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Is baby ready for solid foods? (What do the experts say?)

Image courtesy of imagerymajestic / FreeDigitalPhotos.net

Image courtesy of imagerymajestic / FreeDigitalPhotos.net

Health experts and breastfeeding experts agree that it’s best to wait until your baby is around six months old before offering any food other than breastmilk. There has been a large amount of research on this, and most health organizations have updated their recommendations to agree with current research. Unfortunately, many health care providers and written materials are not up to date in what they are advising parents.

Following are just a few of the organizations that recommend that all babies be exclusively breastfed (no cereal, juice or any other foods) for the first 6 months of life (not the first 4-6 months):

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Most babies will become developmentally and physiologically ready to eat solid foods between 6 and 8 months of age.

Why wait until 6 months for solids?

Although many of the reasons listed here assume that your baby is breastfed or fed breastmilk only, experts generally recommend that solids be delayed for formula fed babies also.

  • Baby will have greater protection from illness.
     Although children continue to receive many immunities from breastmilk for as long as they breastfeed, the greatest immunity occurs while a baby is exclusively breastfed. Breastmilk contains 50+ known immune factors, and also facilitates the development of “good bacteria” that protect baby’s gut.  Studies have shown that many illnesses and conditions are less likely to occur when baby receives any amount of breastmilk. Exclusive breastfeeding for at least 3-4 months (compared to non-exclusive breastfeeding) further decreases the risk of respiratory tract infections, ear infections, necrotizing enterocolitis (NEC), sudden infant death syndrome (SIDS), allergic disease, celiac disease, and type 1 diabetes.  Exclusive breastfeeding for 6 months (compared to 4-6 months), further decreases the risk of gastrointestinal infection and respiratory infection. (AAP 2012, Naylor & Morrow  2001)
  • Baby’s digestive system will have time to mature.
    opengutIf solids are started before a baby’s system is ready to handle them, they are poorly digested and may cause unpleasant reactions (digestive upset, gas, constipation, etc.).  Digestion of fats, protein, and complex carbohydrates is incomplete in infancy, but human milk contains enzymes that aid efficient digestion (Naylor & Morrow  2001).In addition, from birth until somewhere between four and six months of age babies possess what is often referred to as an “open gut.” This means that the spaces between the cells of the small intestines will readily allow intact macromolecules, including whole proteins and pathogens, to pass directly into the bloodstream. This is great for your breastfed baby as it allows beneficial antibodies in breastmilk to pass more directly into baby’s bloodstream, but it also means that large proteins from other foods (which may predispose baby to allergies) and disease-causing pathogens can pass right through, too. During baby’s first 4-6 months, while the gut is still “open,” antibodies (sIgA) from breastmilk coat baby’s digestive tract and provide passive immunity, reducing the likelihood of illness and allergic reactions before gut closure occurs. Baby starts producing these antibodies on his own at around 6 months, and gut closure should have occurred by this time also. For more on this subject, see:  How Breast Milk Protects Newborns, and The Virgin Gut: A Note for Parents.
  • Baby will be developmentally ready to eat foods that are not liquids.
    A review done by Naylor & Morrow (2001) concluded, “These clinical reports indicate that the majority of normal full term infants are not developmentally ready for the transition from suckling to sucking or for managing semi-solids and solid foods in addition to liquids until between six and eight months of age.”
  • Baby will have a lower risk of obesity in the future.
    The early introduction of solids in infancy is associated with increased body fat and weight in adolescents and adults. (AAP 2012, Wilson 1998, von Kries 1999, Kalies 2005)
  • Starting solids will be easier.
    Babies who start solids later can feed themselves.
  • Baby may have more protection from iron-deficiency anemia.
    The introduction of iron supplements and iron-fortified foods, particularly during the first six months, reduces the efficiency of baby’s iron absorption. In one study of healthy, full-term infants (Pisacane, 1995), the researchers concluded that babies who were exclusively breastfed for 7 months (and were not give iron supplements or iron-fortified cereals) had significantly higher hemoglobin levels at one year than breastfed babies who received solid foods earlier than seven months. The researchers found no cases of anemia within the first year in babies breastfed exclusively for seven months and concluded that breastfeeding exclusively for seven months reduces the risk of anemia. See Is Iron-Supplementation Necessary? for more information.
  • Mom will more easily maintain her milk supply.
    Studies have shown that for babies under six months, solids tend to replace breastmilk in a baby’s diet – they do not add to baby’s total intake (WHO 2003, Cohen 1994, Dewey 1999). The more solids that baby eats, the less milk he takes from mom, and less milk taken from mom means less milk production. Babies who eat lots of solids or who start solids early tend to wean prematurely.
  • Mom is less likely to become pregnant.
    Breastfeeding is most effective in preventing pregnancy when your baby is exclusively breastfed and all of his nutritional and sucking needs are satisfied at the breast (Don’t believe this? It’s strongly supported by research – see Breastfeeding and Fertility for more information). Mothers who exclusively breastfeed for 6 months vs 4 months have a longer duration of lactational amenorrhea (the natural postpartum infertility that occurs when a woman is not menstruating due to breastfeeding). (Kramer & Kakuma, 2012)
  • Mom can more quickly lose extra “baby weight.”
    Mothers who exclusively breastfeed their babies for 6 months (compared to 4 months) have more rapid postpartum weight loss (Kramer & Kakuma, 2012).

Have you heard that foods should be introduced into the infant diet between 4 and 6 months to reduce the risk of developing allergy, celiac disease or type 1 diabetes mellitus?

The current evidence has been reviewed by several authorities, and the conclusion was that there is insufficient evidence to support the introduction of gluten (or other solid foods) into the infant diet before 6 months.

  • 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.
    “Although infants should still be managed individually so that insufficient growth or other adverse outcomes are not ignored and appropriate interventions are provided, the available evidence demonstrates no apparent risks in recommending, as a general policy, exclusive breastfeeding for the first six months of life in both developing and developed-country settings.”
  • American Academy of Pediatrics, Section on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 2012;129(3):e827-41.
    “Overall, there is an association between increased duration of breastfeeding and reduced risk of celiac disease when measured as the presence of celiac antibodies. The critical protective factor appears to be not the timing of the gluten exposure but the overlap of breastfeeding at the time of the initial gluten ingestion. Thus, gluten-containing foods should be introduced while the infant is receiving only breast milk and not infant formula or other bovine milk products.”
  • SACN/COT statement on the timing of the introduction of gluten into the infant diet – March 2011.
    SACN (Scientific Advisory Committee on Nutrition) and COT (Committee on Toxicity of Chemicals in Food, Consumer Products and the Environment) in the UK concluded: “Overall currently available evidence on the timing of introduction of gluten into the infant diet and subsequent risk of coeliac disease and T1DM (type 1 diabetes mellitus) is insufficient to support recommendations about the appropriate timing of introduction of gluten into the infant diet beyond 3 completed months of age, for either the general population or high-risk sub-populations.”
  • WHO Statement: Exclusive breastfeeding for six months best for babies everywhere (15 January 2011)
  • UNICEF UK response to media reports questioning the recommendation to introduce solid food to babies at 6 months (2011)
    “Ensuring that the mother is not anaemic and that cord cutting is delayed will in turn ensure that the baby’s own body stores and breastmilk will provide sufficient iron for over 6 months. The majority of the food commonly introduced to babies in the early months such as cereal, fruit and vegetables are low in iron and will therefore not help prevent IDA. However, if they are introduced before a baby needs them, they will displace breastmilk from the baby’s diet and may thereby reduce the amount of iron consumed.””The incidence of genuine food allergy (as opposed to food intolerance) is rare. There is speculation and some observational data that when there is a family history of true allergy then early introduction of certain foods may be beneficial. Random control trials are now being undertaken to test this theory. Should this prove to be the case (which is by no means certain) then high risk families would need to be advised on a case-by-case basis. This would not affect public policy as applied to the majority of children not affected by allergies.”
  • Is baby’s risk for type I diabetes increased if solids are introduced before 3 months or after 6 months? at KellyMom

Additional information & references

Comparisons between different lengths of exclusive breastfeeding: