Is my baby ready for solid foods?

August 2, 2011. Posted in: Solid Foods

What do the experts say?

Health experts and breastfeeding experts agree that it’s best to wait until your baby is around six months old before offering solid foods. The American Academy of Pediatrics, the World Health Organization, and many other health organizations recommend that babies be exclusively breastfed (no cereal, juice or other foods) for the first 6 months of life.  I’m not going into the many health benefits of delaying solids here; see When Should Baby Start Solids? for more information.

Developmental signs that baby is ready for solids

Solids readiness depends on both the maturity of baby’s digestive tract and baby’s developmental readiness for solids. Although the maturity of baby’s digestive system is not something that we can readily observe, research indicates that 6 months appears to be ideal for avoiding increased illness and other health risks of too-early solids. After this point, different babies are ready for solids at different times — developmental readiness for solids cannot be determined using a calendar. Most babies are developmentally ready for solids somewhere between 6 and 8 months.

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.

We often state that a sign of solids readiness is when baby exhibits a long-term increased demand to breastfeed (sometime around 6 months or later) that is unrelated to illness, teething pain, a change in routine or a growth spurt. However, it can be hard to judge whether baby’s increased breastfeeding is related to readiness for solids. Many 6-month-old babies are teething, growth spurting, beginning to experience separation anxiety, and experiencing many other developmental changes that can lead to increased breastfeeding – sometimes all at once! Make sure you look at all the signs of solids readiness as a whole, because increased breastfeeding alone is not likely to be an accurate guide to baby’s readiness.

More on developmental readiness…

In April 2001, a literature review (PDF) “of the developmental readiness of normal full term infants to progress from exclusive breastfeeding to the introduction of complementary foods” was jointly published by Wellstart International and the LINKAGES Project. Per the authors, “The review does not focus on health outcomes associated with discontinuing exclusive breastfeeding at a particular age but rather on the biologic/developmental readiness for this complex experience. Four processes or functions were selected for inclusion: gastrointestinal, immunologic, oral motor and the maternal reproductive processes that relate to the continuation of lactation and the provision of breastmilk.”
Following are some of the conclusions of this review:

  • “Thus, exclusive breastfeeding to about six months allows the infant to have greater immunologic protection and limit the exposure to pathogens at a vulnerable age. This in turn permits the energy and nutrients that might otherwise be diverted to provide for immunologic responses to be available and utilized for other growth and developmental processes.”
  • “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 6 and 8 months of age.”
  • “Using this available information on the development of oral motor function, maternal reproductive physiology and development of the infant’s immunologic and gastrointestinal function, the expert review team concluded that the probable age of readiness for most full term infants to discontinue exclusive breastfeeding and begin complementary foods appears to be near six months or perhaps a little beyond. The also felt that there is probable convergence of such readiness across the several relevant processes.”
  • “The consensus opinion of the expert review group was that given the available information and the lack of evidence of significant harm to either normal mothers or normal infants, there is no reason to conclude that exclusive breastfeeding should not continue to six months.”

What about starting solids AFTER 6 months? At what point does baby need nutrition from solids that cannot be provided by breastmilk alone?

Medical research tells us that exclusive breastfeeding allows babies to thrive for the first 6 months. In the words of the World Health Organization,

“Breastfeeding is an unequalled way of providing ideal food for the healthy growth and development of infants… A recent review of evidence has shown that, on a population basis, exclusive breastfeeding for 6 months is the optimal way of feeding infants.”

But what if baby is not very interested in solids at six months and you’d prefer to wait longer? Some babies do thrive on breastmilk alone until 9-12 months or later. You might hear people say, “Food before one is just for fun,” but perhaps this should be changed to “Food before one is mainly for fun.” As long as your baby is continuing to grow and develop as he should, your milk is meeting his needs well. Sometime after six months, however, babies will gradually begin to need more iron and zinc than that provided by breastmilk alone – at that point, additional nutrients can be obtained from small amounts of solids. Continue to watch your baby for signs that he is ready for solids and offer solids for him to try – baby can decide whether or not to eat them. No matter when baby begins solid foods, breastmilk should make up the majority of baby’s nutrition through the end of the first year.

What if my 4-5 month old seems developmentally ready for solids?

Four- to five-month-old babies are sometimes very eager to participate at mealtime, but it doesn’t necessarily mean that they are ready to eat solids – more often it’s just the normal developmental urge to do what everyone else is doing. Research studies tell us that there are many health advantages to delaying solids for about 6 months for all babies, not just the babies who are not yet interested in mealtime.

There are a number of things you can do to let baby participate in mealtimes without starting solids:

  • Let baby sit with the family at mealtime – in a lap, booster seat or high chair.
  • Give baby a cup of water or expressed milk. Your baby can entertain himself at mealtime while learning to use a cup. 1-3 ounces of water in the cup should be plenty (often for the entire day). Many moms choose to use only water or a small amount of breastmilk to avoid wasting the “liquid gold” while baby learns to use the cup.
  • Offer baby sips of water from your cup or straw. Even if baby hasn’t figured out how to use a straw yet, you can put your straw in water, block the top end of the straw with your finger to trap a little water in the straw, then let baby drink the water from the lower end of the straw (unblock the top end once it’s in baby’s mouth).
  • Offer baby spoons, cups, bowls and other baby-safe eating utensils to play with during mealtime.
  • Give baby an ice cube (if it’s a baby-safe size & shape) or ice chips to play with.
  • Offer baby a momsicle (popsicle made from breastmilk) or slushy frozen breastmilk to eat with a spoon.

Myths about solids readiness

There are many myths and outdated information regarding how to tell if baby is ready for solids.

MYTH: Baby’s weight has reached a “magic” number

Just because your baby achieves “x” number of pounds, or has doubled birth weight, (or however much your baby weighs) does not mean that she is automatically ready for solids – particularly if she is under 6 months.

The American Academy of Pediatrics/World Health Organization recommendations for starting solids at 6 months or later has no exceptions for babies who weigh more. The research that I’ve seen on the health benefits of starting solids at 6 months and later holds for all babies, no matter what their weight.

It’s the maturity of the digestive tract and baby’s developmental readiness that makes the difference, not baby’s weight.

 

It’s rather interesting to note that moms are told to start solids for both big and small babies. It’s not even uncommon to hear opposite arguments for both sides from the same person!

MYTH: “Your baby is big so you need to start solids.”

Moms might be told to start solids for differing reasons when they have a large baby.

Some are told that since baby is big, they won’t be able to produce enough milk to satisfy baby. This is quite untrue – almost all mothers have the ability to produce enough milk to exclusively breastfeed twins and even triplets. If you allow your baby to nurse on cue, your body will make enough milk for your baby. In addition, research tells us that exclusively breastfed babies do not increase the amount of milk they drink after the first 4 weeks or so – after the first month, milk intake stays constant (except for temporary appetite spurts) until sometime after six months when baby begins to eat more solid foods and decrease milk intake.

Other moms are told that baby is eating too much, so mom should reduce baby’s intake by limiting nursing and/or starting solids. There is absolutely NO evidence that a large breastfed baby will become a large child or adult, and limiting nursing can be quite dangerous for a baby. Read more here: Is my exclusively breastfed baby gaining too much weight?

MYTH: “Your baby is small so you need to start solids.”

Another reason often given for starting solids is because baby is small (see Normal Growth of Breastfed Babies). I really don’t see the sense in this. Ounce for ounce, breastmilk has more calories than most baby-safe solid foods and significantly more nutrients than any type of solid food that you can feed your baby. In addition, starting solids will quite possibly reduce the amount of milk that your baby is getting overall, rather than increase overall intake. One of the first recommendations for a baby who genuinely has slow weight gain is to decrease or eliminate solid foods and nurse more often.

MYTH: Baby needs to start solids because there is not enough iron in breastmilk.

An additional reason given for starting solids is the “lack of iron in breastmilk.” Breastmilk does have lower iron levels than formula, but the iron in breastmilk is more readily absorbed by the baby’s gut than the iron in formula. Also, formula-fed babies tend to lose iron through fissures that develop in their intestines as a result of damage from cow’s milk. Breastfed babies do not lose this iron. At some point after the first 6 months (later in the first year for a lot of babies), babies will require an additional source of iron other than mother’s milk. This can most often be obtained through small amounts of solid food. Read more on iron and the breastfed baby here: Is Iron Supplementation Necessary?.

MYTH: Baby needs solids so he will sleep longer at night.

The popular belief that feeding solids at night will help baby sleep through the night has no basis in fact. See Will giving formula or solids at night help baby to sleep better?

MYTH: If you don’t start solids by “x” months, then baby will have problems with solid foods

This is another myth that is not supported by research for normally developing, healthy babies. Keep reading for more on this…

Is there a “window of opportunity” for starting solids?

There is certainly a “window of opportunity” for starting solids, but this varies widely from baby to baby. At some point (usually around 6-8 months) baby will become developmentally ready to eat solid foods (able to sit up, chew, pick up food, etc.). At around the same age, the gastrointestinal tract is physiologically mature enough to handle a diversity of foods. At this point, most healthy babies will be ready and willing to eat (even if it’s only occasionally and in tiny amounts).

Occasionally, parents will be told that baby must start solids by 6 months (or 8 months, or 10 months) or baby will have problems learning to accept and eat foods that require chewing. This “limited window of opportunity” idea is widely believed, but unproven.

I’ve not been able to find any research data to support the idea that there is a limited window of opportunity for introducing solids in normally developing, healthy children. There does appear to be some limited evidence that babies who have been tube-fed long-term or have serious developmental delays may have problems learning to eat if they don’t get a chance to practice eating solids between 6 & 10 months. A small study involving case studies of several mentally delayed children was done back in 1964 (Illingworth RS, Lister J. The critical or sensitive period, with special reference to certain feeding problems in infants and children. J Pediatr 1964;65(6) part 1:839-48.). This study suggested that there may be a “critical and/or sensitive” period for introducing chewable textures to these children, and if solids are not introduced during this time, an important developmental milestone may be missed (possibly leading to rejection of solids later on). This study is the only one I’ve found referenced with regard to the “limited window of opportunity” claims regarding the normal development of children.

I asked a speech & language pathologist I know about her experiences with this. She has worked with many young children who have feeding problems, including developmental delays and problems with chewing and oral texture aversion. She said that she could not think of any reason that delaying solids would cause feeding problems, and said that the the problems in the children she had worked with had generally started at birth or relatively soon after. None of these children had a feeding problem caused by a delayed start to solid foods.

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