Joy Anderson AM, Dietitian, International Board Certified Lactation Consultant and Breastfeeding Counsellor.
Joy has a special interest in food intolerance and food allergy in babies.
The World Health Organization (WHO),1 the National Health and Medical Research Council (NHMRC)2 and ABA all currently recommend 6 months of exclusive breastfeeding and then the introduction of solids while breastfeeding continues. Exclusive breastfeeding means no other food or drink.
Many mothers find they get different advice about introducing solids from different sources.
There are two main questions:
1. What age should a baby start solids?
2. What foods should be offered and when?
With regard to allergies, we used to think we knew how to reduce the risk of allergy, that is, delay new foods until the baby was older and more mature. However, recent research studies have shown this to be incorrect. The number of children becoming allergic to foods has risen sharply in recent years in Western countries. Finding out what we are doing wrong has been the aim of recent and current research in several parts of the world, including Australia.
It is important to note there has been no good evidence to suggest there is any greater chance of allergy in babies not fed solids until 6 months compared to those who start solids at 4 or 5 months. Also, allergy is not the only consideration in timing of solids.3 There are also nutritional issues, risk of illness, risk of the baby receiving too little breastmilk and developmental readiness. Many people think that risk of illness from formula-feeding or dirty solids is only a problem in poor countries. However, there are many studies showing that breastfeeding protects babies from illness in Western countries as well.3 This supports keeping the timing for exclusive breastfeeding to around 6 months.
Therefore, Australian recommendations in the current (December 2012) Australian Infant Feeding Guidelines2 are to introduce solids at around 6 months of age.
Due to some inconsistent advice in the Australian community at the time, 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 included the following recommendations:4
- 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.
Guidelines with ages can only ever be approximate as babies develop at different rates. When your baby is ready for solids, they will show signs of readiness, which is a better guide for an individual baby. They will show a great interest in what you are eating, perhaps try to grab your food. They will have lost the tongue-thrust reflex that pushes food back out of the mouth, and they will be able to sit upright. These signs 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 in Australia, but these do not contain zinc. The best foods for these two minerals are meats and their vegetarian alternatives.
The old guidelines also recommended delaying allergenic foods, 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 UK5 and Australia6 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 begun, a variety of foods should be given, and the type and order do not matter. Research suggests that starting 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, keep breastfeeding as new foods are begun. Research suggests that this may reduce the risk of the baby developing allergies.2 It used to be thought that this also applied to coeliac disease.7 However, the latest evidence is that the way a baby is fed when gluten is begun does not affect this risk.8
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 need to avoid those foods. In many cases, their breastfeeding mother also has to avoid those foods, but in other cases, the foods do not seem to go through the milk.
There is insufficient evidence to advise pregnant women to avoid allergens to reduce the risk of allergy in the child.9 It is possible that eating allergenic foods during pregnancy could actually be protective.10.11
In answer to these questions:
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.
For more information
See ABA booklet Breastfeeding: and family foods
And website article Breastfeeding and family foods
Breastfeeding: and family foods booklet
Breastfeeding and Family Foods helps parents outline the process of introducing family foods to a baby.
1. World Health Organization 2014, Exclusive breastfeeding. http://www.who.int/nutrition/topics/exclusive_breastfeeding/en/index.html
2. National Health and Medical Research Council 2012, Infant Feeding Guidelines. Australian Government, Canberra. Available at https://nhmrc.gov.au/about-us/publications/infant-feeding-guidelines-information-health-workers
3. Anderson J, Malley K, Snell R 2009, Is 6 months still the best for exclusive breastfeeding and introduction of solids? A literature review with consideration to the risk of the development of allergies. Breastfeeding Review 17(2): 23–31.
4. Netting MJ, Campbell DE, Koplin JJ et al 2017, An Australian consensus in infant feeding guidelines to prevent food allergy: Outcomes from the Australian Infant Feeding Summit. J Allergy Clin Immunol Pract 5(6): 1617–1624.
5. Du Toit G, Roberts G, Sayre PH et al 2015, Randomized trial of peanut consumption in infants at risk for peanut allergy. New Engl J Med 372(9): 803–813. Available at http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4416404/
6. Koplin JJ, Osborne NJ, Wake M et al 2010, Can early introduction of egg prevent egg allergy in infants? A population-based study. J Allergy Clin Immunol 126(4): 807–813. Available at https://www.jacionline.org/article/S0091-6749(10)01173-5/fulltext
7. Ivarsson A, Hernell O, Stenlund H, Persson LA 2002, Breast-feeding protects against celiac disease. Am J Clin Nutr 75: 914–921. Available at http://www.ajcn.org/cgi/content/full/75/5/914
8. Szajewska H, Shamir R, Mearin ML et al 2016. Gluten introduction and the risk of coeliac disease. A position paper by the European Society for Paediatric Gastroenterology, Hepatology & Nutrition. J Paediatr Gastroenterol Nutr 62(3): 507–513.
9. Kramer MS, Kakuma R 2012. Maternal dietary antigen avoidance during pregnancy or lactation, or both, for preventing or treating atopic disease in the child. Cochrane Database Syst Rev Issue 9. Art. No.: CD000133. DOI: 10.1002/14651858.CD000133.pub3. Available at https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7045459/
10. Frazier AL, Camargo CA, Malspeis S, Willett WC, Young MC 2014. Prospective study of peripregnancy consumption of peanuts or tree nuts by mothers and the risk of peanut or tree nut allergy in their offspring. JAMA Pediatr 168(2): 156–162. Available at https://jamanetwork.com/journals/jamapediatrics/fullarticle/1793699
11. Tuokkola J, Luukkainen P, Tapanainen H et al 2016. Maternal diet during pregnancy and lactation and cow’s milk allergy in offspring. Eur J Clin Nutr 70(5): 554–559.
© Australian Breastfeeding Association
The information on this website does not replace advice from your health care providers.