Why Delay Solids?

• Reasons for delaying solids
• Additional information
• References

Health experts and breastfeeding experts agree that it’s best to wait until your baby is around six months old before offering solid foods. There has been a large amount of research on this in the recent past, and most health organizations have updated their recommendations to agree with current research. Unfortunately, many health care providers are not up to date in what they’re telling parents, and many, many books are not up to date.

The following organizations 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):

• World Health Organization
• UNICEF
• American Academy of Pediatrics
• American Academy of Family Physicians
• Australian National Health and Medical Research Council
• Health Canada

Most babies will become developmentally and physiologically ready to eat solids by 6-9 months of age. For some babies, delaying solids longer than six months can be a good thing; for example, some doctors may recommend delaying solids for 12 months if there is a family history of allergies.

Reasons for delaying solids

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

• Delaying solids gives baby greater protection from illness.
  Although babies continue to receive many immunities from breastmilk for as long as they nurse, the greatest immunity occurs while a baby is exclusively breastfed. Breastmilk contains 50+ known immune factors, and probably many more that are still unknown. One study has shown that babies who were exclusively breastfed for 4+ months had 40% fewer ear infections than breastfed babies whose diets were supplemented with other foods. The probability of respiratory illness occurring at any time during childhood is significantly reduced if the child is fed exclusively breast milk for at least 15 weeks and no solid foods are introduced during this time. (Wilson, 1998) Many other studies have also linked the degree of exclusivity of breastfeeding to enhanced health benefits (see Immune factors in human milk).
• Delaying solids gives baby’s digestive system time to mature.
  If 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.). Protein digestion is incomplete in infancy. Gastric acid and pepsin are secreted at birth and increase toward adult values over the following 3 to 4 months. The pancreatic enzyme amylase does not reach adequate levels for digestion of starches until around 6 months, and carbohydrate enzymes such as maltase, isomaltase, and sucrase do not reach adult levels until around 7 months. Young infants also have low levels of lipase and bile salts, so fat digestion does not reach adult levels until 6-9 months.
• Delaying solids decreases the risk of food allergies.
  It is well documented that prolonged exclusive breastfeeding results in a lower incidence of food allergies (see Allergy References). 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. See How Breast Milk Protects Newborns and The Case for the Virgin Gut for more on this subject.
• Delaying solids helps to protect baby 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. Healthy, full-term infants who are breastfed exclusively for periods of 6-9 months have been shown to maintain normal hemoglobin values and normal iron stores. In one study (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.
  
• Delaying solids helps to protect baby from future obesity.
  The early introduction of solids is associated with increased body fat and weight in childhood. (for example, see Wilson 1998, von Kries 1999, Kalies 2005)
• Delaying solids helps mom to maintain her milk supply.
  Studies have shown that for a young baby solids replace milk in a baby’s diet – they do not add to baby’s total intake. 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.
• Delaying solids helps to space babies.
  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.
• Delaying solids makes starting solids easier.
  Babies who start solids later can feed themselves and are not as likely to have allergic reactions to foods.

Additional information

• Solid Foods and the Breastfed Baby at this website
• Is Iron-Supplementation Necessary? at this website
• When will baby be ready for solid foods? at this website
• Solid Food: Best Delayed by Becky Flora, IBCLC
•  Supplementation of the Breastfed Baby: “Just One Bottle Won’t Hurt”—or Will It? by Marsha Walker, RN, IBCLC
• The Case for the Virgin Gut: Even the Occasional Bottle of Formula Has Its Risks by Ann Calandro, RNC, IBCLC
• Breast-Milk: The White Blood by Arlene Jacobs
• WHO Resources on Child Nutrition

References

•  WHO: Guiding principles for complementary feeding of the breastfed child
• WHO: Feeding the non-breastfed child 6-24 months of age (March 2004)
•  WHO: Complementary feeding: report of the global consultation, and summary of guiding principles for complementary feeding of the breastfed child. (2002)
•  WHO: The Optimal Duration of Exclusive Breastfeeding: A Systematic Review WHO/NHD/01.08 (2002)
•  WHO Global strategy for infant and young child feeding: the optimal duration of exclusive breastfeeding A54/INF.DOC./4 (1 May 2001)
•  Developmental Readiness of Normal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction of Complementary Foods: Reviews of the Relevant Literature Concerning Infant Gastrointestinal, Immunologic, Oral Motor and Maternal Reproductive and Lactational Development (April 2001), Audrey J. Naylor, MD, DrPH and Ardythe L Morrow, PhD, Editors.
•  WHO: The Optimal Duration of Exclusive Breastfeeding: Report of an Expert Consultation WHO/FCH/CAH/01.24 (28-30 March 2001)
• Chantry CJ, Howard CR, Auinger P. Full breastfeeding duration and associated decrease in respiratory tract infection in US children. Pediatrics. 2006 Feb;117(2):425-32.
• Optimal duration of exclusive breast feeding in low income countries (editorial). Black RE and Victora CG. BMJ 2002 (30 November);325:1252-1253.
• Rethinking current recommendations to introduce solid food between four and six months to exclusively breastfeeding infants. Borresen, HC. J Hum Lact 1995 Sep;11(3):201-4.
• How Breast Milk Protects Newborns by Jack Newman, MD
• Protective nutrients and bacterial colonization in the immature human gut (abstract)
• The Bacterial Flora of Humans by Kenneth Todar, PhD

  “At birth the entire intestinal tract is sterile, but bacteria enter with the first feed. The initial colonizing bacteria vary with the food source of the infant. In breast-fed infants bifidobacteria account for more than 90% of the total intestinal bacteria. Enterobacteriaceae and enterococci are regularly present, but in low proportions, while bacteroides, staphylococci, lactobacilli and clostridia are practically absent. In bottle-fed infants, bifidobacteria are not predominant. When breast-fed infants are switched to a diet of cow’s milk or solid food, bifidobacteria are progressively joined by enterics, bacteroides, enterococci lactobacilli and clostridia. Apparently, human milk contains a growth factor that enriches for growth of bifidobacteria, and these bacteria play an important role in preventing colonization of the infant intestinal tract by non indigenous or pathogenic species.”

• Mohrbacher, N. and Stock, J. BREASTFEEDING ANSWER BOOK. Schaumburg, Illinois, USA; La Leche League International 1997.
• American Academy of Pediatrics, Work Group on Breastfeeding. Breastfeeding and the Use of Human Milk. Pediatrics. 1997;100(6):1035
• Pisacane A, et al. Iron status in breast-fed infants. J Pediatr 1995 Sep;127(3):429-31.
• Sleisenger & Fordtran. Gastrointestinal and Liver Disease, 6th ed. W. B. Saunders Company (1998): p. 1495-1497.

Comparisons between different lengths of exclusive breastfeeding:

• Kramer MS, Kakuma R. The optimal duration of exclusive breastfeeding: a systematic review. Adv Exp Med Biol. 2004;554:63-77.
  From the abstract: Infants who are breastfed exclusively for 6 months experience less morbidity from gastrointestinal tract infection than infants who were mixed breastfed as of 3 or 4 months of age. No deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for 6 months or longer. Moreover, the mothers of such infants have more prolonged lactational amenorrhea and faster postpartum weight loss. Based on the results of this review, the World Health Assembly adopted a resolution to recommend exclusive breastfeeding for 6 months to its member countries.
• Onayade AA, Abiona TC, Abayomi IO, Makanjuola RO. The first six month growth and illness of exclusively and non-exclusively breast-fed infants in Nigeria. East Afr Med J. 2004 Mar;81(3):146-53.
  CONCLUSION: It is concluded that exclusive breast-feeding supported adequate growth during the first six months of life for most of the infants studied. Early introduction of complementary foods did not provide any advantages in terms of weight gain in our environment, it was frequently associated with illness episodes and growth faltering. Many mothers however require support, encouragement and access to health care providers to breastfeed exclusively for the first six months of life.
• Kramer MS, et al. Infant growth and health outcomes associated with 3 compared with 6 mo of exclusive breastfeeding. Am J Clin Nutr. 2003 Aug;78(2):291-5.
  CONCLUSIONS: Exclusive breastfeeding for 6 mo is associated with a lower risk of gastrointestinal infection and no demonstrable adverse health effects in the first year of life.
•  WHO: The optimal duration of exclusive breastfeeding. A systematic review
  WHO/FCH/CAH/01.23 (2002)
  (compares introduction of solids at 3-4 months vs 6 months)
• Kramer MS, Kakuma R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst Rev. 2002;(1):CD003517.
  (compares introduction of solids at 3-4 months vs 6 months)
  From the reviewer’s conclusions: “Infants who are exclusively breastfed for six months experience less morbidity from gastrointestinal infection than those who are mixed breastfed as of three or four months, and no deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for six months or longer. Moreover, the mothers of such infants have more prolonged lactational amenorrhea.”
• Dewey KG, Cohen RJ, Brown KH, Rivera LL. Effects of exclusive breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Honduras. J Nutr. 2001 Feb;131(2):262-7.
• Hop LT, Gross R, Giay T, Sastroamidjojo S, Schultink W, Lang NT. Premature complementary feeding is associated with poorer growth of vietnamese children. J Nutr. 2000 Nov;130(11):2683-90.
  (mainly compares introduction of solids before/after 3 mo)
• Wilson AC, et al. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 1998 January;316:21-25. (compares introduction of solids before/after 15 weeks)