancy are based on concerns related to iron deficiency1and recommendations related to reduced fat milks are based on concerns that low energy intake might compromise growth and nutritional status.3

The importance of maternal attitudes to breastfeeding has long been recognised as an important element in achieving compliance with UK recommendations.9 Parental attitudes to weaning practice have received less attention but would appear to be often misinformed,5 with adverse consequences for some infants.6 Further research on the importance of parental attitudes and beliefs would help elucidate the underlying causes of non-compliance with Department of Health recommendations on weaning,2 and further research on the public health implications of non-compliance is recommended.

In view of the potential hazards,1 public health strategy should continue to focus on avoidance of early weaning. There may be a case for relaxing the recommendations4 on weaning practice, but as these represent a critical review of the available evidence, any modification of current advice must be approached with care. Recommendations are generally cautious, seek to avoid risks to public health, and should not be modified without a further review of the evidence.

The extent of non-compliance shown by this study could lead to the conclusion that current guidelines are failing to reach their target audience. Our evidence that weaning practice was sensitive to education, social class, and the input of health professionals, implies that there is some scope for improvement in this area. Such an improvement might be practical if educational messages can be focused on the appropriate groups—that is, on families of lower social class and educational attainment.