Confused about introducing solids?

by Joy Anderson, Accredited Practising Dietitian, International Board Certified Lactation Consultant and Breastfeeding Counsellor.
Joy has a special interest in food intolerance and food allergy in babies.

Many mothers are confused about introducing solids as they get different advice from different authorities and health professionals. This article is designed to help explain why there is conflicting advice.

There are two questions:

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

2. What foods should be offered and when?

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.

In 2008, authorities in several Western countries3,4 recommended that solids should definitely not be introduced before 4 months and should be offered no later than 6 months. The Australian Society for Clinical Immunology and Allergy (ASCIA)5 has supported this and has influenced many health professionals’ recommendations in this country, which is why this is often still heard. The intention was not to mean the ‘right’ time to begin solids is 4 months, rather at some point in between these two ages, when the baby shows readiness. Unfortunately, some have incorrectly interpreted this as meaning all babies should start solids at 4 months.

With regard to allergies, scientists still don’t really know for sure what is the best time to introduce solids. We used to think delaying the introduction of new foods until the baby was older and more mature would reduce the risk of allergy. However, recent research has cast doubt on this. The number of children becoming allergic to foods has risen sharply in recent years in Western countries. Finding out what we are doing wrong is the aim of current research in several parts of the world, including the UK and Australia.

However, there has been no evidence that introducing solids at 4, versus 5, versus 6 months is any different in terms of allergy risk. In addition, it should be recognised that allergy is not the only consideration in timing of solids.6 Nutritional issues, risk of illness, risk of the baby receiving too little breastmilk and developmental readiness all need 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 too. 6 This supports keeping the timing for exclusive breastfeeding to 6 months.

Therefore, Australian recommendations in the current (Dec 2012) Australian Infant Feeding Guidelines2 are to introduce solids at around 6 months of age.

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 in Australia 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 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 have disproved this. It is now thought that once solids are introduced, a variety of foods should be given and the type and order do not matter. 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 and coeliac disease.2,7

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 makes no difference to the risk of allergy development in the child.8

In answer to these questions:

1. What age should a baby be introduced to solids?
Currently the WHO and NHMRC recommendation of 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

References

1.  World Health Organization 2014, Exclusive breastfeeding.

2.  National Health and Medical Research Council 2012, Infant Feeding Guidelines. Australian Government, Canberra. 

3.  ESPGHAN Committee on Nutrition: Agostoni C, Decsi T, Fewtrell M, Goulet O, Kolacek S, Koletzko B, Fleischer Michaelsen K, Moreno L, Punti J, Rigo J, Shamir R, Szajewska H, Turck D, van Goudoever J 2008, Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J Pediatr Gastroenterol Nutr 46(1): 99–110.

4.  Greer FR, Sicherer SH, Burks AW, the Committee on Nutrition and Section on Allergy and Immunology 2008, Effects of early nutritional interventions on the development of atopic disease in infants and children: the role of maternal dietary restriction, breastfeeding, timing of introduction of complementary foods, and hydrolysed formulas. Pediatrics 121(1): 183–191.

5. Australian Society of Clinical Immunology and Allergy 2011, Infant Feeding Advice.

6.  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.

7.  Ivarsson A, Hernell O, Stenlund H, Persson LA 2002, Breast-feeding protects against celiac disease. Am J Clin Nutr 75: 914–921.

8.  Australian Society of Clinical Immunology and Allergy 2010, Allergy Prevention Children.

© Australian Breastfeeding Association Reviewed January 2014