The “When” of Introducing Solids

When should solids be introduced? There is no real easy way to answer this question, because national recommendations differ, and the decision also depends on a baby’s development and nutritional needs.

The American Academy of Pediatrics (AAP) and the UK government both encourage exclusive breastfeeding till baby is around 6 months of age (26 weeks), which follows World Health Organization (WHO) guidelines. However, according to the European Food Safety Authority (EFSA), the introduction of solids between 4-6 months of age is safe, and while exclusive breastfeeding until 6 months of age will be nutritionally adequate for the majority of infants, the EFSA acknowledges that some infants may need to start solids before 6 months of age. All are in agreement though that solids should be introduced no earlier than 4 months of age (or 17 weeks). And after 6 months of age, solids need to be introduced to provide adequate nutrition for the growing baby.

From a recent review of 23 published studies, it was concluded that exclusive breastfeeding for 6 months (compared to mixed feeding after 3-4 months of exclusive breastfeeding) may benefit baby by lessening gastrointestinal infections, while helping the mother lose weight and prevent pregnancies. However, doing so did not appear in the long run to affect baby’s growth, obesity, behavior, cognitive ability or impact allergic disease. Besides this, some research suggests that introducing gluten into a baby’s diet between 4-6 months whilst breastfeeding may reduce the risk of development of celiac disease and type 1 diabetes. Large scale randomized studies are now underway to study this, as well as the possibility of an earlier introduction of potentially allergenic foods alongside breastfeeding leading to a reduced prevalence of food allergies at a later stage (http://www.preventCD.com and http://www.EATStudy.co.uk). Another study seemed to show that introducing solids alongside breastfeeding between 4-6 months in a high income country may have a small but positive effect on the baby’s iron status. There may also be a link between an earlier introduction of solids (alongside certain parental prompting behaviors) and a greater acceptance of novel (new) fruits later on in preschool years.

The 2012 AAP policy statement “Breastfeeding and the Use of Human Milk”, however, states many positive benefits from 6 month’s exclusive breastfeeding, citing numerous studies. For the baby these include less gastrointestinal disease, ear infections, respiratory illnesses, asthma, eczema, while for the mother the benefits of delayed menstruation and post-natal weight loss. In this statement, though, the AAP states that it is aware of the fact that, “for some infants, because of family and medical history, individual developmental status, and/or social and cultural dynamics, complementary feeding, including gluten containing grains, begins earlier than 6 months of age.” If solids are begun before 6 months of age, the AAP recommends that this should be done while the infant is feeding only breast milk.

So is it better to introduce solids before or after 6 months of age?? I think the bottomline is this–
If you want to introduce solids to your baby before 6 months of age, look for these signs of readiness first before introducing them: 1) Baby can support own head/neck and stay in a sitting position, 2) Baby can coordinate eyes, hands, mouth to pick up food and put food into the mouth without help, and 3)Baby can swallow food.

If you decide instead to introduce solids to your baby at 6 months, you may want to start with more iron rich solids and give gluten containing foods (preferably alongside breastfeeding) sooner rather than later. Pureed meats and pulses like lentils will provide more iron and zinc than pureed fruits and vegetables. In the United States, baby cereals are fortified with iron and zinc as well. Gluten can be found in grains like wheat, barley and rye, and many commercially processed products may also contain gluten. Simply soften down adult wheat cereals (like Weetabix® or Shredded Wheat®) with enough expressed breast milk, formula or water to make your own wheat-based ‘porridge’ to offer baby. Hope this discussion helps you in your decision!

References:
1. Greer FR, Sicherer SH and Burks AW . Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolyzed formulas. Pediatrics 2008; 183-191. http://pediatrics.aappublications.org/content/121/1/183.full.pdf+html?sid=2d9308a9-4dc5-45bd-9d3b-13b9d5306bbb
2. Section on Breastfeeding. American Academy of Pediatrics. Breastfeeding and the use of human milk. Pediatrics 2012;129: 3: e827-e841. http://pediatrics.aappublications.org/content/129/3/e827.full.pdf+html. Accessed 31 July, 2013.
3. Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD003517. DOI: 10.1002/14651858.CD003517.pub2.
4. Szajewska H, Chmielewska A, Piescik-Lech M, et al. Systematic review: early infant feeding and the prevention of coeliac disease. Aliment Pharmacol Ther 2012; 36: 607–618.
5. Ludvigsson JF, Fasano A. Timing of introduction of gluten and celiac disease risk. Ann Nutr Metab 2012; 60(suppl 2): 22–29.
6. Scientific Advisory Committee on Nutrition and Committee on Toxicity. Joint Statement: Timing of Introduction of Gluten into Infant Diet. http://www.sacn.gov.uk/pdfs/sacn_cot_statement_timing_of_introduction_of_gluten_into_.pdf
Released March 2011. Accessed July 5, 2013.
7. Jonsdottir OH, Thorsdottier I, Hibberd PL, Fewtrell MS, et al. Timing of the introduction of Complementary Foods in Infancy: A Randomized Controlled Trial. Pediatrics 2012;130: 6: 1038-1045. http://pediatrics.aappublications.org/content/130/6/1038.abstract. Accessed 5, July 2013.
8. Blissett J, Bennett C, Donohoe J, et al. Predicting successful introduction of novel fruit to preschool children. J Acad Nutr Diet 2012; 112:1959-1967. http://download.journals.elsevierhealth.com/pdfs/journals/2212-2672/PIIS2212267212014256.pdf Accessed 6 July, 2013.

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