On Starting Solids
I was addressing a topic that comes up frequently in parenting groups today, that of when to start solids. The poster wondered why her pediatrician now recommended starting solids at four months when she had recommended six months in the past. Several of the posters noted that Health Canada, the Canadian Pediatric Society, the World Health Organization, and La Leche League all recommend waiting until around the middle of the first year of a baby’s life.
So why the discrepancy, and does it make a difference anyway?
The new research that was touted at industry sponsored conferences seemed to suggest that early introduction of solids might reduce the risk of allergy, type 1 diabetes, and celiac disease. Thorough reviews of these studies showed that finding were inconclusive as to providing any benefit from starting early solids, and findings did not address the known risks of early introduction of solids.
One rationale for early solids is low iron. Most babies have sufficient iron stores to six months and beyond – more if the cord was left to pulse at birth, less in preterm births. Iron can be measured by a simple heel prick and a bioavailable (easily absorbed) supplement can be given. Early infant foods often include purees of fruit and vegetables (which are not very iron dense) and iron fortified infant cereal. Iron in infant cereal is not very bioavailable and binds to the lactoferrin in human milk resulting in less total available iron and a resulting premature depletion of natural iron stores.
Another reason for recommending early solids is that baby will sleep longer at night. Not only is this reason untrue, and there is no evidence to back it up, but there are many protective reasons for baby to wake and feed during the night. Night waking protects babies from SIDS, breastmilk has a higher calorie content at night, and maternal prolactin levels are at their peak between 3:00am and 5:00am. All of this means babies are safer and grow well, and mothers maintain a good milk supply, when they are nursed through the night.
So the next question might be, is there any harm done by starting solids early?
The simple answer is yes.
Infants drink (on average) the same volume of human milk each day during the period of one to six months of age. This is the peak of milk production which begins to slowly decline after six months postpartum. So any other foods consumed during this time replace calories and nutrients found in human milk. This leads to decreased milk production and potential early weaning as well as nutrient deficiencies.
The infant’s gut does not mature until after six months of age, and is sometimes referred to as the virgin gut. The presence of human milk in the digestive track protect against inflammation and confers antibodies that the baby does not begin to make on his own until the sixth month of life. This is protective against illness and allergy during this very sensitive period. Introducing foods other than breastmilk to the gut during this time causes damage to the gut lining and delays the maturation of the gut and digestive system.
By starting solids during the middle of the first year of life, one can avoid fortified infant cereal and pureed infant foods entirely, as baby is developmentally ready to pick up, chew, swallow and digest solids which can be family table foods. These foods will be a complement to breast milk, not a replacement for it. Breastmilk continues to make up the bulk of babies’ caloric need for the rest of the first year of life.
From the kellymom website:
Signs that indicate baby is developmentally ready for solids include:
- Baby can sit up well without support.
- Baby has lost the tongue-thrust reflex and does not automatically push solids out of his mouth with his tongue.
- Baby is ready and willing to chew.
- Baby is developing a “pincer” grasp, where he picks up food or other objects between thumb and forefinger. Using the fingers and scraping the food into the palm of the hand (palmar grasp) does not substitute for pincer grasp development.
- Baby is eager to participate in mealtime and may try to grab food and put it in his mouth.
Some potential first foods to try with baby could include:
- steamed sweet potato or carrot, cut into strips
- beef, cooked to medium and cut into strips
- hard boiled or scrambled eggs
- soft cooked pasta
Watch for signs of readiness, choose appropriate family foods, and keep on breastfeeding throughout this fun, and messy, new phase.