Introducing Solids


 

The World Health Organisation (WHO), currently recommend 6 months of exclusive breastfeeding and then the introduction of solids while breastfeeding continues. Exclusive breastfeeding means no other food or drink.

 

It is important to note there has been no good evidence to suggest there is any greater incidence of allergy in babies not fed solids until 6 months compared to those who are introduced to solids at 4 or 5 months. In addition, it should be recognised that allergy is not the only consideration in timing of solids. There are also nutritional issues, risk of illness, risk of the baby receiving too little breastmilk and developmental readiness to be considered. Many people think that risk of illness from formula-feeding or dirty solids is only a significant problem in poor countries. However, there are many studies showing that breastfeeding protects babies from illness in Western countries as well. This supports keeping the timing for exclusive breastfeeding to around 6 months.

Therefore, current recommendations are to introduce solids at around 6 months of age.

An Infant Feeding Summit hosted by the Centre for Food and Allergy Research was held in May 2016. A consensus agreement, supported by published evidence, was accepted at this Summit and the following recommendations were:

  • When your infant is ready, at around 6 months, but not before 4 months, start to introduce a variety of solid foods, starting with iron rich foods, while continuing breastfeeding.

  • All infants should be given allergenic solid foods including peanut butter, cooked egg and dairy and wheat products in the first year of life. This includes infants at high risk of allergy.

  • Hydrolysed (partially and extensively) infant formula is not recommended for prevention of allergic disease.

    The Australian Society for Clinical Immunology and Allergy (ASCIA) has a web page on Infant feeding and allergy prevention to reflect these recommendations and this provides a good summary of the topic overall.

    Guidelines with ages can only ever be approximate as babies develop at different rates. When your baby is ready for solids, he will show signs of readiness, which is a better guide for an individual baby – he will show a great interest in what you are eating, perhaps try to grab your food; he will have lost the tongue-thrust reflex that pushes food back out of the mouth; and he will be able to sit upright. These tend to occur at around 6 months of age, with some a little earlier and others a little later.

    Iron and zinc are two minerals needed from solids from about 6 months onwards but this varies between babies. Because we don’t know which babies are in most need, we usually aim to start giving all babies solids containing these minerals from this age. Iron-fortified cereals are often used  but these do not contain zinc. The best foods for these two minerals are meats and their vegetarian alternatives.

    The older guidelines also recommended delaying introduction of certain foods that are considered particularly allergenic, such as cows’ milk, nuts, wheat, soy, egg and fish, which was thought to reduce the risk of allergy to these foods by allowing the baby’s system to mature. However, recent population studies and some large controlled trials carried out in the UK5and Australia have disproved this, for peanuts and egg respectively. This change is also reflected in the recommendations listed above.

    It is now recommended that once solids are introduced, a variety of foods should be given and the type and order do not matter. Research suggests that introducing the most allergenic foods (as mentioned above) by about 10–12 months of age is associated with a reduced risk of allergy developing. A gap of 2–3 days between each new food should be enough, in case there is some reaction.

    Regardless of the age your baby starts solids, it is recommended that breastfeeding continue during the process of introducing new foods. Research suggests that this may reduce the risk of the baby developing allergies. It used to be thought that this also applied to coeliac disease, however, the latest evidence is that whether a baby is being breastfed at the time of gluten introduction or not does not affect this risk.

    Note that parents with a baby who has symptoms of allergy already should seek advice from a health professional about introducing solids.

    If a baby or child already has a food allergy, they and their breastfeeding mother usually need to avoid those foods. Also, studies have shown that avoiding allergens during pregnancy does not reduce the risk of allergy development in the child.

In summary:

 

1. What age should a baby be introduced to solids?

Currently the WHO and NHMRC recommendation of around 6 months for introduction of solids is current and backed up by research.

2. What foods should be offered and when?

A wide variety of foods when the baby shows readiness, starting at about 6 months.

Reference:

https://www.breastfeeding.asn.au/bf-info/weaning-and-introducing-solids/solidsconfusion