I'm not a pediatrician, a nutritionist, or a gastroenterologist. I'm a curious parent, probably just like you, who wanted to cut through the confusion and figure out when my baby should start solid foods, how much my baby should be eating and what he should be eating. I wanted to know if babies can eat citrus and why I should avoid feeding my baby honey. Because I have Celiac Disease, I especially wanted to know when I should feed my baby gluten, eggs and other allergens.
Because I'm a child development nerd, I wanted to look at the research behind the recommendations. I share what I've learned not as a suggestion of what you should or shouldn't do, merely to offer some "food for thought" as you decide what's right for your child.
This is the first part of a series on Starting Solid Foods. Subscribe to receive new posts in your inbox.
*When, possible, I used research published in large, highly respected peer-reviewed journals. I also attempted to find research that was available in full text when possible but to get your hands on full text for a few, you may have to visit your nearest university.
When Should I Start Feeding My Baby Solids?
While the previous recommendation was to begin solids at 4-6 months, the general consensus in the medical community now appears to be that the best time to introduce solids is around 6 months. The research seems to support the idea that gross motor (head control and sitting) and oral motor readiness for eating coincides with intestinal and immunological readiness.
- A comprehensive review of literature related to immunology, gastroenterology, oral motor function and maternal reproductive function concluded that "near 6 months or perhaps a little beyond" is likely the age that full-term babies are ready to begin complementary foods.
- The most specific recommendations I found were in a position paper published in The Journal of Pediatric Gastroenterology and Nutrition in 2008, which recommended complementary feeding begin after 17 weeks but before 26 weeks of age ( 3.9 months and 5.9 months). They conclude that the gut and kidneys of a baby are ready to metabolize solids at 4 months but acknowledge that motor skill readiness for feeding is acquired on a broader range of ages.
- A VERY frequently cited study that I was unable to get my hands on the full-text or abstract of (1) indicates that lumpy or textured foods should be introduced by 10 months to avoid later feeding difficulties. Anecdotally, in my years treating infant, toddler and childhood feeding problems, more than half of the children I treated for sensory-based feeding aversions (avoiding certain textures of foods) had solids introduced at or later than 8 months of age. I'm uncertain of when "lumpy" foods were introduced but one could presume it would have been some time after 8 months and might likely have been closer to or after 10 months.
- The World Health Organization recommends introducing complementary foods at 6 months of age, citing studies that report introducing foods before 6 months often reduces an infant's intake of breastmilk. They offer impressive free booklets, Guiding Principles For Complementary Feeding of the Breastfed Child and Guiding Principles For Feeding Non-Breastfed Children 6-24 Months of Age. The WHO is reported to be heavily biased toward supporting breastfeeding as the ultimate consideration of when to start solids and much of their research is in developing nations. WHO considers infant formula a complementary food.
- The American Academy of Pediatrics recommends initiating solids at "around 6 months" and relies primarily on growth and motor milestones as signs of readiness for solid foods - good head control, sitting with some support, doubled birth weight or a minimum of 13 pounds, and becoming interested in food (watching others eat or reaching for food)
- The Academy of Nutrition and Dietetics recommends 4-6 months as the ideal for initiating solid foods. They do, however, recommend consulting with your child's pediatrician.
- Several studies indicate that babies who had complimentary foods added to their diets at 4 months showed no significant difference in growth than babies who were exclusively breastfed until 6 months of age. In one study, the group who started solids at 4 months did have higher blood iron levels but no difference in rates of anemia.
*Northstone K, Emmett P, Nethersole F, and the ALSPAC Study Team. The effect of age of introduction to lumpy solids on foods eaten and reported feeding difficulties at 6 and 15 months. J Hum Nutr Dietet, 2001, 14:43 - 54.
My pediatrician told me to start solid foods at 4 months.
Based on comments on the CanDo Kiddo Facebook page, I'm not alone in my experience of being urged at my baby's 4 month well child visit to begin solids. It's confusing and disconcerting when your doctor is telling you to do something that you've heard is outdated advice. I think as parents we have several options.
I would recommend asking your doctor specifically what about your child's health or development leads them to believe that they should begin solids earlier than is currently recommended. There may be extenuating circumstances or cases that might merit beginning solids before 6 months and your doctor should be willing to share those with you.
As parents, we are entitled to make our own informed decisions about our child's nutrition.
What Growth Chart is your pediatrician using?
Did you know there are two widely used growth charts in the US? The Centers for Disease Control and Prevention and the World Health Organization publish different growth charts. But the CDC recommends using the WHO growth charts from birth to 2 years of age. Even though the CDC has their own chart for 0-2. I know - confusing! The American Academy of Pediatrics supports the use of the WHO charts until 2.
For comparison, at his 4 month appointment, our baby was in the 83rd %ile for weight on the CDC charts and 76th %ile on the WHO charts. If your pediatrician expresses concern about your child's growth, be sure to clarify which growth chart is being used.
What we did.
I share our family's decision not because I feel it's the best, but because as a mom I often want to know what other parents did so that I can explore the full range of different options.
Our pediatrician had concerns that our son's growth rate had slowed. I didn't share those concerns. [He had dropped from the high 80th percentiles to the high 70's since his 2 month appointment. But he had doubled his birth weight plus 2 pounds by 4 months and was still gaining well over a pound a month.] I also didn't feel that adding solids was the most effective way to increase his caloric intake (research backs up this feeling). At 4 months he required a lot of support for sitting and sat at the dinner table with us with no interest in our food. I made some efforts to increase his intake of breastmilk, but without stressing about it.
By 5 months, he was sitting independently, lunging for our spoons and screamed at me as I ate a bowl of ice cream. So we started solids at 22 weeks. I had planned on starting at 6 months but adjusted based on my baby's signals.
How Sleep and Play Positions Relate To Feeding
Research indicates that sleeping on the back is related to slower gross motor development in babies. At 6 months of age, only 22% of babies studied who slept on their backs were independently sitting (as compared to the 50% expected by the researchers). YOU SHOULD ALWAYS PUT YOUR BABY TO SLEEP ON HIS or HER BACK. But it's important to keep in mind that by using independent sitting as a sign of readiness for eating solids, we may be seeing a shift toward later introduction of solids since the Back To Sleep/Safe to Sleep recommendation started in 1994.
Tummy Time has been shown to promote independent sitting and other gross motor milestones. So we should add "helping to prepare your baby to eat solids" to the super long list of ways that Tummy Time affects development.
Based on what I read, babies' bodies may not be ready to digest and metabolize solid foods before 4 months. There weren't any negative effects that I found to starting solids between 4 and 6 months and the recommendation of 6 months appears to be based on supporting and continuing breastfeeding until 6 months. There doesn't appear to be any NEED to start solids before 6 months and many babies aren't yet showing physical signs of readiness for solids before 6 months.
Your baby's doctor is a valuable resource and should always be consulted. Based on your child's individual signs of readiness, developmental and feeding history, and your doctor's advice, you make the decision that feels right for your baby.
This is, of course, not all the research or information out there on the topic. I'd love to hear what you've found helpful and to share those resources and perspectives with other parents. What resources - books, articles, suggestions - did you use to help you decide when to start solids? Share in the comments below.
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