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

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

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.

The World Health Organization (WHO), tasked with making recommendations for the entire world, “recommends that infants start receiving complementary foods at six months of age in addition to breast milk.” They also make it clear that solid foods are important, as the period of late infancy is a time of rapid growth and development, and breast milk alone just isn’t enough for most babies. “Complementary feeding should be timely, meaning that all infants should start receiving foods in addition to breast milk from 6 months onwards.” The government recommendations in Australia [PDF] and the U.K. mirror the WHO’s advice.

The European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHN) calls 6 months of EBF “a desirable goal.” But they also add, “In all infants… the introduction of complementary foods should not be before 17 weeks but should not be delayed beyond 26 weeks.”3 [PDF] In their statement on breastfeeding [PDF], the same committee writes, “In industrialized countries, there is at present no scientific evidence that introducing complementary foods to breastfed infants between 4 and 6 months of age is a disadvantage relative to introduction after 6 months.”4 The European Food Safety Authority came to similar conclusions [PDF].5

In the U.S., the American Academy of Pediatrics (AAP) 2012 Policy Statement, “Breastfeeding and the Use of Human Milk [PDF],” written by the AAP’s Section on Breastfeeding, recommends “exclusive breastfeeding for about 6 months, followed by continued breastfeeding as complementary foods are introduced…”6

However, scroll around the AAP’s website for parents, and you’ll find that the advice there focuses on developmental readiness (holding head up, sitting up, opening mouth for food, etc.) rather than age. Only later, in an italicized note, do they mention, “The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months.” There is no mention of what to do if you aren’t exclusively breastfeeding or of why it might be important to wait on solids until 6 months if you’re breastfeeding but not if you’re feeding formula (or some combination of the two).

Also within the U.S., the American Academy of Allergy, Asthma and Immunology recommends starting solids between 4 and 6 months based on some data (discussed below) that this may decrease the risk of developing food allergies. You can read their recommendations on preventing allergies here [PDF] – it’s a great summary of the current research. (This paragraph added 5/15/15 after reminder of this from a reader.)

One thing that’s certain is that what families actually do when it comes to starting solids is all over the map. According to the 2014 CDC Breastfeeding Report Card [PDF], just 19% of babies are exclusively breastfed at 6 months. A survey of 1,334 U.S. mothers, published in 2013, found that 40% introduced their babies to solids before 4 months, and only 7% waited until 6 months.7

Just about everyone agrees that is best to wait until 4 months to start solids. Studies have shown that introducing solids before 3-4 months can increase the risk of eczema at age 10, celiac disease, type 1 diabetes, wheezing in childhood, and increased body weight in childhood.8–11

However, the debate over starting solids at 4 versus 6 months continues. Which is better? Let’s take a look at what the science says.

How does starting solids affect nutrition?

As far as I can tell, there have only been three randomized controlled trials (RCTs) of starting solids at 4 versus 6 months. The RCT design is the gold standard for a clinical trial, and it gives us the best chance at determining how age of starting solids might cause different outcomes in babies’ health. (Most studies of infant feeding use observational study designs, which are always complicated by confounding factors and can only show correlations, not causation.)

The first two of the RCTs were conducted in Honduras in the 1990s.12,13 In both studies, mothers of infants were randomly split into two groups. Researchers asked one group to exclusively breastfeed (EBF) their babies until 6 months. They asked the other group to start solids at 4 months (while continuing to breastfeed) and gave them jarred commercial foods and advice on sanitary feeding practices, reducing the risk of foodborne illness. This was an important part of the study design in a setting where families might lack access to refrigeration or clean water, but we still have to be careful about applying these data to more developed countries, because factors such as maternal malnutrition and infant growth rates may be different. Happily, a third RCT with a similar design was conducted more recently in Iceland.14 It turns out that all three of these studies had similar findings:

  • Effects on infant growth: Whether babies started solids at 4 months or 6 months did not affect their growth during this time, suggesting that either method provides enough calories and nutrients for normal growth. The Iceland study also followed babies out to 18 months and 3 years, and they found no difference in growth at these ages (weight, length, head circumference, BMI, risk of overweight).15
  • Effects on energy intake: The Iceland trial included careful measurement of breast milk and solid food intake at 6 months. Not surprisingly, the babies that started solid foods at 4 months ate a little less breast milk (average of 818 g/d) compared to those EBF through 6 months (901 g/d). They made up the difference with solid foods, however, so total calorie intake was not different (560-570 kcal/d).16 Similar results were seen in the Honduras studies. This is exactly what we’d expect given the similar growth between groups, and it shows that infants are good at self-regulating calorie intake to meet their needs.
  • Effects on nutrient status: The main nutrient of concern during the second half of the first year of life is iron. In one of the Honduran studies, starting solids at 4 months gave babies higher hemoglobin, hematocrit, and iron stores (measured by plasma ferritin) at 6 months of age compared to the 6 month EBF babies.17 In the Iceland study, the 4-month solids group also had higher iron stores than the 6-month group.14 However, ferritin levels were adequate in both groups of Icelandic babies, and the number of babies with iron deficiency or iron deficiency anemia was not significantly different. Thus, an earlier start at solids may give breastfed babies a little boost in iron, but it isn’t clear that this is really clinically relevant – that is, it may or may not make a difference to babies’ health. (The same cannot be said for delaying solids beyond 6 months; risk of iron deficiency does seem to increase in this situation.)

Observational studies support the conclusion that babies grow and develop well whether they start solids at 4 or 6 months. A 2012 Cochrane review looked at 23 studies (from both developing and developed countries) and concluded that 6 months of exclusive breastfeeding is usually sufficient to support healthy infant growth.18 The authors are cautious about applying this conclusion to every baby, though: “The data are insufficient to rule out a modest increase in risk of under nutrition with exclusive breastfeeding for six months and grossly inadequate to reach conclusions about the effects of prolonged (more than six months) exclusive breastfeeding.”

How does starting solids affect risk of infection?

In developing countries, where many families may lack access to clean water and/or refrigeration, the risk of illness dramatically increases when babies start solids. With the introduction of solid foods comes potential exposure to pathogens that may contaminate food, water, or utensils. For example, one study in the rural Phillipines found up to a 13-fold increased risk of diarrhea with feeding solids. This factor alone justifies the WHO’s recommendation for 6 months of exclusive breastfeeding in these settings.

But with access to clean food and careful feeding practices, the risk of infection with solids appears to be much lower and maybe not a concern at all. In a study of 16,000 U.K. infants, tracked for the first 8 months of life, starting solids didn’t increase their risk of hospitalization for diarrhea or lower respiratory tract infection, regardless of the age they took their first bite.19 Strangely, the Honduras RCTs found that the 6-month EBF babies were actually a little more likely to get sick (upper respiratory tract infections in one study12 and diarrhea in the other13) compared with those starting solids at 4 months.

One study, conducted in Belarus, found no difference in respiratory tract or ear infections but an increased risk of gastrointestinal infections in babies EBF to 3-4 months compared to those EBF for 6 months.20 The difference amounts to one extra case of diarrhea per 42 babies introduced to solids earlier. However, there was no difference in hospitalization for GI infections, so this increase seems to be in minor illnesses. It also includes some babies that were just 3 months old, and at least some of these infections could probably be prevented with more careful food prep practices.

So does starting solids increase the likelihood that your baby will get sick? Most studies say no, but one says that there may be a small increase in episodes of minor diarrhea.

How does starting solids affect the risk of allergies and chronic diseases?

When babies start eating solid foods, new proteins bombard their GI tracts. The immune system needs to learn about these proteins and recognize them as acceptable passengers through the GI tract rather than pathogenic invaders. Food allergies represent a failure to tolerate these food proteins.

For allergies and some chronic immune diseases, there appears to be a sweet spot for when to introduce solid foods. For example, one study found that children first exposed to wheat between 4 and 6 months (versus after 6 months) had a 4-fold decreased risk of wheat allergy.21 Another found that children who first had cooked egg at 4-6 months had the lowest incidence of egg allergy, whereas those starting egg at 10-12 months had a 6-fold increased risk.16 These studies were observational – not randomized – and there are a host of confounding factors that can muddle the waters of infant feeding research. However, the recent peanut study (an RCT, explained in my post here) clearly showed that exposure early in life reduces allergy, although timing and amounts of exposure will need to be defined for different allergens.

There is some evidence that a window of opportunity may exist for gluten as it affects the development of celiac disease. Earlier observational studies showed that infants who ate gluten after 3 months of age but before 6-7 months had lower risk of celiac disease. However, 2 RCTs (explained in my post here) published in 2014 showed that age of introduction of gluten (at 4 months, 6 months, or 12 months) didn’t ultimately affect the development of celiac. An observational study also showed lower risk of type 1 diabetes when cereals (including rice and gluten-containing grains) were introduced between 4 and 6 months.22 However, an RCT comparing gluten introduction at 6 or 12 months found no difference in risk of developing islet autoimmunity (ref 22a – this sentence added 5/15).

Either way, the research here suggests starting solids – particularly these potentially allergenic foods – by around 6 months may reduce allergy risk. Or it may not, but it doesn’t seem to hurt.

How does starting solids affect mom’s health?

In the Honduras studies, moms that exclusively breastfed their babies for 6 months were more likely to still have lactational amenorrhea (i.e., not have their periods) compared with those starting solids at 4 months. In one of these studies, 6 months of EBF resulted in more weight loss for moms (a difference of 0.6 kg or 1.3 lb between 4 and 6 months).23 Depending on your personal situation, these differences may or may not be benefits to you. Either way, exclusive breastfeeding or even amenorrhea is no guarantee that you won’t get pregnant, so don’t count on it as birth control.

What if I’m not breastfeeding?

Many of the studies I’ve discussed so far were specifically focused on when to introduce solids to breastfed babies. Is the decision different for a formula-fed baby? Not really. Some of the studies on infection and allergy risk included formula-fed babies, so those findings apply to both groups. If you’re feeding an iron-fortified formula, you don’t really need to worry about iron deficiency. Factors such as lactational amenorrhea and weight loss are obviously specific to breastfeeding.

We’ve covered a lot of ground, so let’s put these considerations in one place:

starting solids tableReader Roxanne’s bottle-refusing baby inspired this post. In her situation, she has a baby who is hungry, and given the mix of risks and benefits of starting solids, it seems reasonable to give solids a try. Roxanne’s pediatrician told her the same thing, and she gradually started introducing some solids to her baby.

Each situation is different. Public health recommendations are intentionally simple and easy to understand, but babies and their families are complex. If you’ve read this far, then you understand that the research behind this question is also complex and doesn’t give us a clear right or wrong answer. This post focused on health outcomes related to starting solid foods, but it ignores what may be the most important factor of all: each baby’s developmental readiness and interest in solids. In my next post, I’ll write about how to tell if your baby is ready for solids.

Click here to read 4 Signs Your Baby Is Ready for Solid Foods.

Share your experience in the comments. What advice did you receive about starting solids? What did you actually do?

read more about feeding

References:

  1. Lozoff, B. Birth and Bonding in Non-Industrial Societies. Dev. Med. Child Neurol. 25, 595–600 (1983).
  2. Sellen, D. W. Comparison of infant feeding patterns reported for nonindustrial populations with current recommendations. J. Nutr. 131, 2707–2715 (2001).
  3. Agostoni, C. et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 46, 99–110 (2008).
  4. ESPGHAN Committee on Nutrition: et al. Breast-feeding: A Commentary by the ESPGHAN Committee on Nutrition. J. Pediatr. Gastroenterol. 49, 112–125 (2009).
  5. EFSA Panel on Dietetic Products, Nutrition and Allergies. Scientific Opinion on the appropriate age for introduction of complementary feeding of infants. Eur. Food Saf. Auth. J. 7, 2–38 (2009).
  6. American Academy of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 129, e827–841 (2012).
  7. Clayton, H. B., Li, R., Perrine, C. G. & Scanlon, K. S. Prevalence and Reasons for Introducing Infants Early to Solid Foods: Variations by Milk Feeding Type. Pediatrics 131, e1108–e1114 (2013).
  8. Fergusson, D. M., Horwood, L. J. & Shannon, F. T. Early Solid Feeding and Recurrent Childhood Eczema: A 10-Year Longitudinal Study. Pediatrics 86, 541–546 (1990).
  9. Norris, J. M. et al. Risk of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. J. Am. Med. Assoc. 293, 2343–2351 (2005).
  10. Norris, J. M. et al. Timing of initial cereal exposure in infancy and risk of islet autoimmunity. J. Am. Med. Assoc. 290, 1713–1720 (2003).
  11. Wilson, A. C. et al. Relation of infant diet to childhood health: seven year follow up of cohort of children in Dundee infant feeding study. BMJ 316, 21–25 (1998).
  12. Cohen, R. J., Brown, K. H., Dewey, K. G., Canahuati, J. & Landa Rivera, L. Effects of age of introduction of complementary foods on infant breast milk intake, total energy intake, and growth: a randomised intervention study in Honduras. The Lancet 344, 288–293 (1994).
  13. Dewey, K. G., Cohen, R. J., Brown, K. H. & Rivera, L. L. Age of introduction of complementary foods and growth of term, low-birth-weight, breast-fed infants: a randomized intervention study in Honduras. Am. J. Clin. Nutr. 69, 679–686 (1999).
  14. Jonsdottir, O. H. et al. Timing of the Introduction of Complementary Foods in Infancy: A Randomized Controlled Trial. Pediatrics 130, 1038–1045 (2012).
  15. Jonsdottir, O. H. et al. Exclusive breastfeeding for 4 versus 6 months and growth in early childhood. Acta Paediatr. 103, 105–111 (2013).
  16. Wells, J. C. et al. Randomized controlled trial of 4 compared with 6 mo of exclusive breastfeeding in Iceland: differences in breast-milk intake by stable-isotope probe. Am. J. Clin. Nutr. 96, 73–79 (2012).
  17. Dewey, K. G., Cohen, R. J., Rivera, L. L. & Brown, K. H. Effects of age of introduction of complementary foods on iron status of breast-fed infants in Honduras. Am. J. Clin. Nutr. 67, 878–884 (1998).
  18. Kramer, M. S. & Kakuma, R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst. Rev. 8, CD003517 (2012).
  19. Quigley, M. A., Kelly, Y. J. & Sacker, A. Infant feeding, solid foods and hospitalisation in the first 8 months after birth. Arch. Dis. Child. 94, 148–150 (2009).
  20. Kramer, M. S. et al. Infant growth and health outcomes associated with 3 compared with 6 mo of exclusive breastfeeding. Am. J. Clin. Nutr. 78, 291–295 (2003).
  21. Poole, J. A. et al. Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy. Pediatrics 117, 2175–2182 (2006).
  22. Frederiksen, B. et al. Infant Exposures and Development of Type 1 Diabetes Mellitus: The Diabetes Autoimmunity Study in the Young (DAISY). JAMA Pediatr. 167, 808–815 (2013).
  23. Dewey, K. G., Cohen, R. J., Brown, K. H. & Rivera, L. L. Effects of exclusive breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Honduras. J. Nutr. 131, 262–267 (2001).

(22a). Hummel, S., Pflüger, M., Hummel, M., Bonifacio, E. & Ziegler, A.-G. Primary dietary intervention study to reduce the risk of islet autoimmunity in children at increased risk for type 1 diabetes: the BABYDIET study. Diabetes Care 34, 1301–1305 (2011).

Here’s another post, from a blog I love, on this topic: When Is It Best To Introduce Solids at Expecting Science.

 

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81 Comments
  1. Our pediatrician suggested starting rice cereal at 5 months for the iron, then introducing everything else starting at 6 months. (Given the research coming out about delayed introduction increasing allergy risk, he specifically recommended introducing eggs, shellfish, and pretty much everything except honey before one year.) We followed his advice, in part because it aligned well with our son’s interest in food. At 5 months, he enjoyed tasting the cereal and playing with the spoon; around 6 months, he started wanting to eat noticeable quantities.

    Like

    May 14, 2015
    • That seems like reasonable advice, and I’m glad it worked well for you. I’ll write more about my top picks for first foods in the coming weeks. Ideally, I think it is good to start offering a variety of foods, including meat, early on, though I also think cereals are a good option. I’m interested in hearing what different pediatricians suggest, particularly since the AAP’s official recommendation is 6 months of EBF but that isn’t what we see happening in practice (and based on all the research I covered in this post, I don’t really think we have the evidence to back that recommendation for all babies). So much of advice about solid foods is rooted in tradition, and the reality is that different timing and types of foods work well for different babies – no need to be too rigid about it:)

      Like

      May 14, 2015
      • I should probably add that this was this year (our kid is now 9 months old and starting to show a definite interest in self-feeding, although he continues to enjoy being spoon-fed, too).

        Like

        May 14, 2015
      • Deanna Laurence #

        Everything I read said to wait till 6 months, my babies were growing great so their doctor said whatever we were doing was fine. I was never able to produce enough milk to exclusively breastfeed, we left the NICU with neosure and we supplemented with neosure for a month then all of the sudden every time we fed them formula they puked it all over you. All the doctor could recommend was to try other formulas. We tried all kinds of other formulas. With every single one we would feed them between 2 and 4 ounces, and they would puke it all over us, to the point where everything they were wearing and everything we were wearing was soaked. Saw the doctor and they gave us medicine for reflux, but the medicine didn’t make a difference and my boys hated taking it so I stopped the meds, stopped using formula and introduced solids and baby cereal at two months. They never got sick from solids or baby cereal. We still tried formula to supplement occasionally mostly because of social pressure saying they were too young to be eating solids and it wasn’t until they were 7 or 8 months old that formula stopped making them sick after every serving. Now they are 9.5 months, 95 percentile for weight, they love every food you present to them whether it be baby food or normal food, haven’t had any signs of food allergies, or iron deficiency. I was very disappointed by my doctors advise about formula. I was working with a lactation consultant at that time and she said that it can take up to 10 days of feedings for a baby to get used to a new formula and since we were only supplementing once or twice a day I didn’t figure we would ever get to the point where we would reach “used to” and I kinda feel like reflux meds are over prescribed.

        Like

        May 16, 2015
  2. We started supplementing with formula around 6 weeks due to supply issues, and our daughter continued to have a diet of breastmilk and formula until around five (maybe five and half) months, when we started solids. E. had been curious about solids, had been holding her head up well for months, sitting up comfortably, and standing with support for at least a month before we introduced solids. We also checked with our doctor, who said he didn’t have a strong opinion about when we introduced solids, as long as we were thoughtful about it. He recommended starting with vegetables. She wasn’t sure what to do with the food at first, since it was a new thing, but the concept that this stuff was food and she could swallow it clicked when we tried avocado. I introduced wheat sometime in that first month, too, and planned out introducing major allergies, like eggs and peanuts, so she’d get early exposure (with baby Benadryl on hand just in case). E. was happier with finger foods than purees from very early, so we mostly didn’t do baby food, per se. We tended to chop up what we were eating and give it to her. We tried the pouch stuff a few times when people gave them to us or when we went camping, and she liked those (except for the times she accidentally squirted herself in the face), but was still more excited about solids like the grown-ups were eating.

    E. is nearly two now, and she likes most foods with varying degrees of enthusiasm. She still has a hard time with some chewy things, so she’s not always excited about some meats and isn’t great at chewing leafy greens yet. She’s interested in most foods, especially if they come with some sort of sauce. Now that she can use a spoon without help, she likes foods with a more pureed consistency as well. She wants to try nearly everything. So far, she hasn’t developed any food allergies, and we’re hoping it’ll stay that way. As with most toddlers, her appetite fluctuates from day to day, but she’s gaining weight normally and is healthy.

    Like

    May 14, 2015
    • Anna, thanks for sharing your experience! Cee was the same way in that she wasn’t that interested in foods that we offered on a spoon, but she was really enthusiastic about feeding herself. We haven’t really started solids with BabyM yet, but I think he’s close to being ready. He loves getting his vitamin D drops on a spoon at the dinner table, so I have a feeling that he may be more interested in spoon-feeding than his sister.

      Like

      May 14, 2015
  3. Thank you for this well presented discussion of what we know and do not know about solid foods in babies! I very much appreciate the new data on allergy and tolerance- to my immunologist side, it make sense to introduce earlier when the thymus is most active in tolerance training, but not so early that the gut is too immature.
    One issue I would love to see more study on is the window of readiness developmentally. I worry that if we arbitrarily set a time, we are missing optimal start time for a specific child, which might then lead to a different set of feeding difficulties. While we as pediatricians try to make the best of data we have with guidelines, we may not be so good at explaining the subtlety of individual development and the limitations of the data available.
    My advice for typical infants usually boils down to the following: Feed the baby, breastmilk if possible and as long as feasible, any affordable formula when not , and offer ‘real’ food safely prepared when the baby is asking for it (readiness cues).

    Like

    May 14, 2015
    • I absolutely agree with you that there should be more research and attention paid to a window of developmental readiness. There is a little research on this, but it isn’t the best quality. I’ll discuss it in my next post. My opinion is that when we set rigid age-based recommendations (i.e. 6 months of EBF), we take parents’ focus off of the baby’s individual readiness, and that’s probably the most important factor. That’s why I like the 4-6 months range recommendation better – with some advice about developmental readiness. That helps parents tune into where their babies are at and puts some trust in babies to tell us when they’re ready. I think that’s important for getting off on the right foot with feeding.

      Like

      May 14, 2015
  4. Anya #

    I have been reading on this topic for months now because my husband has a seafood allergy and that places our son in a higher risk category for food allergies. I introduced some veggies, fruits and oatmeal between 4.5 and 6 months. He had egg and wheat at about six months. I am going to introduce all the allergens soon but we are going to see an allergist before introducing fish.

    Like

    May 14, 2015
    • Tom Adams #

      The IAAAA recommends introduction of highly allergenic foods like shellfish early regardless of a family history unless the child is already known to be allergic or already seems to reacting to the food. The recommend spacing the introduction of highly allergenic foods so that the parent may have some chance of linking any reaction to a specific food. The recommend allergy testing if any reactions are detected.

      There is some (unproven as far as I know) scientific speculation that delayed introduction runs in families that have allergies and that it’s the practice of delaying, not biological inheritance, that is causing allergies to run in some families.

      Like

      May 26, 2015
      • Tom Adams #

        Sorry about the typos, let me correct:

        The IAAAA recommends introduction of highly allergenic foods like shellfish early regardless of a family history unless the child is already known to be allergic or already seems to be reacting to the food. They recommend spacing the introduction of highly allergenic foods so that the parent may have some chance of linking any reaction to a specific food. They recommend allergy testing if any reactions are detected.

        Like

        May 26, 2015
  5. Jonathan R #

    Both my children were anxious to begin eating solid food as early as 4 months and would begin grabbing for foods. I suppose that’s a peril of family mealtimes.

    Like

    May 14, 2015
    • That’s true – babies’ interests will align with their experiences as they develop. I think time as a family around the table is important, and if it inspires more interest in solid foods, and your baby is at least 4 months old, why not include them in mealtimes? Seems natural. If you were a hunter-gatherer, you would probably be pre-chewing foods and handing them to your baby so he’d let you eat in peace:)

      Like

      May 14, 2015
  6. KT #

    I breastfed both my girls (am still nursing the 8 month old). With the first I was strongly in favor of waiting to introduce food until 6 months. 2 weeks before she hit that mark she was swiping at our food and nursing around the clock with an early onset 6 month growth spurt. I figured if her body was demanding the calories it was time. Within 3 days she was basically gobbling up every puree we could give her. I loosely followed the then-guidelines to avoid allergens.

    With the current infant she seemed to be swiping at our food and was fussy during family meals by 4 months. She was easily sucking down 30 oz. of breast milk a day. She could sit in her high chair. As far as I could tell she was basically “ready” I introduced solids right around 5 months. She was not a fan at all. But then I added in meat at 6 months along with letting her have allergenic foods like peanut butter. It was as if a switch flipped. Not sure if it was the age or the fact that the food I was giving her now involved protein, fat, iron, zinc, etc., but she became a great little eater. I know 6-11 months is the “period of exploration” for solids, so it may have just been age. However I wonder if her body’s instinctive knowledge of what nutrients it needed beyond breast milk may have also played a role. It doesn’t seem coincidental to me that the foods she gravitates towards provide nutrients that are least found in breast milk.

    Like

    May 14, 2015
    • That’s fascinating! Foods like meat and peanut butter are more calorie-dense and satiating (because fat and protein), and that could have made them more desirable. I know a specific appetite for salt has been well-studied, but I don’t think there is great research on other nutrients. Wikipedia says a specific appetite for iron has been demonstrated in humans but doesn’t cite any sources (and I couldn’t find one in a quick PubMed search, but I probably don’t have good search terms). I’ll have to look into that more. It could also be a coincidence, but regardless, I’m sure she’s a smart baby:)

      Like

      May 14, 2015
  7. Emily #

    Our son just had his 4-month visit last week and the pediatrician recommended starting cereal now. We plan to wait till closer to 6 months (we want to start with finger foods and he’s not quite ready for that yet). They said that’s fine but we should give him iron drops in the meantime.

    Like

    May 14, 2015
  8. Steph #

    This was so interesting! I’m looking forward to your book coming out and wish I’d had it two years ago when my first was born. I EBF her for 6 months and then introduced solids as per the APA guidelines, but she didn’t really go for them until 7 months, at which point she went for them like crazy. I was pretty indoctrinated into the APA guidelines, so was surprised when the AAAI guidelines came out recently talking about 4 months or after – I had no idea there was any debate. I’m interested to read your next post on readiness signs, since I think I’ll try to be a little more flexible if my now 3-month-old shows interest in solids before 6 months.

    Like

    May 14, 2015
    • Steph – Thanks for the reminder – I should have included the AAAAI recommendations and will add them now. I think this has really been an ongoing debate since the WHO changed their recommendation from 4-6 months to 6 months EBF in 2001. Even then, there wasn’t really compelling evidence for this change in developed countries, but I think it has been adopted by the AAP and in the U.K. and Australia as part of breastfeeding promotion efforts. To me, it’s a really interesting academic debate, but to those of us feeding babies and wondering what to do (and often juggling different factors, like Roxanne), I think the data support some flexibility depending on baby and life circumstances.

      I’m copying this paragraph from the ESPGHAN guidelines (2008) because it captures some of the controversy and history around this recommendation:

      “Following the WHO systematic review and expert
      consultation, in 2001 the World Health Assembly
      revised its recommendation to exclusive breast-feeding
      for 6 months and partial breast-feeding thereafter. In the
      recommendations from the expert consultation, it was
      stated that the recommendation applies to populations,
      and it was recognized that some mothers would be
      unable to, or would choose not to, follow this recommendation
      and that these mothers should also be supported
      to optimise their infant’s nutrition (4). Many
      countries have since adopted this recommendation for
      the duration of exclusive breast-feeding, sometimes with
      qualifications, whereas other countries continue to
      recommend the introduction of complementary feeding
      between 4 and 6 months. However, there has been disagreement
      between advisory bodies even within the same
      country, reflecting the limited scientific evidence from
      industrialised countries upon which the WHO recommendation
      was based, and the fact that the recommendation is
      far removed from current feeding practices in many
      countries. Given that the WHO recommendation is not
      directly applicable to formula-fed infants, some countries
      have adopted different recommendations regarding the
      introduction of complementary foods in these infants.”

      Like

      May 15, 2015
  9. Great post, incredibly thorough and incredibly clear, as always. I am curious if you encountered any other research on Type 1 Diabetes and gluten. My daughter was recently diagnosed, and there is some evidence that gluten may contribute in some way, either to the initial development of autoimmunity or in the conversion to hyperglycemia.

    Like

    May 14, 2015
  10. we just had our 4 month visit and my pediatrician suggested we start introducing whatever we’re eating. If we have eggs, dip a finger in the egg and give her a taste. Same with peanut butter or any other food. Then we should follow baby’s lead to find out if she wants more. She even recommended we read Baby Led Weaning, although she said the info in the book about allergens is outdated. Apparently, she had long been recommending early introductions of allergenic foods to her patients, even before the new study that recently came out.

    Like

    May 14, 2015
    • Interesting, thanks for sharing your experience!

      Like

      May 15, 2015
  11. Eva #

    Timely–thank you! We started solids two weeks ago, just past five months. I’m pumping at work, and we were operating on razor-thin margins with meeting his daytime demand for milk (he refused to take the occasional bottle of formula). Anyway, as we were talking to our pediatrician at the 4 month appointment about when and how to eventually introduce solids, she mentioned it might take some of the pressure off with breastfeeding. She said to start with veggies and cereals (fruits first would give him a sweet tooth, she advised); we asked if we could skip cereals and try finger foods first; she shrugged and said that was perfectly fine. She said if he was interested enough that we were starting to feel guilty eating in front of him, that was a good sign.

    He’s a very physical baby, very strong and intense, and was starting to reach for food and intently watch people eat. He couldn’t sit up completely on his own, but could sit in a high chair with his chest and elbows resting against the tray to keep him up. So we went for it.

    We started with a baby led weaning approach — roasted sweet potato spears, avocado, and hard boiled egg were his first three foods. He was thrilled, which made me feel like we’d done the right thing. However, his manual skills aren’t quite up to his appetite, and he always seems very happy if I hold some of his food for him to eat out of my hand, so we may try some purees now, too. He loves plain yogurt off a spoon.

    I think my husband would have waited a little longer to start solids, and that would have been fine too, but I feel like the kid was ready. He did have some disturbed sleep for the first 10 days, which got better when we scaled the haphazard solid feeding schedule back to breakfasts only. Could have all been coincidences, though.

    Like

    May 14, 2015
    • Hi Eva – Thanks for sharing your experience. I was about to write that there’s actually no evidence that avoiding fruits as first foods will help babies develop more of a taste for vegetables. That has been traditional advice, but it wasn’t supported by the research (albeit not great research). But when I went looking for citations, I found a recent paper that suggests that starting with vegetables does increase vegetable intake through 12 months – although this might just be about parental habits in feeding and not babies’ preference. Anyway, it certainly doesn’t hurt to focus on veggies at first. http://www.ncbi.nlm.nih.gov/pubmed/24973508

      I think you’re smart to be flexible about spoon-feeding and self-feeding. Some people really want to do strict baby-led weaning, but I’m not convinced that’s necessarily better for all babies. Some babies like spoon-feeding, and it opens up more food variety at this stage, when not all foods can be offered as soft chunks. The important thing is to be responsive to your baby’s signals of hunger and satiety, and speed of feeding, when spoon-feeding. And enjoy it! I really love feeding babies who are enthusiastic about food:)

      Like

      May 15, 2015
  12. Eva #

    Also, I asked the doctor specifically about how to make sure the baby gets enough iron, and she said they don’t test for it till 12 months and not to worry about it. That’s somewhat at odds with what you’ve written about breastfed babies and iron, i know.

    Like

    May 14, 2015
    • I don’t know why they don’t test for low iron until 12 months. It seems like 9 months might be more appropriate. But I also think there’s no reason to suspect your baby will have a problem with low iron if he’s enthusiastic about solids. Egg yolk is a pretty good source of iron. Meat and fish are the best. Legumes are also good sources and well-liked by babies.

      Like

      May 15, 2015
      • Eva #

        Thanks so much for your replies. Can’t wait to read your book.

        Like

        May 15, 2015
  13. This post is so timely for me! Our daughter is also just over 4 months old and her pediatrician said we can start solids at anytime… which seems strange to me since she is not sitting without support. She also recommended starting Vitamin D drops since she is EBF and not receiving much D. I’m not concerned about her iron stores for the moment because we did delay her cord clamping at birth. My main question is: how does this new research regarding allergies/autoimmune diseases and the start of solid foods relate to the “open gut” theory? Does it totally negate this theory now? I waited until my twins (my first kids) were 6 months to introduce solids, as that was the recommendation 2 years ago. It’s amazing how fast these recommendations change!

    Like

    May 14, 2015
    • The “open gut” hypothesis was never supported by good evidence as far as I can tell – at least the idea that the gut is “open” until 6 months – it probably is true to some extent at younger ages, which maybe is why we see that greater risk of celiac and type 1 diabetes in babies that start solids before 3-4 months. I haven’t seen any evidence to support the idea that introducing solids between 4-6 months has a detrimental effect on the gut, except for that one study discussed in the post that shows an increase in minor GI infections.

      The recommendations about solid foods have vary by country and even by professional organization within countries. No wonder you’re confused!

      Like

      May 15, 2015
  14. krs #

    My baby is about a week younger than yours, and I’d planned to do baby led weaning, but we ended up starting spoon fed solids at exactly four months because he was constipated- only going once a week or less. I know this can be normal for breastfed babies but he was extremely uncomfortable, so we started giving him lentils, sweet potatoes, beans and boiled prunes, all mashed. He loves them all and immediately was eating about a half cup at a time, which our pediatrician OKed. It fixed the constipation, and an added bonus was that as soon as he started the solids, he also started sleeping through the night. Other than skipping the night feeding he seems to be nursing just as much, so I’m curious if he’ll also be growing faster (he’s always been OK but on the small side).

    Like

    May 15, 2015
  15. Very informative post. My paediatrician recommended solids like rice and pulses when my daughter was 4 months old. First liquid and then in semi solid form. I also started giving her fruits and fruit juices like banana, mango, watermelon juice etc.
    Now my daughter has developed a habit of solid food and happily takes her bites. She is 6 months old now.

    Like

    May 15, 2015
  16. Alison #

    With our younger daughter (now almost 2) we tried to start at 5-6 months, but she had no interest until almost a year. This despite not liking the bottle and me working and leaving her 6+ hours a day from 6 months. She would eat a little with the sitter, but whether spoon-fed or finger-food she didn’t want much until she was about 10 months old, when it was like a switch went off and she started to eat anything (and still does). She was a tiny bit low in iron at one year, but that was gone by 15 months. I think it is so baby dependent!! She had a lot of tummy issues and so we were seeing a great GI/allergist and he said that some kids’ digestive tracks just develop more slowly than others. This is hardly surprising when you think of differences in other development (e.g. walking).

    Like

    May 15, 2015
    • Absolutely agree that babies’ development of both physiology and interest varies a lot, and it seems silly to think that every baby would be ready right at 6 months, not before and not after! I also believe that it is really important not to force or pressure your baby to eat anything she doesn’t want or more than she wants, so I think you were right to follow her lead, with an eye on iron. (You can always add an iron supplement if needed, but it often isn’t.)

      Like

      May 15, 2015
  17. Hello! I found this post very interesting. Thanks!
    My daughter’s pediatrician asked us not to introduce solids until she was 6 months old. She said something about her digestive system not being ready for some things. Plus, I was breastfeeding.
    We did follow her advice (and still do) since we suppose her to be very good in her field since she is part of UNICEF’s team of specialists that develop (and publish) guidelines for parents about children’s nutrition.
    But now I read this post and I wonder…

    Like

    May 15, 2015
    • Oh! You are the first commenter to say that your pediatrician recommended waiting until 6 months! There are many people, especially those interested in supporting and encouraging better breastfeeding rates, that think that 6 months EBF is best, and that’s why we see those recommendations. I don’t think there is strong evidence either way, and there is an ongoing controversy about it. It might be interesting to ask her more about digestive system readiness, but she could be saying that based on the study finding increased risk of mild GI infections. I’m sure your pediatrician is great. I intentionally tried to write this post to simply represent the science (which is complicated!) and leave the decision about what is right for you based on your preferences, your baby, and your pediatrician. Not intended as medical advice:)

      Liked by 1 person

      May 15, 2015
      • Don’t worry, I know better. I’ll keep following her advice, since she is a wonderful professional in many ways and I trust her judgment.
        My girl doesn´t BF any longer but I keep reading on the topic because I find it amusing.
        For me, a person that doesn’t study science (I’m an ESL teacher), all of this is complicated. I know for a fact that I have worst and less information and understanding than people who tell me different things. And the desitions I make based on that affects my baby’s development.
        So it’s a matter of trust. On institutions and people.
        I find it very difficult, so I keep reading and “talking” about it. And your post is filled with information and sources, so I just find it very interesting.

        Like

        May 16, 2015
        • Absolutely. I’m a big believer in finding health care providers that you trust and build a good relationship with them. That’s a tremendous asset to parenting. It can really help you to relax about questions like these and enjoy the process with your baby. None of us can know everything, so it’s great to have expert advice from well-educated people that you trust. Plus, your daughter’s pediatrician knows you and knows your daughter, and she can give advice based on that. No blog can do that. Who knows, she may have given Roxanne different advice given her situation. “Official” advice aside, I think most pediatricians do a great job with giving practical advice to fit each family’s situation, culture, and priorities. I really respect your open-mindedness to learning more, and I bet your pediatrician would be open to discussing the evidence with you as well.

          Liked by 1 person

          May 16, 2015
  18. b #

    Did the studies recommend/use a specific amount of solids per day? I’ve always heard that breastmilk is higher in calories than most solids, and that that is why you are supposed to breastfeed immediately(-ish) before feeding other foods until 1 – to make sure that most calories are still from breastmilk and that baby isn’t filling up on lower calorie solids.

    Also, was there any influence noted from the different introduction times for solid foods on the duration of breastfeeding?

    Like

    May 15, 2015
    • Breast milk is more calorie and nutrient-dense than pureed fruits and vegetables (usually thinned with water), but not necessarily other foods. For example, cereals will often be mixed with breast milk or formula, and meats and eggs contain significant fat that increases the caloric content. There are different theories about how and when to offer solids, but I can’t find firm research support for one or the other way. I like the advice to start at one meal per day and gradually increase from there. That way, you can follow baby’s lead and let her eat what she wants at that one meal and then breastfeed on demand for the rest of the day. I also like the WHO document on complementary feeding, though it is targeted more to developing countries (and as you can guess, I think that starting solids between 4-6 months in developed settings is fine). They recommend 2-3 solid meals at 6-8 months and then 3-4 at 9-23 months, with 1-2 snacks as needed. This is based on estimated nutrient and calorie needs from solid foods, distributed out to reasonable meal sizes. But I think you really don’t want to be too rigid about this – meal frequency and size will be determined in part by how feeding foods and breast milk fits into your day. (Here’s the link for the WHO document: (http://www.who.int/maternal_child_adolescent/documents/a85622/en/)

      Your question about duration of breastfeeding is really interesting, because that is one of the rationales for recommending EBF for 6 months (i.e. starting solids may lead to earlier weaning from breast milk). The Iceland trial actually looked at this question and found that, yes, 6 months of EBF did increase total duration of breastfeeding. I think it is important to be aware of this, but it seems like the best way to address it is to discuss it directly with moms, not indirectly through the recommendation for 6 months of EBF. http://www.ncbi.nlm.nih.gov/pubmed/24621390

      Like

      May 15, 2015
  19. samitakaur1974 #

    Reblogged this on myideasaremine and commented:
    Between 4 to 6 months. Start with lentil soup. Basically it should be sieved well. Should be like clear soup.

    Like

    May 15, 2015
  20. mt #

    We started solids at 5 months. Our doctor ok’d it, mainly because we were anxious that after months of (what seemed like) nonstop nursing, our son was barley hugging the bottom of the growth curve. He was holding his head up at that point, and once he got a taste of solid food, that was it (avocado, sweet potato, and porridge). I had planned to nurse for 1 year, but at 10 months, my son was completely uninterested in nursing. I decided to to press the issue.

    We also gave him dairy much sooner than the AAP recommends (we were overseas but aware of the AAP guidelines). I looked at the doctor skeptically when he said we could mix butter into our son’s porridge, but he said it was common practice where we were, and from what I could tell, the babies there generally looked very robust!

    I think the AAP has a hard job–anxious parents want THE answer, but there are a wide range of natural and healthy practices!

    Like

    May 15, 2015
    • The AAP does have a hard job, as do all of these organizations. You’re so right. As do pediatricians. In this case, as well as others, I think pediatricians have to sometimes reconcile what is held up as the “ideal practice” with what will work for individual babies and families, while remaining both evidence-based and supportive. Not easy, but in the case of solid foods, I think you’re right that we can all relax and accept that there are lots of “right” ways to do it. Given the different pace of development of different babies, it seems silly to expect all babies to be ready at exactly the same age.

      Regarding dairy, the current U.S. recommendation (and in Europe, too) is to avoid drinking cow’s milk until age 1. However, it’s fine to introduce cheese, yogurt, butter, etc. along with other foods. Too much milk gets in the way of iron absorption, and breast milk or formula are better-suited to the nutrient needs of babies, but a little dairy is just fine.

      Liked by 1 person

      May 15, 2015
  21. Teresa #

    Oh my head. I’ve been reading about this topic for a long time. My pedi suggested we wait til 6 months and most of what I read suggests the same. We have no history of allergies and I was confident that my healthy diet would provide great breast milk. We introduced fruits, veggies, grains, and so on. My daughter loves food. Everything was perfect until we came to egg. She had a small reaction. So then we waited a while and tried again. She had the same tiny red dot reaction. I was advised to stop dairy, gluten and egg to let the gut heal. Oh she also had mild eczema. Her skin is now baby smooth but I’m now stumped. Should we try these foods again? Is the gut healed? Is there really leaky gut? Like I said, oh my head. By the way, I love your blog and recommend it to all my mommy friends. Big thanks!

    Liked by 1 person

    May 15, 2015
    • Hi Teresa – I can’t give you medical advice here, but I would suggest that you discuss this with your pediatrician and maybe a pediatric allergist. I don’t really buy the leaky gut idea or the necessity of healing the gut, but I’m no expert. I do know that many parents assume that their kids are allergic to foods when they really have outgrown the allergy, so it is worth talking with an allergist so that you don’t have to unnecessarily restrict foods.

      Thanks for recommending my blog! I’m glad you like it!

      Like

      May 15, 2015
  22. Helen Gray #

    Thank you for this review of the evidence. It would be very helpful if you could also consider the following:
    1) can you tell us which of those researchers – and which studies – have been funded by baby food industry and industry organisations? Transparency of conflict of interest is essential in evaluating their results.
    2) I don’t think we know yet what normal iron levels are for babies who do not have early cord clamping
    3) Higher levels of iron are not necessarily good, high iron can actually be toxic for babies. I believe there has been some evidence that excessive amounts of follow-on formula can produce this.
    4) In fact breastfeeding under six months can be very effectivene as contraception (as effective as condoms) if LAM guidelines are followed: http://www.ncbi.nlm.nih.gov/m/pubmed/9262927/

    I look forward to reading more of your investigative writing!

    Like

    May 15, 2015
    • Hi Helen,

      No time to respond to all of your questions at the moment as I hear BabyM stirring from his nap, but I’ve gotten through checking on funding sources for you so want to copy them here.

      Cohen 1994 – Thrasher Research Fund, WHO, UNICEF/Honduras, Institute for Reproductive Health. Foods provided by Gerber.
      Dewey 1999 – Sponsored by UNICEF, USAID
      Dewey 2001 – Thrasher, WHO, UNICEF, Institute for Reproductive Health, USAID
      Jonsdottir (Iceland Study) – Mead Johnson and the Eimskip Fund of the University of Iceland. (“The sponsors of the study had no role in study design, data collection, data analysis, data interpretation, preparation of the report or the decision to submit for publication.”)
      Kramer 2003 – Thrasher Research Fund, the National Health Research Development Program (Health Canada), UNICEF, and WHO
      Quigley 2009 – National Perinatal Epidemiology Unit, funded by Department of Health in England
      Poole 2006 – NIH (National Institute of Health, USA)
      Frederickson 2013 – NIH
      Hummel 2011 – various national Dutch and German health organizations
      Kramer and Kakuma 2012 (Cochrane Review) – McGill University, Canadian Institutes of Health Research, Canadian Cochrane Network, WHO

      The only real potential conflict of interest that I see is with the Iceland study (Jonsdottir), and their disclaimer is reassuring. We certainly wouldn’t base all of our conclusions on one study so matter what the results were, but the results in Iceland also align with those seen in Honduras.
      More later… Thanks for the great questions.

      Like

      May 16, 2015
  23. LS #

    Reblogged this on Nutrition.Health.Life..

    Like

    May 16, 2015
  24. Definitely one of my favorite blog! Another useful and timely post! Looking forward to read your next post on how to tell when the baby are ready for solids. My baby is 3,5 months. My grandmother always make such a fuss and push me to start solid because that’s what she did with her babies. She said my breasts size doesn’t seem to be “big enough” (well I am naturally slender), so of course my breast milk alone would not be sufficient for baby. She assumes that my baby is always hungry. But so far my baby is very big and healthy, he weighed perfectly normal. He is even considered a little over-nutrition for his age. Thanks for writing this, now I can argue better and have more peace of mind.

    Like

    May 16, 2015
  25. Gosh – wish you;d been around when I was weaning! Now, do you ahve nay advice for 9 year olds who ‘don’t do green’!!

    Like

    May 18, 2015
    • maggie #

      Try telling them it’s ground-up frogs? 🙂
      My daughter will eat salads if I let her assemble them herself at the table; especially with dried fruits and nuts; same with tacos. We also “hide” vegetables under the cheese on white pizza. Veggies in scrambled eggs are another crowd pleaser in our house. Also, if you can, veggies from a farm share or farmer’s market taste much better. Trader Joes has a really good selection of dried vegies that are crispy like potato chips. They don’t have all the nutrients, but they aren’t bad for snacks.

      Liked by 1 person

      May 18, 2015
  26. maggie #

    I started my daughter on mixed grain baby cereal at 5 weeks, just a little on a spoon. I mixed it with her vitamins so she already liked the taste. Every time she started waking up in the middle of the night, we upped the amount by half a teaspoon. She started herself on other solids at five months by grabbing a peanut-butter cookie from her father at a Christmas party. Our pediatrician was educated in Africa and said “as long as you aren’t feeding her clay from the river bank…” We have no family history of food allergies, and a family tradition of starting with oatmeal between 3 to 5 weeks for several generations. I have a lovely painting from about 1900 that I was given as a gift that shows a mother spoon feeding a baby too young to lift their head. 🙂 My daughter is now 6, and is a fussy eater in that she will only eat what the adults are eating. She won’t do kid’s menu at all.

    Like

    May 18, 2015
  27. Reblogged this on La Sora cecioni and commented:
    Vi segnalo questo articolo su quale sia il momento miliore per iniziare lo svezzamento, dato che è un tema controverso e che forse non ha una risposta unica. Io ho fatto di tutto per aspettare i 6 mesi e credo che questa sia la scelta che tutte dovrebbero fare. Senza farsi prendere dalla foga di inziare qualcosa di nuovo, introducendo piano piano nuovi cibi e nuove consistenze. Perchévin questo percorso di maternità, ricordiamocelo, la pazienza sarà la nostra migliore amica.

    Like

    May 18, 2015
  28. I started my son at 4.5 months, here in Australia the recommendation is no earlier than 6 months and we are advised to breast feed and solid feed from 6-12 months then transition to a sip cup with meals. Crazy isn’t it! Good read, thankyou xx
    http://www.polishedpurposefulpretty.com

    Like

    May 21, 2015
  29. very nice

    Like

    May 27, 2015
  30. Justme #

    My twins were born in 2007 at what seemed to be the height of the breast is best movement. There seemed to be a feeling among my fellow moms that the longer you could withhold solid food the better. I heard many times that children don’t need solid food before 12 months and that “food before one was just for fun.” So, not surprising I knew several moms who withheld solid food until the 8th or 9th month or beyond- and then only introduced food very slowly. One mom in my cohort had a severely underweight child. Both her pediatrician and her LC told her to supplement with formula or solid food prior to six months but she was proud that she managed to hold out until 7.5 months to introduce solid food. I felt a little sorry for the baby as she seemed to be starving and is still a tiny, skinny little thing.

    I introduced food to my babies at around 5 months because it was fun and they seemed ready and definitely felt disapproval from my fellow moms and even the nurse practitioner who ran the Baby and Me class we attended. I felt like the attitude in our community around infant feeding was totally nutty but still felt guilty about my rather free-wheeling approach to it all. Seven years later, I’m not sure if the attitude around infant feeding is still as the same but I sure am glad my kids are past this age. The craziness and “judginess” around food kind of evaporates after a few years when most everyone’s kids – including those who only had the purest of mother’s milk before age one – seem to have developed a taste for Sour Patch Kids and Doritos.

    Like

    July 23, 2015
  31. Rosanna #

    Hi! What are your thoughts on the “open gut” or “virgin gut” theory that gets thrown around regarding introducing foods before 6 months? Is there some truth to it?

    Thanks!

    Like

    September 1, 2015
  32. Lydia #

    My baby gets breastmilk through a gtube (feeding tube into his stomach). He has had very small amounts of rice cereal since three weeks old because anything he takes by mouth must be thickened. The thickening of rice cereal is because he aspirates thin liquids. But it has been VERY minimal, like one or two teaspoons of rice cereal per day. From three to four months old he stopped being able to suck on a bottle so then it was even less, like what he could be fed with a pacifier. Now that he is 5 months old, we are starting greater amounts of rice cereal and spoon-feeding. We want to increase his oral feeding so he develops his swallowing mechanism and can eventually swallow thin liquids and get off the feeding tube. After reading this article, I wish we had started the spoon-feeding of rice cereal a month earlier when he was four months old and could be starting other purees this month. I praise Jesus that he is enjoying the spoon-feeding as there is a fear of becoming averse to oral feeds when so much tube feeding is going on. We believe he will take off in his oral feeding abilities as he is allowed to enjoy more purees. We do not have high hopes that he will ever learn to use a bottle and hope to start him on a sippee cup with thickened liquids as soon as he has the coordination.

    Like

    September 16, 2015
  33. Helena #

    Thank you for posting this. The majority of posts I’ve seen so far are second hand, lack references, are terribly biased, and not nearly as comprehensive. This is a great jumping off point, and I especially appreciate the list of references below for further reading!

    Like

    December 7, 2015
  34. BV olud #

    i like it but i need to be sending informations

    Like

    January 8, 2016
  35. Cat #

    Can you touch on evidence that indicates there is a connection between obesity and starting solids prior to 6 months?

    Like

    January 25, 2016
  36. AH #

    So nice to read a sensible discussion not a hysterical “mommy blog”. My 4 month old Spawn had been miserable and waking hourly for full feeds at night and ratty during the day. He sits up well and is ahead on his milestones. A few cubes of sweet potato smoothed with breast milk and he is a different baby! I had been second guessing myself horribly and worrying about allergies… this really reassured me that I’m doing the right thing. That and his attempts to bite the end of the spoon off!

    Like

    February 7, 2016
  37. My husband really wants to give our nearly-3-month-old tastes of food and I mentioned dangers but he doesn’t feel like the risks are all that worrying. I have trouble finding info that is convincing enough for me to show him proof instead of being b*tchy about the subject. My baby got a finger-taste of red salsa and his face just lit up and he began begging for more food but I said hell no. Do you have anything you could share with me?

    Like

    March 12, 2016
    • Amanda – you can follow the links to pull up studies for him from this paragraph of the post (towards the end of the “What is the official advice?” section:

      “Just about everyone agrees that is best to wait until 4 months to start solids. Studies have shown that introducing solids before 3-4 months can increase the risk of eczema at age 10, celiac disease, type 1 diabetes, wheezing in childhood, and increased body weight in childhood.8–11”

      Also, you might just ask him why he is in such a hurry? What does he think your baby gains by having tastes of food now? There really is no reason to rush solids before your baby is ready, and there is evidence that it is not good for your baby’s health.

      You might also check this post, which explains readiness in more detail. Good luck!
      https://scienceofmom.com/2015/05/28/4-signs-your-baby-is-ready-for-solid-foods/

      Like

      March 12, 2016
  38. Anne M.B. #

    I can’t believe I am just now finding your blog, thank you for this!

    My little boy is 7 months old and we have barely stepped into solids. Our pediatrician said we could start rice cereal and some veggies/fruit after our 4 month check but our son was born six and a half weeks prematurely and just didn’t seem ready.

    Ultimately I decided to go more off of developmental cues than his actual age and it seems to be working for us. He has better head and torso control now and shows interest in what we are eating.

    Thank you again!

    Like

    April 30, 2016

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  15. What’s Up With the Virgin Gut? Do Babies Really Have an “Open Gut” Until 6 Months of Age? | The Science of Mom

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