Major Bleed Risk Falls with Bivalirudin vs Heparin en Route to PCI for STEMI: EUROMAX.

The 30-day risk of death or major bleeding fell significantly in ST-elevation MI (STEMI) patients treated with bivalirudin (Angiomax, the Medicines Company) compared with heparin-based management, both initiated prior to arrival at a hospital for primary PCI, in a large randomized but open-label study[1].

The bivalirudin benefit for that composite end point in the European Ambulance Acute Coronary Syndrome Angiography(EUROMAX) trial was driven by a significant drop in major bleeding, the definition of which excluded bleeding related to CABG surgery.

The heparin-based strategy consisted of either unfractionated heparin (UFH) or the low-molecular-weight heparin enoxaparin(Lovenox, Sanofi). Both groups could receive a GP IIb/IIIa inhibitor provisionally.

EUROMAX was published today in the New England Journal of Medicine with lead author Dr Philippe Gabriel Steg (Hôpital Bichat, Paris, France) to coincide with his presentation of the trial here at TCT 2013 .

Dr Philippe Gabriel Steg

Bivalirudin’s 40% primary-end-point relative risk reduction included a >50% drop in risk for non-CABG major bleeding. On the other hand, the relative risk of stent thrombosis with bivalirudin was nearly threefold what was seen in the heparin group, although absolute rates were very low.

At a media briefing on the trial, Steg said the excess stent thromboses with bivalirudin were driven by events in the acute phase, within 24 hours of PCI. And, he observed, they didn’t translate into more reinfarctions or ischemia-driven revascularization.

Still, “acute stent thrombosis . . . while rarely fatal and not outweighing the advantages of bivalirudin, is the only troubling issue with bivalirudin in STEMI, and we do need strategies to reduce this complication,” according to Dr Gregg W Stone (New York-Presbyterian Hospital/Columbia University Medical Center New York, NY), the assigned discussant following Steg’s formal presentation of EUROMAX.


The trial’s findings are reminiscent of the HORIZONS AMI trial 30-day outcomes reported about six years ago and covered then by heartwire . That trial, Steg et al observe, preceded some important changes in STEMI management and PCI technique that likely affected bleeding risk, changes that were a part of EUROMAX. These included the expansion of radial-artery PCI access, newer antiplatelet agents, reduced GP-IIb/IIIa-inhibitor use, and progressively earlier initiation of IV anticoagulants.

In the >3600-patient HORIZONS AMI, anticoagulation wasn’t started early during transport. But both it and EUROMAX with its nearly 2200 patients saw a decreased bleeding risk and increased stent-thrombosis risk with bivalirudin compared with heparin. But in contrast to EUROMAX, the earlier trial also showed a reduced risk of cardiac death in bivalirudin patients.

The two studies taken together have more to say than either alone. “I think the results of EUROMAX will heavily impact clinical use of bivalirudin in Europe,” Steg said to heartwire . “The results are very consistent wih HORIZONS AMI, even to the point of the stent-thrombosis signal” and are “reassuring enough to embrace [bivalirudin] in the prehospital setting.” That is, he added, “If you want to. [The EUROMAX results] are not mind-blowing because we don’t see a mortality reduction. But they suggest that the benefits seen in HORIZONS AMI can be extended to the contemporary prehospital setting. “

At the media briefing, Dr Bernard Gersh (Mayo Clinic, Rochester, MN), who wasn’t involved in the trial, said, “It’s not that often that you see trials that really will change clinical practice, and I think this will.”

The Role of Prehospital Diagnosis and Treatment

Gersh also said, “I’ve never seen really anything that suggests that prehospital administration [of anticoagulants] and [STEMI] diagnosis is not beneficial.”

But whether they are achievable in the field varies by country, even within Europe. Interviewed, Steg pointed out that at most participating centers, there were no physicians in the ambulances. It does take some expertise to interpret the ECGs, unless the tracings can be transmitted to a center for remote reading. But, he said, “It’s been shown in other trials if you have good trained paramedics, they do just as well if not better than physicians.”

Also speaking at the briefing as a EUROMAX observer, Dr Philippe Généreux (NewYork-Presbyterian Hospital/Columbia University Medical Center, New York, NY) said prehospital STEMI diagnosis and treatment initiation could make the most difference in countries like Canada, “where there aren’t cath labs on every corner” and it might take 45 to 60 minutes for an ambulance to reach a PCI center.

Prospects for prehospital management in the US seem more remote, observers agreed. Dr James B Hermiller, Jr (St Vincent Hospital/The Heart Center of Indiana, Indianapolis,) said at the briefing, “The barrier to this in the US is very great. It’s difficult just to  get ECGs in the field, let alone administer anticoagulants, but we need to get there because this is very important.”

The Open-Label Randomization

EUROMAX randomized patients at centers in nine European countries presenting within 12 hours of onset of symptoms from electrocardiographically defined STEMI, on an open-label basis, to the bivalirudin or heparin strategies. Treatment was initiated in the ambulance or at a non-PCI hospital with subsequent transport to a PCI center.

For the 1089 patients who received bivalirudin, the drug was started as a 0.75-mg/kg bolus followed by an infusion of 1.75 mg/kg/h continued for at least four hours after PCI. The 1109 control patients received UFH at either 100 IU/g or 60 IU/kg with a GP IIb/IIIa inhibitor or were allowed to have enoxaparin at 0.5 mg/kg. Adjuvant GP IIb/IIIa inhibitors were allowed at physicians’ discretion. All patients received aspirin plus a P2Y12 inhibitor.

Relative Risk (95% CI) for Outcomes, Bivalirudin vs Heparin Strategies for STEMI Initiated During Emergency Transport to Primary PCI

End points

RR (95% CI)


30-day death from any cause or non-CABG major bleedinga

0.60 (0.43–0.82)


30-day death from any cause, reinfarction, or non-CABG major bleeding

0.72 (0.54–0.96)


Non-CABG major bleeding

0.43 (0.28–0.66)


Major bleeding (TIMI definition)

0.62 (0.32–1.20)


Severe or life-threatening bleeding (GUSTO definition)

0.61 (0.22–1.68)


Definite stent thrombosisb

2.89 (1.14–7.29)


a. Primary end point 
b. Academic Research Consortium criteria

No significant differences were seen at 30 days for the composite of death, reinfarction, ischemia-driven revascularization, or stroke, or for any stroke or ischemic stroke. A committee blinded to treatment assignment adjudicated bleeding episodes and clinical events.

As discussant, Stone pointed out that PCI via the radial artery, rather than the femoral artery, was done in only 6% of cases in HORIZONS AMI but in 47% of EUROMAX patients. Some predicted that the greater proportion of radial procedures would lead to a much lower major bleeding rate and make it hard for bivalirudin to show an effect. A EUROMAX subgroup analysis found, however, that the benefits of bivalirudin over the heparin-based strategy were consistent for different kinds of patients, including whether their PCI was by the radial or femoral routes.

“Therefore, bivalirudin is beneficial regardless of the access site, and this is because most bleeding in the STEMI and ACS setting is not access-site related,” he said. It’s the non–access-site bleeds to pose the greater threat to later outcomes. So, he said, “the advantages of bivalirudin are present in patients undergoing radial as well as femoral intervention, and radialists should pay attention to this.”

Stone said EUROMAX raises the question of whether using cangrelor (the Medicines Company) as part of the accompanying antiplatelet therapy might help prevent stent thrombosis with bivalirudin, and that’s being addressed in HORIZONS-AMI-2, which is starting soon.

Scientists Officially Link Processed Foods To Autoimmune Disease.

The modern diet of processed foods, takeaways and microwave meals could be to blame for a sharp increase in autoimmune diseases such as multiple sclerosis, including alopecia, asthma and eczema.

A team of scientists from Yale University in the U.S and the University of Erlangen-Nuremberg, in Germany, say junk food diets could be partly to blame.

‘This study is the first to indicate that excess refined and processed salt may be one of the environmental factors driving the increased incidence of autoimmune diseases,’ they said.

Junk foods at fast food restaurants as well as processed foods at grocery retailers represent the largest sources of sodium intake from refined salts.

The Canadian Medical Association Journal sent out an international team of researchers to compare the salt content of 2,124 items from fast food establishments such as Burger King, Domino’s Pizza, Kentucky Fried Chicken, McDonald’s, Pizza Hut and Subway. They found that the average salt content varied between companies and between the same products sold in different countries.

U.S. fast foods are often more than twice as salt-laden as those of other countries. While government-led public health campaigns and legislation efforts have reduced refined salt levels in many countries, the U.S. government has been reluctant to press the issue. That’s left fast-food companies free to go salt crazy, says Norm Campbell, M.D., one of the study authors and a blood-pressure specialist at the University of Calgary.

Many low-fat foods rely on salt–and lots of it–for their flavor. One packet of KFC’s Marzetti Light Italian Dressing might only have 15 calories and 0.5 grams fat, but it also has 510 mg sodium–about 1.5 times as much as one Original Recipe chicken drumstick. (Feel like you’re having too much of a good thing? You probably are.

Bread is the No. 1 source of refined salt consumption in the American diet, according to the Centers for Disease Control and Prevention. Just one 6-inch Roasted Garlic loaf from Subway–just the bread, no meat, no cheeses, no nothing–has 1,260 mg sodium, about as much as 14 strips of bacon.

How Refined Salt Causes Autoimmune Disease

The team from Yale University studied the role of T helper cells in the body. These activate and ‘help’ other cells to fight dangerous pathogens such as bacteria or viruses and battle infections.

Previous research suggests that a subset of these cells – known as Th17 cells – also play an important role in the development of autoimmune diseases.

In the latest study, scientists discovered that exposing these cells in a lab to a table salt solution made them act more ‘aggressively.’

They found that mice fed a diet high in refined salts saw a dramatic increase in the number of Th17 cells in their nervous systems that promoted inflammation.

They were also more likely to develop a severe form of a disease associated with multiple sclerosis in humans.

The scientists then conducted a closer examination of these effects at a molecular level.

Laboratory tests revealed that salt exposure increased the levels of cytokines released by Th17 cells 10 times more than usual. Cytokines are proteins used to pass messages between cells.

Study co-author Ralf Linker, from the University of Erlangen-Nuremberg, said: ‘These findings are an important contribution to the understanding of multiple sclerosis and may offer new targets for a better treatment of the disease, for which at present there is no cure.’

It develops when the immune system mistakes the myelin that surrounds the nerve fibres in the brain and spinal cord for a foreign body.

It strips the myelin off the nerves fibres, which disrupts messages passed between the brain and body causing problems with speech, vision and balance.

Another of the study’s authors, Professor David Hafler, from Yale University, said that nature had clearly not intended for the immune system to attack its host body, so he expected that an external factor was playing a part.

He said: ‘These are not diseases of bad genes alone or diseases caused by the environment, but diseases of a bad interaction between genes and the environment.

‘Humans were genetically selected for conditions in sub-Saharan Africa, where there was no salt. It’s one of the reasons that having a particular gene may make African Americans much more sensitive to salt.
‘Today, Western diets all have high salt content and that has led to increase in hypertension and perhaps autoimmune disease as well.’

The team next plan to study the role that Th17 cells play in autoimmune conditions that affect the skin.
‘It would be interesting to find out if patients with psoriasis can alleviate their symptoms by reducing their salt intake,’ they said.

‘However, the development of autoimmune diseases is a very complex process which depends on many genetic and environmental factors.’

Stick to Good Salts

Refined, processed and bleached salts are the problem. Salt is critical to our health and is the most readily available nonmetallic mineral in the world. Our bodies are not designed to processed refined sodium chloride since it has no nutritional value. However, when a salt is filled with dozens of minerals such as in rose-coloured crystals of Himalayan rock salt or the grey texture of Celtic salt, our bodies benefit tremendously for their incorporation into our diet.

“These mineral salts are identical to the elements of which our bodies have been built and were originally found in the primal ocean from where life originated,” argues Dr Barbara Hendel, researcher and co-author of Water & Salt, The Essence of Life. “We have salty tears and salty perspiration. The chemical and mineral composition of our blood and body fluids are similar to sea water. From the beginning of life, as unborn babies, we are encased in a sack of salty fluid.”

“In water, salt dissolves into mineral ions,” explains Dr Hendel. “These conduct electrical nerve impulses that drive muscle movement and thought processes. Just the simple act of drinking a glass of water requires millions of instructions that come from mineral ions. They’re also needed to balance PH levels in the body.”
Mineral salts, she says, are healthy because they give your body the variety of mineral ions needed to balance its functions, remain healthy and heal. These healing properties have long been recognised in central Europe. At Wieliczka in Poland, a hospital has been carved in a salt mountain. Asthmatics and patients with lung disease and allergies find that breathing air in the saline underground chambers helps improve symptoms in 90 per cent of cases.

Dr Hendel believes too few minerals, rather than too much salt, may be to blame for health problems. It’s a view that is echoed by other academics such as David McCarron, of Oregon Health Sciences University in the US.

He says salt has always been part of the human diet, but what has changed is the mineral content of our food. Instead of eating food high in minerals, such as nuts, fruit and vegetables, people are filling themselves up with “mineral empty” processed food and fizzy drinks.



Drug companies bought their way onto FDA advisory panels.

It is now an undeniable fact that the pharmaceutical industry weaseled its way onto key U.S. Food and Drug Administration (FDA) advisory panels, which were instrumental in shaping the way drugs are safety tested and approved. According to The Washington Post (WP), a recent public records request has revealed that drug companies purchased special access onto these panels, where they were given the keys to the kingdom in swaying decision-makers about official drug policy.

Based on critical information gathered from hundreds of leaked emails, pharmaceutical companies have doled out hundreds of thousands of dollars over the years to attend private meetings with the FDA, many of which were geared towards the regulation and approval of painkiller drugs. Drug companies would reportedly shell out upwards of $25,000 or more per meeting to have their voices heard, a small price to pay for direct access to the $9 billion American painkiller market.

According to the WP, officials from both the FDA and the U.S. National Institutes of Health (NIH) would regularly meet with pharmaceutical representatives in private to discuss regulatory protocols, co-write scientific papers and collaborate on various ways to help streamline the drug approval process. And the only parties who actually paid to attend such meetings were the drug companies, a fact that one official from the NIH expressed serious concerns about in an email, referring to the whole scheme as a “pay to play process.”

Others who have since reviewed the emails agree, noting that, while the FDA did not necessarily benefit financially from these private meetings, many FDA officials went on to work as pharmaceutical consultants. In other words, FDA staff who agreed to grease the palms of the drug industry during these private meetings were later rewarded with high-paying positions in the drug industry. This is just one glaring example of how the line between the regulator (FDA) and the regulated (pharmaceutical companies) has been blurred beyond recognition.

“These e-mails help explain the disastrous decisions the FDA’s analgesic division has made over the last 10 years,” said Craig Mayton, the Columbus, Ohio, attorney who made the public records request to the University of Washington, to the WP. “Instead of protecting the public health, the FDA has been allowing the drug companies to pay for a seat at a small table where all the rules were written.”

Big Pharma, FDA corruption runs deep

It is no longer a conspiracy theory, then, that the drug industry owns the FDA. In this particular case, it was two academics by the names of Robert Dworkin, from the University of Rochester, and Dennis Turk, from the University of Washington, who allegedly orchestrated the painkiller plot. But there have been many other plots with the same ultimate end, a fact that NaturalNews and many others in the so-called “alternative” media have been shouting from the rooftops for years, but that the mainstream media has ignored, until now.

“Shame on the FDA and NIH for sending representatives to this panel, cooked up by two unethical professors and their drug company cronies,” wrote one WP commenter about the scandal. It should be noted that FDA officials actively participated in the painkiller scheme, all the while knowing full well that the private meetings they attended were hatched by Big Pharma. “Congress should come down hard on both agencies for participating in what was clearly pay-to-play, with awful consequences for the health of many suffering Americans.”

Such consequences include a flood of dangerous analgesic drugs to the market that were approved based on questionable or flawed safety studies. According to, the drug industry was successful during these meetings in convincing the FDA to adopt an “enriched enrollment” guidance for safety trials that eliminated patients who experienced adverse reactions. These and other modifications made it much easier for drugs to be declared safe and effective, and thus gain rapid approval.



The What, Why, and How of Baby-Led Weaning .



Most people take it for granted that when a baby starts on solid food he will be spoon fed baby rice or mush, one taste at a time, in a schedule decided by his parents. And although most parents hope their child will turn out to be a ‘good eater,’ the reality is often very different.

The path to relaxed and healthy family meals turns out to be far more difficult than it should be for many families. Mealtime battles, food phobias and fussy eating are just some of the things that parents can face when they start to introduce their little ones to solid food. Many children end up with a limited diet – often based on soft, processed foods – and childhood obesity is on the rise.

In response, a growing number of parents are rejecting the conventions of spoon feeding, turning instead to an approach called baby-led weaning (BLW), which is fast gaining a reputation as a better way to establish long-term healthy attitudes to food in children.

Weaning is used in its fullest sense here – the gradual move away from a milk-only diet, starting with the baby’s first taste of solid food through to the last breast or formula feeding, and taking anything from six months to several years. With baby-led weaning there’s no hurry, and no spoon feeding or baby food. Instead, this is what happens:

  • Babies are allowed to join in with nutritious family meals and feed themselves ‘real’ food with their fingers as soon as they are ready.
  • They choose what to eat, how much and how quickly.
  • There is no pressure for the baby to eat a set amount of food or any particular food group – the emphasis is on allowing him to explore and discover a range of healthy food in his own time.
  • The baby sets the pace for progress with solid foods and decides how quickly he cuts down his milk feedings.

The result is a slower and more enjoyable transition than has been the case for many babies in the past, avoiding many of the common mealtime challenges faced by families, and with potentially healthier outcomes for the infant.

How Does Baby-Led Weaning Work?

Baby-led weaning is based on how babies develop in their first year. It starts when the baby shows signs of being ready to pick up food. This is usually at around six months of age, when he is able to sit upright with little or no support and reach out accurately to grab things with his hands. At this age, most objects get taken to the mouth automatically, as part of the baby’s exploratory play – baby-led weaning extends this natural curiosity to the discovery of food.

Research shows that around six months is also the age that babies’ gastrointestinal and immune systems become able to cope with food other than breastmilk or formula, and their ability to move things around their mouth is mature enough to deal with non-liquids. This is why it’s the age recommended by the World Health Organization and the American Academy of Pediatrics as the optimum time for solids to begin.

However, the research so far has focused almost exclusively on when to introduce solids, rather than how. Baby-led weaning questions the common assumptions about how babies should be fed.

Spoon feeding babies of six months and older mashed or pureed food has no research to support it. It’s simply left over from when solid foods were given to babies when they were much younger, before they were really ready. Spoon feeding is unnecessary for healthy babies of six months – they are able to feed themselves.

The physiological readiness of babies for solid foods coincides with their developing abilities to take food to their mouths and begin to chew. If they have the opportunity, many babies will show their parents they are ready simply by helping themselves to food from someone’s plate.The benefits of allowing a child to follow their instincts for this important part of development may be considerable.

The potential advantages include:

  • Healthy food choices – babies are allowed to explore the tastes, textures and smells of nutritious family food, rather than the blandness and combined flavours associated with baby foods. Some research suggests children who have done BLW as babies make healthier food choices. Most parents report that BLW babies are adventurous, non-fussy eaters.
  • Less obesity – babies are allowed to eat according to their appetite. They can stop eating when they are no longer hungry and are not encouraged to eat more quickly than they want to, have ‘one more spoonful’ or ‘make a clean plate’. Many non-BLW babies have their natural appetite recognition overridden and are encouraged to eat more than they need from the earliest age. Research suggests lower BMI in children age 2-6 years who have done BLW.
  • Natural jaw development – babies experience a range of textures from the start, allowing chewing skills to develop naturally. This may facilitate speech development and help to reduce the need for orthodontic treatment later. And, because food that requires chewing spends longer being mixed with saliva in the mouth, BLW may promote enhanced digestion.
  • Improved hand-eye coordination and dexterity – BLW babies have lots of practice exploring different shapes and textures in food, learning how to grip them and get them to their mouth, and later how to manage silverware.
  • Confidence and enjoyment at mealtimes – No pressure to eat means no mealtime battles, making eating as a family more relaxed and enjoyable. Shared mealtimes also allow babies to copy siblings and parents, learning to share and take turns, and developing social skills.

Baby’s First Foods

Baby-led weaning revolves around shared mealtimes, where the whole family eats food that is nutritious, safe, and – as far as possible – free from added salt, sugar, chemicals, and other extras unsuitable for infants. Because the digestive tract of a six-month-old is ready for solid foods, there is no need to restrict the baby to one new food at a time. Almost any healthy family food is suitable, although the way it is presented may need to be adapted so that the baby can handle it easily in the early days. The exceptions are the same as for spoon feeding and include honey, raw eggs, and types of fish that may contain high levels of mercury. Any foods linked to a family history of allergy should be introduced under the guidance of a physician.

Only very small amounts of solid food are needed at first – mainly to supply additional iron and zinc – and it will usually be several weeks before there is any noticeable change to the baby’s appetite for his milk feedings. This allows the baby’s gut to adjust at a natural pace and ensures that milk feedings are not cut back too soon.

All babies are different, but most babies will not need significant amounts of solid food until they are around nine months. This means that babies naturally develop the ability to feed themselves with these foods before they begin to need them – and they are skilled at eating a range of foods by the time this need kicks in.

How to do Baby-Led Weaning:

  1. Choose a time when the baby is not tired or hungry. The baby doesn’t yet know solid food can fill his tummy – his appetite is still satisfied by the breast or bottle. Food will be just an exciting new toy at first, and he won’t be able to relax or concentrate on exploring it if he is tired or hungry.
  2. Sit the baby up to the table with everyone else. He can be either in a high chair or on an adult’s lap – supported, if necessary, so that he can use his hands and arms freely. Make sure he is sitting upright to handle food, not lying back or slumped.
  3. Dress the baby in a protective bib – or just a diaper, if the house is warm enough – and cover the area under his chair with a large clean cloth or plastic sheet, so that dropped food can be handed back. BLW can be very messy in the beginning but babies learn quickly and, with the opportunity to practice whenever anyone else is eating, they rapidly become skilled eaters and make less mess.
  4. Offer the baby a few pieces at a time of the same healthy food as everyone else (or a selection from it), in a shape and size that he can handle easily and a consistency that is firm enough to grasp while being soft enough to chew. To start with, this means sticks or strips of food but, gradually, he will show that he can manage smaller pieces and a variety of consistencies. Plates and cutlery may be distracting at first so pieces of food can be offered on the highchair tray or clean table top.
  5. Allow the baby to explore the food and to eat at his own pace (if at all). This means no hurrying or trying to persuade him to eat, and allowing him to squidge, smear and examine the food as much as he needs. Don’t expect him to eat much at first – he will eat when he is ready.
  6. Offer water in a small shot-sized cup, which will be easy for the baby to pick up, but don’t be surprised if a breastfeeding baby continues to prefer to use the breast to quench his thirst for several weeks or months after he has started to eat solid foods.
  7. Don’t allow anyone but the baby to put food in his mouth – making sure he is in control of what goes into his mouth is an important part of keeping your baby safe.
  8. Don’t offer small, hard foods – small foods, such as grapes and cherry tomatoes, should be cut in half; stones should be removed from fruits such as olives or plums. Nuts, whole or in pieces, are not suitable for babies.

Baby-led weaning works best when the focus is on opportunities for play and learning, rather than on eating. As the baby’s skills develop, he will gradually eat more at shared mealtimes and his appetite for milk will reduce. Provided the parents are responsive to the baby’s cues, the changeover from milk to family meals will happen naturally, led by the baby.

Learning to Chew and Swallow Food Naturally and Safely

Babies naturally develop eating skills in a set order (in much the same way as they always learn to sit up before they learn to walk). The normal sequence that babies follow in the period between five and seven months of age is:

Bringing things to the mouth

Biting and munching


Purposeful swallowing

Allowing the baby to remain in control ensures that this sequence is not rushed and keeps the baby safe. Most early bites of food will fall forward, out of the baby’s mouth. This protects his airway until he is mature enough to swallow safely – and if he is not able to bite off a piece of food, he is probably not ready to chew it. This is why it is important that no one should try to ‘help’ the baby by putting pieces of food in his mouth for him.

Gagging (or retching) is common in the early stages of BLW. The gag reflex prevents food being pushed too far back without having been chewed adequately, and it is particularly sensitive between six and eight months. As the baby matures, he becomes more skilled at chewing and the point at which the gag reflex is triggered moves farther back in his mouth, so gagging occurs less often. Although gagging can appear alarming to parents, babies are rarely bothered by it, and it may be that it is an important part of helping them to learn not to overfill their mouths.

Working with Babies, Not Fighting Against Them

All healthy, able-bodied babies roll over, sit up, crawl and walk when they are developmentally ready, provided they are given the opportunity. Most people wouldn’t dream of deciding the date for a baby to start walking, and of introducing a ‘walking programme’ on that day. They would also consider it positively cruel to prevent the child from walking before this designated day arrived. Yet the conventional approach to introducing solids takes exactly this line.

Baby-led weaning is based on the understanding that most feeding difficulties and mealtime battles stem from the fact that the goals of the parent are in conflict with the instincts of the child. Now that we know there is no need to introduce solid foods until six months – and certainly no need for jars or mush – it’s time to look again at what babies can do, and accord them the respect, autonomy and ‘real’ food they deserve. The result will be happier – and healthier – shared eating experiences for all.

About the Authors

Gill Rapley and Tracey Murkett are the authors of Baby-led Weaning: The essential guide to introducing solid foods – and helping your baby to grow up a happy and confident eater and The Baby-led Weaning Cookbook: 130 recipes that will help your baby learn to eat solid foods – and that the whole family will enjoy, both published in the USA by The Experiment. Gill and Tracey are also the authors of Baby-led Breastfeeding: Follow your baby’s instincts for relaxed and easy nursing, by the same publishers. All three titles are published in the UK by Vermilion, under their original titles. You can find more information from Gill and Tracey by visiting and