Why Delay Solids?
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
- US Department of Health & Human Services
- American Academy of Pediatrics
- American Academy of Family Physicians
- American Dietetic Association
- Australian National Health and Medical Research Council
- Royal Australian College of General Practitioners
- 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.
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 and Risks of Artificial Feeding). - 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 and Risks of Artificial Feeding). 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
Is my baby ready for solid foods?
- What do the experts say?
- Developmental signs that baby is ready for solids
- At what point does baby
need nutrition from solids
that cannot be provided by breastmilk alone? - What if my 4-5 month old seems developmentally ready for solids?
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. Some doctors may recommend delaying solids for the first year if there is a family history of allergies. I'm not going into the many health benefits of delaying solids here; see Why Delay Solids? for more information.
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 the allergies 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 nurse (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 nursing is related to readiness for solids. Many (if not most) 6-month-old babies are teething, growth spurting and experiencing many developmental changes that can lead to increased nursing – sometimes all at once! Make sure you look at all the signs of solids readiness as a whole, because increased nursing alone is not likely to be an accurate guide to baby’s readiness.
More on developmental readiness...
In April 2001, a literature
review (
)
"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."
Medical research tells us that exclusive breastfeeding allows babies to thrive for the first 6 months and often beyond. 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.”
Breastmilk should make up the majority of baby’s nutrition through the end of the first year. At some point toward the end of the first year, most 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.
Some babies thrive on breastmilk alone until 12 months or later - as long as your baby is continuing to gain weight and grow as he should, your milk is meeting his needs well.
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.
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" numberJust 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. 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. Sometime after the first 6 months (much later for a lot of babies), most 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 foodsThis 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 retarded 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.
So, in summary, the biological signs of readiness are the ability to sit by one's self, having teeth to chew, ability to put food into their own mouth intentionally, having no tongue thrust reflex...
Solids in the FIRST YEAR are solely for practice. Your baby should not rely on nutrition from solids in the first year. If they reduce the amount they're nursing when fed solids, you need to reduce the solids fed. Introduce foods slowly, and know if when you first start, and your baby has a reaction, it takes TWO WEEKS of solid breastfeeding-only to fix the gut.
There's no rush. Figure that your baby can live to be 100. By waiting a few MONTHS, you can severely alter, for better or worse, the quality of their life.
Of course you can post it! You'll get people who are pissed (mostly because their reasons were just debunked!), but hopefully some people learn. :)
(Oh, you asked if I could... yeah, I will when I get back from the store.)
Seriously, I've been called a bitch soooooo many times just by posting info, it doesn't bug me anymore.
So far, so good, in both "birth groups" except for one women who says,"Come ON, people put cereal in bottles. There's no reason I can't feed my 4 month old."
I wanted to yell, "All the reasons not to are RIGHT INFRONT OF YOUR FACE!"
Tommy is almost 7 months old and has had a nibble here and there. He is SOOO interested in food, I have never seen a baby as curious about food as him, but he still does the tongue thrust thing, so even when I try to give him a pinch of something he just shoves it right back out. It's like he wants to learn but doesn't know what to do. I'm not in any hurry to give him 'real' food though. For me, it's actually more of a hassle to sit and try and spoon feed him right now than to just hook him up to the jugs lol
I haven't started solids yet and Miikka is 6 months old this week. I know daycare has started asking but I told them no, I'm using the excuse for now that he hasn't doubled his birthweight. They won't understand anything else I tell them, in fact I'm not sure they understood that part, they do understand no though. Fortunatly I don't have anyone around to push it so he just nurses. I think he still has his tongue thrust reflex right now too, I haven't given him anything. He is constantly trying to get my food though. Once I do start solids, I'm just going to make my own. I've gone this far with natural methods, I'll stick with it. He doesn't like bottles though and he hasn't figured out sippy cups either. He has some time. Thanks for all the info cause I needed some more info to keep delaying. I know I haven't really delayed, he's only six months, lol but to delay further.
Question of the Day 11/12/10
- RanaAurora
on Nov. 11, 2009 at 12:59 PM