4 Signs Your Baby Is Ready for Solid Foods

My last post went into great detail about the research on age of starting solids and health outcomes, including nutrition, growth, illness, and allergies. If you read that post, you know that there are small risks and benefits of starting earlier or later (in the range of 4-6 months), but there’s no evidence for an optimal age of starting solids for all babies. Here’s what to look for instead, starting with a brief summary of the data on age:

1. Your baby is at least 4 months of age.

Read my post on this if you want to know the details and see the references. If not, here’s a summary:

  • There is good evidence that it’s best to wait until at least 4 months of age to start solids, unless advised otherwise by a doctor for a specific medical reason.
  • Starting solids between 4 and 6 months of age may give babies a boost in iron nutrition, assuming they’re getting some good dietary sources of iron. Exposure to potentially allergenic foods, such as wheat and eggs, by about 6 months may reduce the risk of allergy to those foods.
  • Exclusive breastfeeding until 6 months of age may reduce your baby’s risk of minor gastrointestinal infections, although this isn’t shown in all studies. For moms, it may also result in greater weight loss and prolonged lactational amenorrhea.

Whether or not you start solids at 4 months, 6 months, or somewhere in between is up to you and your baby. The research on this topic is still evolving, and either is a fine choice. In fact, given that babies develop at different rates, it seems unlikely that all babies would be ready to start solids the moment the clock strikes midnight on their 4-month birthday or 6-month birthday.

This was the same sentiment eloquently expressed in a 2009 editorial by British pediatrician Martin Ward Platt, using the term “weaning” to mean starting solid foods:

“The weaning debate has been largely predicated on the notion that there is some magic age at which, or from which, it is in some sense ‘‘safe’’ or ‘‘optimal’’ to introduce solids. Yet it is highly counterintuitive that such an age exists. In what other area of developmental biology is there any such rigid age threshold for anything? We all recognize that age thresholds are legal inventions to create workable rules and definitions, and have no meaning in physiology or development, yet when we talk about weaning we seem to forget this.”1

Given this, it’s really up to you to follow your baby’s lead, watching for the developmental signs discussed in the rest of this post.

2. Your baby can sit upright and hold his head up straight.

These gross motor skills signal that your baby has the core body strength and stability needed to eat solid foods. Pediatric feeding specialist and certified speech language pathologist Melanie Potock explained why this is so important on my Facebook page:

“Gross motor stability (in this case trunk stability) provides the support for fine motor skills. It’s very hard to learn to eat purees off a spoon or do any sort of self-feeding of soft solids if the trunk is not supported. Try it yourself by letting your trunk relax and fall into the back of your dining chair, slightly slumped. Now stay that way and try to bite, chew and swallow. Imagine if you were just learning to eat this way!”

[I’m thrilled that Melanie Potock wrote a guest post explaining more about why stability is so important and how to best seat your baby comfortably at the table here: S.I.T.! Feeding Your Child Using Stability and Independence at the Table]

In other words, when babies have gross motor stability in place, they’ll have a much easier time with the fine motor and oral motor skills needed for feeding. That means that baby should be able to sit comfortably upright, on his own or with a little support, and hold his head up to face you. In one study, babies were able to sit in a caregiver’s lap without help at 5.5 months, on average, but this milestone was quite variable (standard deviation of 2 months).2

Trunk stability is also important because it allows you and your baby to be able to be face-to-face during feeding and for your baby to be an active participant in deciding whether, how much, and how fast to eat. You offer baby a bite, and he leans forward and opens his mouth if he’d like to accept, or he turns his head away to say no thanks. With good trunk stability, a baby can communicate his wants and needs to you, and you can be responsive to them. This way, feeding becomes a respectful and pleasant conversation between the two of you.3

Feed your baby responsively, watching for his cues of wanting more or being done, like a back-and-forth conversation.

3. Your baby has the oral motor skills to handle solid foods.

At birth, most babies are already skilled at sucking. Sucking is an involuntary reflex that develops around 32 weeks of gestation, and babies practice it in utero before birth. Sucking gives them the skill to efficiently transfer milk through a nipple, whether from breast or bottle.

To eat from a spoon, a baby needs a different set of oral motor skills. Continue reading

Starting Solids: 4 Months, 6 Months, or Somewhere In Between?

Science of Mom reader Roxanne left a comment on my post about the recent peanut allergy study. She wondered about starting solid foods with her 4-month-old baby boy:

“Do you have an opinion on starting solids at 4 months versus 6 months? I noticed that many of the studies on allergy include babies in the 4-6 month range, but I think that the current recommendation is to wait until 6 months. I ask because my baby WILL NOT drink out of a bottle while I’m at work. He is miserable all day. I’m only gone 8-3 including travel time, so if he could just get a little something at 11am, I think he might actually nap and not cry all day. We have tried everything. If you know of any studies please let me know. He is 18 weeks old.”

I totally understand Roxanne’s confusion, because there’s lots of conflicting advice on this topic. This is a question that I tackled in-depth in my book (due out in July!), but I wanted to offer some of this information on my blog as well.

Let’s start by getting our terminology straight.

Starting solids is just the beginning of a slow transition from an exclusive milk diet to a diet of table foods. In some countries, this is also called “weaning,” which is confusing since the same term means stopping milk feeding in the U.S. (i.e. weaning from breastfeeding, weaning from a bottle). “Complementary feeding” is often used in the research and public health worlds. This is an apt term, because the goal with feeding solids to babies is to complement breast milk or formula, which will continue to provide most of babies’ calories through at least the end of the first year.

Should you give your baby solid foods at 4 months, 6 months, or somewhere in between? The research on this question is complex.

Should you give your baby solid foods at 4 months, 6 months, or somewhere in between? The research on this question is complex.

What is the history of starting solids?

There is a common assumption that longer exclusive breastfeeding – and longer delay in starting solids foods – must be more natural, and hence, healthier. But looking at traditional human cultures, with no access to commercial baby food, modern pediatricians, or divisive Internet forums, can give us valuable perspective on what is “natural.” A survey of childbirth and breastfeeding practices in 186 non-industrial cultures reported that solid foods were routinely introduced before 6 months, a finding that surprised the author:

“Contrary to the expectation of a prolonged period of breast-milk as the sole source of infant nutrition, solid foods were introduced before one month of age in one-third of the cultures, at between one and six months in another third, and was postponed more than six months for only one-third.”1

A more recent cross-cultural analysis of 113 nonindustrial populations from around the world found that parenting introduced solid foods before 6 months in more than half, with 5-6 months being the most common time for introduction.2

Human diets and infant care practices vary tremendously around the world, so it’s impossible to say if starting solids at 4 months or 6 months is more natural. As to which is healthier – well, that’s where we need to look at the science.

What is the official advice about starting solid foods?

Public health and professional organizations fall into two camps when it comes to recommendations about solids foods: they either recommend starting between 4 and 6 months OR at 6 months. There are well-respected organizations on both sides. Continue reading

My Book – The Science of Mom – is Available for Pre-order!

UPDATE – June 2015 – The publication date of my book has moved around a bit. I now expect it to be available in mid-August. You can still pre-order the book on Amazon.

_____

Imagine my surprise when, last week, my editor at Johns Hopkins Press emailed me to ask that I check over the Amazon page for my book. What? There’s an Amazon page?! As far as I knew, my book wasn’t coming out until the fall. I did a search for my name and book title on Amazon, that great vault of hundreds of thousands of books, this is what I found:

Screen Shot 2015-04-20 at 8.18.02 PM

(This is an affiliate link, so if you order my book through this link, I’ll get a little added commission. Thank you!)

I guess this is really happening, dear readers! And it’s happening sooner than I thought. The book will be released on July 2, and it’s available for pre-order now!

science of mom cover

(Affiliate link)

This is super exciting but also terrifying at the same time. It means that some people might actually read my book. They might like it or they might not, and that’s just the way it is. I hope you read it and like it, though. I would not have had the motivation or courage to write this book if not for all of you – smart people who read my blog and comment on it. You showed me that there are other parents out there, like me, who are curious and want to know more about the science of parenting. You showed me that tone matters – that if we are going to communicate and support each other, we have to start from a place of respect for each other. You showed me that our stories matter, and that nuance is important. As I dug into the science of parenting decisions, I found examples where science gives us a clear course of action but just as many where the science is so murky that we are left to follow our hearts, well-informed as they may be, and hope for the best.

Another surprise when I scanned through my book’s Amazon page for the first time was the reviews. I hadn’t seen these yet, and they brought tears to my eyes. What I was trying to do with this book came through to these readers, and that made me so happy. Here’s what several wonderful folks had to say about my book:

Finally, someone has brought some science—and some sense—to the mommy wars. Should be required reading for all new (and old) parents. 

~Emily Oster, Brown University, author of Expecting Better: Why the Conventional Pregnancy Wisdom Is Wrong—And What You Really Need to Know

Alice Callahan has written a breakthrough book, combining the compassion, warmth, and angst of a mother with the measured reasoning of a scientist. She helps parents not only understand how science works, but how they can access that science to answer their questions. She’s found a way to access the scientist in all of us.

~Paul A. Offit, MD, The Children’s Hospital of Philadelphia

Yes! An easy-to-read, fascinating, nuanced review of the science behind new parents’ biggest health questions. Many of these issues—infant sleep, breastfeeding, vaccines—have or will hit your ‘Should I panic?’ button. With gentle guidance, Alice Callahan puts your fears to rest.

~Tracy Cutchlow, author of Zero to Five: 70 Essential Parenting Tips Based on Science (and What I’ve Learned So Far)

Too many of today’s parents treat science as a weapon, using it to justify some choices and condemn others. Yet, most don’t fully understand what science can and cannot tell us. By giving parents a comprehensive understanding of how science relates to parenting, Alice Callahan has helped us turn this weapon into a tool for peace. Callahan untangles basic scientific concepts, reveals the realities and limitations of research, and advocates for a measured approach to parenting science that eschews absolutes and acknowledges nuance. The Science of Mom is a rare gem in the parenting canon—smart, sensitive, and a lifesaver for a generation of parents caught in the nebulous spider’s web of Internet ‘wisdom.’ 

~Suzanne Barston, author of Bottled Up: How the Way We Feed Babies Has Come to Define Motherhood, and Why It Shouldn’t

Families routinely search for health information. The Science of Mom makes it easy collecting evidence for health decisions and putting it into perspective with a mom-to-mom connection. Callahan’s advice is thoughtful, backed by science and feels fueled of love. She is willing to provide powerful advice when detailing the science and safety of vaccines. Keep this book in arm’s reach as you support your infant for calm and direction. 

~Wendy Sue Swanson, MD, MBE, FAAP, Seattle Children’s Hospital, author of Mama Doc Medicine: Finding Calm and Confidence in Parenting, Child Health, and Work-Life Balance

Fascinating! Think of all the controversial, hot-button topics that parents obsess about in a child’s first year—from vaccines and feeding, bed-sharing to sleep training. Weighing the scientific evidence, Callahan offers balanced insights and in-depth answers—a far cry from the oversimplified advice prescribed by many ‘parenting experts.’ The result: a must-have guide that’s substantive and extremely engaging. 

~Jena Pincott, author of Do Chocolate Lovers Have Sweeter Babies? The Surprising Science of Pregnancy

I’m so grateful to these thoughtful people, all authors themselves, for taking the time to read my manuscript and write short reviews.

I hope you’ll check out my book and let me know what you think!

What To Do About Babies and Peanuts: New Study Finds Early Exposure Can Prevent Allergy

You’ve probably already seen headlines about a study showing that feeding children small amounts of peanut products in the first 5 years of life can prevent the development of peanut allergy. The study was conducted in the U.K., led by Gideon Lack of King’s College London, and was published this week in the New England Journal of Medicine (free full text available here).1

Why is this study important?

Photo by Sanja Gjenero

Photo by Sanja Gjenero

Food allergies are on the rise in Western countries, and peanut allergy is one of the scariest. In the U.S., more than 2% of children and their families are now living with a peanut allergy, representing a 5-fold increase in prevalence since 1997.2,3 And this allergy isn’t just an inconvenience; it’s now the biggest cause of anaphylaxis and death related to food allergy in the U.S.4 This is a huge concern to parents wondering when and how to introduce peanuts to their kids, but the advice on this matter has been really confusing over the last 15 years.

In 2000, the AAP recommended delaying the introduction of peanut and other commonly allergenic foods (i.e., wheat, eggs, fish, cow’s milk) until at least the first birthday and until age 3 for kids thought to be high-risk for allergy.5 While this advice may have seemed reasonable, it was never based on good evidence – just a best guess based on knowledge at the time.

Meanwhile, the incidence of food allergies continued to climb, and epidemiological evidence emerged that avoiding allergens might backfire. In 2008, the AAP issued new guidelines stating that there was no evidence that delaying introduction of solid foods, including common allergens, beyond 4 to 6 months of age would protect children from developing allergies.6 This document was intentionally vague, because at the time, there weren’t any studies to give more specific guidance on when to introduce what, in what amounts, etc. And this flip-flop in advice, which was also mirrored in many other countries, has left a lot of parents confused.

Gideon Lack and colleagues published a study in 2008 that found that the incidence of peanut allergy among Jewish children in the U.K. was 10-fold higher compared with those growing up in Israel.7 Comparing the mean age of introduction of peanut protein between the two countries, they found that babies in Israel were commonly introduced to peanut in their first year, while babies in the U.K. were not. This led them to their hypothesis that early exposure to peanut might help prevent the development of peanut allergy, and that’s what the current study tested.

How was this study conducted?

The researchers recruited babies between the ages of 4 and 11 months that were high risk for developing peanut allergy because they had severe eczema, egg allergy, or both. Continue reading

Measles Is Serious (A History Lesson from My Grandmother)

Measles is back. The outbreak of this highly contagious viral illness that started at Disneyland in December has spread across the country and shows no signs of slowing. As of February 6, the CDC reported 121 cases in 17 states in this year alone, most linked to Disneyland. In 2014, we had 644 cases of measles in the U.S. This is a striking increase compared to the last 15 years, when we usually saw less than 100 cases in an entire year.

measles 2015 CDCI’m sorry that so many people have been sickened in this outbreak and hope that it is reined in soon. This is no easy task given our mobile society and the fact that we like to congregate in places like Disneyland, schools, doctors’ offices, hospitals, airplanes, and shopping malls. Add to that the pockets of unvaccinated people where measles can easily spread, and we have a recipe for still more outbreaks until we can improve vaccination rates. In this situation, I particularly feel for those who can’t be vaccinated. Babies under 12 months of age and people who are too immunocompromised to get the MMR vaccine, like cancer patients receiving chemotherapy, are counting on the rest of us to get vaccinated and reduce the spread of this disease. Right now, we’re letting them down.

One positive outcome to this outbreak is that it has sparked lots more conversation about vaccines. It inspired me to be more public about proudly stating that our family is fully vaccinated. And I wrote an op-ed piece for my local paper, the Register-Guard, about the risk of measles in our community, given the low vaccination rates in our schools.

FB profile pic(Our baby, of course, has so far only received the newborn Hepatitis B dose. He won’t receive the MMR shot, which includes the measles vaccine, until 12 months of age.)

I spent a lot of time researching vaccines last year for my book. The result is an in-depth look at vaccine development, risks and benefits, and safety testing and monitoring. I also cover some specific vaccine concerns, like whether or not we give too many too soon (we don’t) and if we should be worried about aluminum in vaccines (we shouldn’t). (I don’t just tell you these things, though; I break down the science for you.) I read hundreds of papers about childhood vaccines, talked with researchers, and felt more confident than ever about vaccinating my kids on the recommended schedule.

There was one other bit of vaccine research that may have been the most meaningful to me: I flew to Florida to interview my grandmother, now 90 years old. She raised seven children before most of today’s vaccines existed. She was a mother during the 1952 polio epidemic that killed 3,145 and paralyzed more than 21,000 in the U.S. She was having her babies before a vaccine for rubella was available. That disease caused 11,250 miscarriages, 2,100 stillbirths, and 20,000 children to be born with birth defects in a 1964-1965 outbreak in the U.S.

My grandmother also nursed her children through the measles. Before the vaccine, nearly every child suffered through a case of measles at some point in childhood. During the current measles outbreak, I’ve seen some comments downplaying the seriousness of this disease. After all, most kids did survive measles without long-term consequences. However, many didn’t. Among those who didn’t survive was my grandparent’s second child, Frankie. In 1956, at the age of 6, he died of encephalitis, or inflammation of the brain, a complication of measles.

My dad was the oldest of my grandparents’ children and the first of 3 boys: Richard, Frankie, and Larry. When the boys were little, the family lived in a faculty housing unit at Princeton, where my grandfather was an English professor. The families that shared the building were a tight-knit community. They built a playground together and parents took turns keeping an eye on the kids. “It was such a marvelous place to grow up,” my grandmother told me. “There were a whole bunch of kids, and you knew every single parent. Had conferences about your children and so on.”

Three brothers (from left to right): Richard, Frankie, and Larry Green, circa 1953 or 1954, in Princeton, New Jersey. Frankie died in 1956, at age 6, of encephalitis caused by measles. Photo by Margaret Green, used with permission.

Three brothers (from left to right): Richard, Frankie, and Larry Green, circa 1953 or 1954, in Princeton, New Jersey. Frankie died in 1956, at age 6, of encephalitis caused by measles. Photo by Margaret Green, used with permission.

In May of 1956, all three boys came down with measles. My grandmother remembers neighbors remarking that they were lucky to get it all at once, although this wasn’t surprising given that measles is one of the most contagious pathogens on earth. Those infected are contagious for several days before the characteristic rash appears, and the virus can survive in respiratory droplets, suspended in the air, for two days. Continue reading

Pertussis Vaccination in Every Pregnancy: Is it Safe and Effective?

I’m now 37 weeks pregnant, and it blows my mind how quickly this pregnancy has flown by. Now the days are ticking by faster than I can tick things off of my to-do list, and I can feel my body warming up for birth with increasing Braxton Hicks contractions and the baby dropping into my pelvis.

Preparing for a new baby means lots of things to me. There is the physical preparation of washing and folding tiny clothes and setting up baby’s space for changing and sleeping (in our bedroom for now). There is the arduous task of coming up with names – two of them, since we don’t know the baby’s sex. There is the mental preparation of imagining life with a new baby, trying to map out a few strategies for coping with wakeful nights and baby-filled days. There are the talks with Cee about how things will change and how they will stay the same, how she can help us with the baby, and how we’ll help her to adapt to the change in her life.

There’s also the very important aspect of making sure that we do everything we can to protect our new baby’s health, especially before the first round of immunizations at 2 months. This baby will be born during the season of flu and cold viruses, and this year is predicted to be a pretty bad one for the flu. Just south of our home in Oregon, California has so far recorded nearly 10,000 cases of pertussis, also known as whooping cough, this year, more than they’ve seen in 70 years. Cee will be exposed to a range of pathogens in preschool, and my husband will encounter them in his job in healthcare. We’ll do our best to protect our baby by leaving our shoes at the front door, changing clothes when needed, and washing our hands frequently. I also plan to breastfeed, which should confer some passive protection to the baby. However, some of the most important protection has hopefully already been given to this baby during pregnancy, because I’ve been vaccinated for both the flu (as soon as the vaccine was available this season, around 26 weeks) and pertussis around 34 weeks.

Getting vaccinated for flu and pertussis during pregnancy can protect your baby from these serious illnesses during early infancy.

Getting vaccinated for flu and pertussis during pregnancy can help protect your baby from these serious illnesses during early infancy.

The flu vaccine was first recommended for pregnant women in 1964,1 and there is a large body of research showing that the flu shot is safe in pregnancy and an effective way of preventing flu infections in expecting moms, which can pose a significant risk to the fetus. There’s also good evidence that influenza antibodies are transferred to the baby in utero,2 reducing baby’s chances of infection and hospitalization with the flu in early infancy.3,4 (Several of the above links direct you to evidence-based articles written by Tara Haelle on her blogs at Red Wine and Apple Sauce and Forbes. If you want to keep up with vaccine and other health news, Tara is an excellent blogger and science journalist to follow.)

The latest news on this year’s flu season is showing that most of the cases seen so far have been identified as being caused by seasonal influenza A H3N2, a nasty strain, and about half of these are a new subtype that isn’t well-covered by this year’s flu vaccine. If you haven’t yet gotten a flu shot this season, don’t let this news deter you. The flu vaccine will still protect you from the older strains of the flu and might decrease the severity of an infection with the newer type. The vaccine is very safe and still offers the best protection against the flu for you and your baby.

The recommendation that women be vaccinated against pertussis in every pregnancy – using the Tdap vaccine here in the U.S. – was new in 2012. It wasn’t recommended when I was pregnant with Cee in 2010, although I had recently gotten a Tdap booster for my job at the time. Several pregnant friends and readers have emailed me this fall asking if Tdap in pregnancy is safe and if they really need it, particularly if they were just vaccinated in the last couple of years. The good news is that there have been quite a few studies published on these questions in just the last year or two, and I’ll focus the rest of this post on the evidence for the Tdap shot in pregnancy.

What is the concern about pertussis in young infants?

We’ve seen big increases in pertussis recently, especially over the last decade. In 2012, there were more than 48,000 cases reported in the U.S., making it the worst year since 1955. Pertussis hits young infants the hardest. Among the 20 deaths from pertussis in the U.S. in 2012, 15 were in infants less than 3 months of age [PDF]. The first dose of pertussis vaccine is usually given with the DTaP shot at 2 months of age, and before this time, infants are particularly vulnerable to the disease. The 2012 recommendation that women be vaccinated with Tdap in the third trimester of every pregnancy came in response to these infant deaths, the hope being that maternal antibodies to pertussis could help protect infants during those first few months of life. Continue reading

Can Fetal Movements Predict a Baby’s Sex or Temperament?

I’m now 31 weeks pregnant. The weeks are flying by, and for the most part, I’m relishing all the physical changes in my body and the preparations for this baby. We waited a long time for this pregnancy, and it will probably be my last. I curl around my belly at night and think about the baby growing inside me. I wonder about the person that he or she will become and how our little family will adapt to welcome a second child. (We’ve chosen not to learn the sex of this baby until its birth.)

When I was pregnant with Cee and about to become a mom for the first time, I thought a lot about what kind of mother I would be and how this big life transition might alter my identity, my career path, my marriage, and my daily life. The baby-to-be was kind of a vague amalgamation of all the babies I’d known.

This time around, having been around many more babies, I recognize the individuals that babies are from the first days of life – and even in utero – and I spend a lot more time wondering about this baby’s temperament and personality. Introverted and contemplative, like Cee? Or totally different?

Filling me with wonder, this baby moves around in utero a lot, and this feels very different from my experience carrying Cee. I didn’t feel movement from Cee until around 23 weeks, but I began to feel this baby move at 16 weeks. And this baby continues to be very active, more than I remember with Cee, especially making big, dramatic movements in the evening hours but also having significant activity bouts throughout the day (and sometimes in the middle of the night, of course).

Because we don’t know the sex of this baby, I’m often asked if I have any predictions on that front. How would I know, I think? I don’t feel like I have any kind of gut instinct for this kind of thing, and I don’t buy into any of the old wives tails. But if I’m pushed to make a guess, I guess that this baby is a boy. And when I ask myself why that is, it comes down to this observation about more fetal movements. This baby feels different from Cee, and my brain makes a jump to sex as a possible explanation. And then I stop, remind myself that I’m perpetuating a total gender stereotype, and feel embarrassed.

One day, I repeated all of this to a friend as we walked together (complete with an apology for the gender stereotype), with Cee riding her bike within hearing distance. A couple of weeks later, my mom was talking to Cee on the phone and asked her if she thought the baby would be a boy or a girl. Cee answered in what seemed like a verbatim copy of my own explanation: “Well, Mom thinks that it’s a boy, because the baby moves around a lot inside of her, and I didn’t move very much.” Yikes. From now on, I’m keeping my mouth shut. And for the record, Cee is really hoping for a little sister.

All of this left me wondering if fetal movements can actually predict anything about the baby, whether sex or temperament, in postnatal life. I happened to be corresponding with Jena Pincott, author of Do Chocolate Lovers Have Sweeter Babies?, a few weeks ago, and I asked her if she knew of any research on this. She wrote back, “As for ‘in utero’ forecasts, my prediction is that your 2015 is going to be very, very busy!” and sent me a few research articles. I dug around and found quite a few more studies of this question. Finally, I could stop speculating and start talking science! Here’s what I found:

How is this question studied?

Most studies use ultrasound or a Doppler transducer placed on the mother’s belly to us baby profile croppedmeasure fetal movements. Most are conducted over a period of about an hour, during which the moms are asked to rest, and the best studies take several of these measurements over the course of the pregnancy. Studies of postnatal temperament then use standardized behavioral observations or questionnaires to describe aspects of the baby’s behavior.

Is it true that some fetuses are more active than others?

I wondered if my perception that I was carrying a more active fetus is this pregnancy was really true or if it was influenced by other factors? Continue reading

The Whole Truth About Infant Cereals: 7 Science-Based Tips

I recently received an email from a reader with a question about baby cereals:

“My wife and I are expecting a baby this October. We are planning to breastfeed but have lots of questions about introducing solid foods, particularly cereals. Do we have to feed the baby commercial baby cereals? I am concerned about all the extra crap that is put into commercial food, including unnecessary sugars and possible GMOs. Is there another product or whole food option that we could use to introduce grains to our baby instead of a commercial cereal product?”

~Brenda and Leah in San Diego, CA

Baby cereals have made a big swing in popularity over the last couple of generations. It wasn’t long ago that they were considered an essential first food, given to baby within the first months or even weeks of life. These days, in some circles, they’ve become a marker of lazy parenting, with conscientious parents choosing instead to prepare their own organic carrot purees or scrambling eggs with butter and breast milk. Cereals, meanwhile, get slammed in blog posts that call them over-processed, pointless, and even toxic. The movement towards more real foods for babies is definitely a good thing, but the scare-mongering about baby cereals is not. Brenda and Leah’s question is a great one, and it deserves an answer that is science-based, not sensationalized.

mother feeding her baby

1. You don’t have to feed a commercial baby cereal.

The reason infant cereals are typically recommended is that they are fortified with iron, and iron can become limiting during late infancy, particularly in breastfed babies. In early infancy, babies are mostly using stored iron that was transferred from mom during pregnancy, but by around 6 months, those stores run low, and they need to be getting some iron from solid foods. At this age, babies are growing and developing rapidly, and studies show that iron deficiency in infancy can cause developmental delays and lasting cognitive deficits.1–3 Breastfed babies are at greatest risk for iron deficiency,4,5 because breast milk is quite low in iron. (The iron in breast milk is efficiently absorbed, but there simply isn’t much of it.)

Commercial baby cereals are fortified with iron, effectively making it an easy way to deliver extra iron to lots of babies. In one study, among breastfed babies fed a fortified cereal daily, only 2.5% developed iron deficiency, compared with 14% of babies fed solids at their parents’ discretion.6 Infant formula is also fortified with iron, so babies that are formula-fed for at least half of their milk meals generally get enough iron that way.

However, there are other sources of iron that are actually better than fortified cereals. Meat, poultry, and fish all contain heme iron, which is more efficiently absorbed in the digestive tract than nonheme iron, the form found in plants like spinach and beans, as well as fortified cereals. Including a source of heme iron in a meal also increases the absorption of nonheme iron, so serving baby a little chicken with lentils actually increases the bioavailability of iron from the lentils. Baby cereals are often recommended as first foods, but this is based more on tradition and culture than on any scientific evidence. There is no reason why you can’t introduce those great heme sources of iron (meat, poultry, fish) as first foods, and in fact, this is now recommended by the AAP. If your baby is consuming 1-2 small servings of meat per day, plus other sources of non-heme iron, then there’s no reason that you have to supplement with an iron-fortified cereal. See more of my tips on ensuring that your baby gets enough iron in this post: 5 Practical Ways to Increase Iron in Your Baby’s Diet. Also, note that your pediatrician should test your baby for anemia around 12 months, so this will at least alert you if your baby is very deficient in iron.

Many babies and their parents also opt to skip spoon-feeding entirely, doing some version of Baby-Led Weaning. Cee simply wasn’t interested in being spoon-fed pureed foods, but she loved feeding herself soft finger foods. That meant that she ate very little infant cereal, except what I baked into muffins or pancakes (mostly to use up the box, but I figured she could also use the extra iron). This route can be fun and appropriate for babies that are ready to self-feed by around 6 months; others may need spoon-feeding and may love the interaction of feeding with a tuned-in caregiver.8 There are lots of options here, and the most important thing is to offer iron-rich foods (cereal or otherwise) and to follow your baby’s lead with texture and timing.

2. Commercial baby cereals may not be as bad as you think.

Here’s the Nutrition Facts label and ingredient list for Gerber’s oatmeal cereal (this one happens to be an organic product, but the conventional version is otherwise the same):

gerber oatmeal label

What’s in baby cereals? Take a look at the ingredient list. Continue reading

New Research on Gluten Introduction to Infants and Risk of Celiac Disease

If you’re worried about your child’s risk of celiac disease and wondering when to introduce gluten-containing foods, then you’ll want to know about two new studies published in the New England Journal of Medicine this week.

Gluten is delicious to most of us, but it can be devastating to those with celiac disease. Photo by Adrian van Leen

Gluten is delicious to most of us, but it can be devastating to those with celiac disease. Photo by Adrian van Leen

Celiac disease is an immune response to gluten, a protein found in wheat, barley, and rye. It causes inflammation and damage to the small intestine, and while it can be successfully managed with a gluten-free diet, it is a lifelong disease. (Celiac disease is distinct from non-celiac gluten sensitivity, which is a murky and controversial condition that may not be related to gluten at all.)

I reviewed the research on early infant feeding and risk of celiac disease on my blog about a year ago (Breastfeeding, Gluten Introduction, and Risk of Celiac Disease). I have since received lots of comments and messages from parents concerned about this, so I wanted to be sure to write about these important new studies.

These latest studies dramatically advance our understanding of this topic because they are randomized controlled trials. Both started with a group of babies already identified as being high-risk for celiac disease, randomly assigned them to different time of introduction of gluten, and then tracked their development of the disease. Previous studies were all observational, thus only able to identify associations between variables, and were limited by confounding factors and other sources of bias.

The first study was led by researchers in the Netherlands but included children born in 7 European countries and in Israel. 944 babies were identified as being high-risk for celiac based on a genetic predisposition (HLA genotype) and having a first-degree relative (parent or sibling) with celiac. The babies were randomized to two groups, and one group was given a small amount (100 mg) of gluten starting at 4 months of age, while the control group was given a placebo and instructed not to introduce gluten until 6 months, at which point parents in both groups were advised to gradually introduce gluten-containing foods. The incidence of celiac disease was tracked through 3 years of age, with all suspected cases confirmed with an intestinal biopsy. Overall, about 5% of the study participants developed celiac disease by age 3, and it made no difference whether gluten was introduced at 4 or 6 months. It also made no difference whether the babies were breastfed (exclusively or not) or currently breastfed at the time of gluten introduction.

The second study was conducted in Italy and had a similar design but instead compared gluten introduction at 6 vs. 12 months. Continue reading

Bed-sharing with Young Infants: Is It Safe After All?

Does bed-sharing with infants increase their risk of SIDS, even without known risk factors such as alcohol use, smoking, and co-sleeping on a couch or chair? A recent study makes what is probably the best attempt to date to answer this question. The study, led by U.K. researcher Peter Blair, was published last week in the journal PLOS ONE and is freely available to the public (yay!).1

Many studies have found that co-sleeping is associated with an increased risk of SIDS, but most of this risk doesn’t come from co-sleeping per se, but rather doing so in particularly hazardous conditions, such as on a couch or with a parent who has been drinking. However, there’s an important, albeit controversial, caveat to this conclusion. Several studies have looked specifically at infants younger than 3 months and still found a significant risk of bed-sharing even in the absence of these other risk factors.2–6 The current study comes to conclusions much more reassuring to bed-sharing parents. In this study, bed-sharing without alcohol, smoking, or couch/chair co-sleeping was not associated with a significant SIDS risk in infants younger than 3 months and even seemed to be protective in older babies. Both of these findings run counter to previous studies and to the sleep recommendations of the AAP, so they deserve a close look.

How was the study conducted? Continue reading