The first months of an infant's life are characterised by rapid growth and development, with a corresponding period of parental learning and upheaval. Much early parental anxiety and uncertainty concerns infant feeding, with new parents seeking advice from family and friends, from books and the media, as well as from the health professionals who have responsibility to provide evidence-based, best practice advice. There is much concern, confusion and controversy around the introduction of solid foods due to changing guidelines and evidence about the health implications of the type and timing of solid foods.
Weaning is defined as the introduction of the first solid foods to infants. It is widely believed that there are significant health implications from the introduction of inappropriate solid foods to infants during weaning, including the risk of eczema, asthma, allergy and obesity. Prior to 2001 the World Health Organisation (WHO) recommended that infants be exclusively breast fed for 4-6 months . However after a systematic review published in 2002  they amended this with the global recommendation that solid foods should not be introduced before 6 months of age for breast-fed infants, however they did not specify any age for formula-fed infants. This systematic review was recently updated  with the group endorsing those previous recommendations of exclusive breastfeeding for the first six months of life in developing and developed countries with the caveat that individual infants should still be managed individually to prevent any adverse outcomes.
In Europe the European Society for Paediatric Gastroenterology, Hepetology, and Nutrition (ESPGHAN) committee position paper's review of practices in Europe in 2008  concluded that complementary feeding should not be introduced before 17 weeks or after 26 weeks and further went on to make recommendations about food groups and when they should be introduced. However while acknowledging that theoretical benefits might accrue from separate recommendation for breast and formula fed infants they concluded that this would present considerable practical difficulties and therefore is undesirable.
In the UK, the six month recommendation of the WHO was endorsed by the Scientific Advisory Committee on Nutrition (2003)  stating that there should be flexibility in the advice given. After a period of heated discussion, in 2004 the United Kingdom (UK) Department of Health  decided on a recommendation that solids should be introduced at around six-months for both breast fed and bottle-fed infants.
In Ireland in 2003 the Department of Health and Children (DoHC)  endorsed the WHO guidelines for exclusive breastfeeding until 6 months, and changes were made to parental infant feeding literature produced by the newly formed Health Service Executive (HSE). However they did not make changes to the recommendations for formula fed infants. The current weaning recommendations in Ireland are that solid foods, except in special circumstances, should be introduced into an infant's diet at around 26 weeks of age for a breast-fed infant and not before 18 weeks for a formula-fed infant. Disparity between these global, European and local recommendations in Ireland may be the cause of some confusion for both parents and health service providers based there.
Contemporary research evidence suggests that babies in Ireland are given solid foods before the recommended age  and a number of studies have shown a link between the early introduction of solids and health risks, such as food intolerance, excess weight gain and Diabetes. Wilson et al,  reported that introducing solids before 15 weeks is associated with an increased likelihood of respiratory illness, particularly wheeze and persistent cough. Foote and Marriott  expressed concern that early solids might cause immune sensitisation and potential stress on the kidneys due to a high solute load from some weaning foods and Morgan et al  suggest that giving solids to pre-term infants before 17 weeks increases risk of eczema. More recently in a birth cohort study, on the timing of solid food introduction and its relationship to eczema, asthma, allergic rhinitis and food and inhalant sensitization at the age of six years  the authors found no evidence supporting a delayed introduction of solids beyond 4-6 months for the prevention of asthma, allergic rhinitis and food and inhalant sensitization at the age of six years. For eczema the results were conflicting however.
In a subsequent paper, late introduction of solid foods was in fact associated with increased risk of allergic sensitization of food (specifically oats and eggs) and inhaled allergens (specifically potatoes and fish) , however the authors stated a limitation of the study being that subjects were selected on the basis of HLA-conferred susceptibility to Type 1 Diabetes which may impact on the generalisability of the findings. Other papers have focused on the potential for nutrient deficiencies from delayed onset of weaning [14, 15].
The Food and Nutrition guidelines for pre-school services 2004  makes recommendations for the order and timing of first foods inclusive of stage 1 (introduction of complementary foods), stage 2 (over a 6 month period) and stage 3 (over a 9-12 month period). The general principles of this include commencing at stage one with gluten free cereals, pureed fruits and vegetables and iron rich foods such as pureed meats, progressing to stage 2 with a wider range including eggs, gluten containing cereals, cheese, and small amounts of cows milk and then stage 3 where most family foods are considered safe with the exception of high salt, sugar and nuts (until age 3).
While much research has focused on the actual recommendations and the issue of late/versus early introduction of solids and the impact on health there has been little investigation of the weaning advice provided by health professionals routinely caring for infants during this important period in their development, even though a recent paper suggests that the influence of health professionals on infant weaning practices has the potential to be as great as cultural values or material resources . This is echoed in the findings of Ewing and Green  who demonstrate the significance of the health visitor in the UK in giving weaning advice. A review of the published literature sourced a number of studies in this area in the UK [19, 20, 11]. The findings of these studies were consistent in that they found that recommendations were varied and knowledge inconsistent. Our search did not source any studies conducted in the Republic of Ireland. The aim of this pilot study then was to explore knowledge and advice practices of health professionals working in Ireland with responsibility for advising parents on infant weaning.