Trying to make sense of the “introducing solids” food fight can be tricky. When, why and which foods to give a baby in addition to milk is a decision all mothers face eventually. This is a surprisingly controversial topic among parents and health professionals due to conflicting advice within the available information.
Let’s look at WHEN to introduce “solids” – which means any foods in addition to milk feeds. Most major health authorities recommend that (ideally) all babies be exclusively breastfed (no cereal, juice or any other foods) for the first 6 months of life – World Health Organization UNICEF American Academy of Pediatrics American Academy of Family Physicians Australian National Health and Medical Research Council Health Canada . If exclusive breastfeeding is not possible, infant formula is the safest substitute milk for babies.
In contrast, some Child Health Nurses and doctors suggest introducing foods in addition to milk to babies from 4 months of age. This view reflects an article published in 2008 (1) which proposed babies whose families have food allergies may have reduced allergies if exposed to certain foods between the ages of 4 and 6 months. This proposal for a specific high risk group was questionably expanded by some health professionals to apply to the wider population of all babies. The current advice from the Australian Society of Clinical Immunology and Allergy (ASCIA) is based on similar research from 2008 and is out of line with more current World Health Organisation Guidelines.
The primary concern about giving babies food between four and 6 months of age is related to nature’s perfect design of baby’s gastrointestinal tract. A breastfed baby is protected from birth by antibodies (slgA) from breastmilk which coat the gut lining providing passive immunity and reducing the potential for pathogens (germs) to pass into the baby’s bloodstream. Formula-fed babies miss out on this protective coating and antibodies. The incidence of illness is significantly lower in breastfed babies, and some breastmilk in baby’s diet is better than none (2).
The baby’s natural “open gut” design has spaces between the cells of the small intestines so beneficial antibodies and nutrients in breastmilk pass readily, but it also means that large proteins from other foods can also pass into the baby’s bloodstream, potentially contributing to gut disturbances and allergic responses. The baby’s gut changes as he matures and around 6 months of age “gut closure” occurs, coinciding with baby starting to produce the protective antibodies on his own. The advice to commence foods other than milk around the age of 6 months is based on this fact – baby’s gut is now ready to safely process foods other than milk.
Gut closure is, of course, a microscopic event. Other evidence your baby is ready to experience foods include physical signs such as being able to sit up without support and having independent control of his head and neck. Baby should be able to reach for and hold food and put it in his mouth to taste and chew. When baby has lost the tongue-thrust reflex which pushes food out of the mouth and uses a thumb and forefinger pincer grasp to pick up items rather than palmer grasp – scraping food with the hand, baby is physically ready to experience food and all its wondrous textures and tastes.
WHY introduce other foods? From a nutritional perspective food before one is mainly for fun, however in the second half of baby’s first year iron stores are reducing and he will gradually require more iron and zinc than is provided by breastmilk alone. Infant formula has higher quantities of iron than breastmilk, but the iron in breastmilk is more readily and completely absorbed. Formula-fed babies can also develop fissures in their intestines and consequently lose iron.
WHICH foods to introduce when baby is ready? This is also a controversial topic – modern society is very focussed/obsessed about diet and passionately endorse many conflicting opinions regarding food choices. Regardless of which foods are chosen, it is important to remember solids should not replace breastfeeding or formula. These remain as the main source of nutrition for the first year of life, and a breastfeed or formula drink should be given prior to offering the complimentary food. The traditional starter food – bland rice cereal – has now been banished from baby’s menu. Here’s the reason why:https://www.youtube.com/watch?t=11&v=b-aP6nOvark
Foods can be introduced in any order, but foods which are high in iron should be included – minced meat or chicken, cooked fish, peas, broccoli and beans, lentils and tofu. You can mix first foods together as there is no need to introduce just one food at a time unless your family has a history of allergies. Other foods to offer include cooked potato, pumpkin, or carrot, apple, melon, avocado or banana, pasta, oats and bread and nut pastes. Dairy foods like yoghurt and full-fat cheese. Cooked egg custards are safe and cooked eggs can be given but not runny or raw eggs. Avoid adding salt or sugar to any of baby’s foods.
First foods can be offered in soft pieces for baby to pick up himself, or mashed, smoothed or pureed and fed by spoon. Start with small quantities – a couple of teaspoons of food, and gradually increase to 1-2 tablespoons according to your baby’s appetite and interest. Increasing the texture from smooth to mashed with soft pieces over a couple of weeks will help baby’s chewing and swallowing reflexes to adapt gradually. Parents worry about baby’s gag response to new tastes and textures however if the foods are soft and in small sections babies soon learn to spit out what is uncomfortable to swallow. Baby Led weaning guides parents how to miss the mush out of your baby’s food experience and move straight on to appropriately prepared family foods.
Offer baby water from a cup or sippy cup after eating food to rinse baby’s mouth. This is especially important for breastfed babies because the food particles in baby’s saliva can cause irritations to mother’s areola and nipple.
ASCIA advise there are no particular allergenic foods that need to be avoided. Recent studies suggest that avoiding allergenic foods does not appear to reduce allergies, and may even be associated with increased risk. Feeding babies solids too early (less than 4 months) or introducing foods too late (after 9 months) increases risks of developing food allergies. For more information about food preparation, feeding utensils and baby’s mealtime steps visit the Raising Children Network and enjoy this messy but fun part of parenting.
Lois Wattis RN, RM, FACM, IBCLC www.newbaby101.com.au