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?
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Organisation
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When to start solids
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Factsheet link
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World Health Organisation
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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!
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|
Australian Breastfeeding Association
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6 months
They have written a very informative
article on this topic - see link.
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National Health and Medical Research Council (The Australian
Government)
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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.
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NSW Health
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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
|
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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