Monday, January 28, 2013

To Start or Not to Start - the Introduction of Solids...The conundrum!

Today we have a guest post from Valerie Gent.  Valerie is an Australian based Speech Pathologist working primarily with infants and children with feeding difficulties.  She has graciously offered to share some insight regarding timelines for starting infants on solid foods.  Take it away Val...

When should I start my baby on solids is a question posed to Paediatric Feeding  Speech Pathologists, Doctors and Baby Health nurses nearly every day. When I answer it in my practice, 'Let's Eat! Paediatric Speech Pathology', I find that it's not always a clear 'yes' or 'no'.


The difficulty being that there are lots of different views on when is the "right" time. I hope to be able to summarise most of the recommended guidelines from different authorities as well as tell you as mums what you need to look for in your own baby.



What are International and Australian organisations recommending?

Organisation
When to start solids
Factsheet link

World Health Organisation

6 months

WHO also notes that at 6 months, infants are likely to be developmentally ready for solids. They also recommend not waiting longer than 6 months as it may affect a child's growth.



On an aside, there is a really strong push in Australia to breast feed up until 12 months with some organisations such as WHO and the Australian Breastfeeding Association recommending it for longer. WHO states that  breast milk provides 'one half or more of a child's energy needs between 6 and 12 months of age, and one third of energy needs between 12 and 24 months.' -  think about it - one third - which is actually a lot!


Australian Breastfeeding Association
6 months

They have written a very informative article on this topic - see link.




National Health and Medical Research Council (The Australian Government)


6 months
They do acknowledge that some babies may benefit from the introduction of solids earlier than 6 months (but not before 4 months of age) - but it is generally advised to discuss this with your doctor first.




Under review - I contacted them when writing this article and they said they should have something available in mid Feb 2013. Email me if you would like this factsheet emailed to you when it's released.

NSW Health

As most of you reading this are Australians living in NSW where my practice "Let's Eat! Paediatric Speech Pathology" is located, I thought it would be helpful to also see what our state health is recommending.
 
6 months






So you may begin to start wondering why I decided to write this blog post? I'm on several "mummy" Facebook groups and it astounded me the varying advice bantered around - controversy, myth, outdated advice and mothers getting quite heated that they had the "right" information with internet links to boot!



Maybe history may explain some of the advice given to mums?
In the early 1900s, Paediatricians recommended cod liver oil and orange juice (with no solids) up until 12 months. More recently, in our grandparent's generation, the recommendation was to start bit earlier than 12 months due to iron deficiencies and in our parent's child bearing era (1950s - 1970s), starting solids was recommended as young as 3-6 weeks of age. So it is likely that our parents started us earlier on solids....


To add more food for thought -

The Australasian Society of Clinical Immunology and Allergy
ASCIA recommends introducing solids between four and six months (whilst breastfeeding) and not to delay the introduction of possible allergenic foods (unless you have a family history of allergies, in which case it's advised you speak with your doctor). Here's a link to their factsheet:
http://www.allergy.org.au/health-professionals/papers/ascia-infant-feeding-advice



What is causing health professionals to hesitate is that there is a lot of debate around solids and their introduction, what we do know is this:

*  Food allergies are rising in Western countries with the frequency of allergic disease in Australia doubling over the past 25 years (ref 1-3)
*  There appears to be a link between allergies and delayed introduction of food but as to starting earlier? A systematic review of the literature suggests there is an increased risk of allergy associated with the earlier introduction (early than 4 months) of solids (ref 3 & 4).



So that's the evidence but how do you as a mum know when your baby is ready for solids?

We use 26 different muscles to eat and swallow. We also have to coordinate our eating and breathing - we hold our breath while we swallow food.  So your baby not only needs to:

  • Develop the right oral muscle strength to control and manage their solids - this is more than just the loss of the 'tongue thrust' reflex which happens around 4-6 months. It is also the development of your baby's jaw, lip seal and tongue.
  • Babies need good body strength (commonly known as core stability) to be able to keep their head and body supported while they concentrate on eating. There is a bit difference in core stability in a 4 month old baby to a 6 month old baby.
  • Show an interest in your food - this is more than just mouthing as most 4-6 month old babies will put just about anything in their mouth - food, fingers, toes etc. The other signs might also be looking at spoons and opening their mouths while you eat, your baby might imitate your chewing/mouth movements etc
  • Another sign is one I don't necessarily agree with - showing hunger signs by waking in the middle of the night. There is a developmental growth spurt around this time so starting solids earlier to help your baby sleep through the night may not necessarily work.


So where does that lead you?

  • Don't start too early (before 4 months) as it is
                    →not ideal for your baby's digestive system
                    →can affect their intake of breastmilk/formula

·        Don't start too late (later than 6 months) as it

                    → may increase their allergy risk
                    → their nutritional sources (zinc and iron) start to deplete (it is a gradual process)

·        Introduce all food types from 6 months and onwards! There is no need to hold back on certain foods (see the Ascia 'infant feeding advice' link above for details). However if you do have a history of allergies in your family, it is best to discuss what to introduce and when with your GP/Paediatrician/Allergy Specialist.



Knowing when your baby is ready for solids is not as clear as black and white. Remember that it is a learning process for them and they may not start eating big amounts for a while which is okay! Let them touch it, taste it and most importantly enjoy the experience. Keep mealtimes as fun, interactive and pressure-free as you can and your baby will thank you for it. Good luck and enjoy this next chapter of your child's life!



References:

1.  Wilkinson, P.W. & Davies, D.P. (1978)  When and why are babies weaned? British Medical Journal 1: 1682-1683
2. Fewtrell, M., Morgan, J. Duggan, C., Gunnlaugsson, G., Hibberd, P., Lucas, A. & Kleinman, R. (2007) Optimal duration of exclusive breastfeeding: what is the evidence to support current recommendations?  American  Journal of  Clinical Nutrition, vol 85 no. 2 635S-638S
3. http://www.allergy.org.au/patients/food-allergy/food-allergy factsheet
4.  Beth A. Tarini, MD; Aaron E. Carroll, MD, MS; Colin M. Sox, MD, MS; Dimitri A. Christakis, MD, MPH. (2013), Systematic Review of the Relationship Between Early Introduction of Solid Foods to Infants and the Development of Allergic Disease, JAMA Paediatrics Vol 167, No. 1
About the author of this blog post:

Valerie is an Australian based Speech Pathologist with 10 years experience in Paediatric Feeding. She has recently opened a private practice called 'Let's Eat! Paediatric Speech Pathology' that caters for Newcastle based babies and children with feeding difficulties. Valerie is passionate about working in the area of paediatric feeding and has been involved in the teaching and training of Australian Speech Pathology University students and allied health professionals. You can find out more about Valerie Gent and 'Let's Eat! Paediatric Speech Pathology' via her website www.letseatspeech.com.au and Facebook page or email her on valerie.gent@letseatspeech.com.au

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