First Bites: Knowing When to Introduce Solids to Your Baby

In this episode, we explore the data and research being conducted on when solid foods should be introduced to infants as well as how and when foods are introduced influence food allergy development. The information  covered draws heavily from the American Academy of Pediatrics and  Centers for Disease Control as well as the European Paediatric Association.  Additionally, discussion of two new research studies published in October on the development of food allergies in relation to infant food introduction are also reviewed to gain insight on how recommendations are evolving based on new data.

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Transcript

Welcome to another episode of Proactive Parenting, a show where I offer you judgment free advice on how to raise value driven children in a way that’s right for your family using the most current scientific research out there. I’m your host, Dr. Deanna Marie Mason. I’m a certified pediatric nurse practitioner, published author, and expert in child development. I’m also the mom of two fabulous teens so I know first hand how much misinformation is out there - and that’s why I’m here. So grab a cup of coffee or tea and settle in. This is a safe space where you can ask questions and get real, honest answers about how to raise kids in the way that works for you.

On today’s episode, let’s take a look at the data and research being conducted on when solid foods should be introduced to infants as well as how and when foods are introduced influence food allergy development. The information we will be covering today is from the American Academy of Pediatrics as well as the Centers for Disease Control. You may more commonly know these groups by their acronyms - the AAP and CDC. Additionally, two new research studies were published in October addressing infant food introduction, so it seems like a good time to look at this information again.

So, let’s start with the recommendations from the AAP and CDC. All major pediatric health organizations recommend introducing solid foods to infants at 6 months. Prior to 6 months, breast milk or formula are sufficient for infant growth and development. However, many parents desire to introduce solid foods earlier because they believe that their baby is interested in solid foods, hungry for more than breast milk or formula, or to help their baby sleep through the night sooner. All of these desire sound reasonable at first glance, but there is more to infant nutrition than meets the eye. Let’s take a look at this topic more closely.

When babies are born, their gut is sterile. They don’t yet have bacterial colonization in their gut to help with breaking down food, vitamin production or gas production to propel stool through the gut. As our babies drink breast milk or formula, the gut slowly colonizes healthy bacteria to help with digestion and vitamin production. These bacteria are essential for the creation of certain vitamins, such as vitamin K, your baby actually gets a shot of vitamin K in the hospital before they leave to make sure their blood can clot, and to break down some components of food so the body can use it. 

Of course, this colonization of the gut can create gassiness in the beginning. This gassiness is useful to help propel the baby’s poo through the large intestine and out of the body. Some of our little kiddos have mild discomfort from this gas that they pass easily while other babies feel it more severely and experience colic. Luckily, for both sets of babies, a little gastric massage can help reduce this discomfort and help propel their bowel contents more easily from the body. If you want to learn how to do this massage, please don’t hesitate to check out my video course on Newborn Care that is available on my website, proactiveparenting.com.

Now, breast milk and formula are easily digested foods that help this natural process of bacteria colonization and gas formation to occur easily. In fact, breast milk is the easiest food for our babies to digest. First, the breasts produce colostrum, which is a protein powerhouse that provides concentrated energy and is easy for our baby to digest. It literally opens up the digestive canal and helps expel the meconium, or black tarry stool that is sitting in our baby’s intestine from swallowing amniotic fluid. And, infant formulas are especially made to have small molecules that are easy on our baby’s gut to break down. So whether an infant is receiving mother’s milk or formula, the gut is not stressed.

But, when we introduce solid foods before the gut is appropriately colonized and ready to process more complex foods, we can actually create increased gassiness, constipation, and discomfort in our baby. When the gut is fully colonized depends on our baby’s body, the composition of the breast milk or formula they are eating, and simply time. We cannot say for sure when each and every baby is fully ready for solid food, but we know that statistically it does not happen before 6 months of age. So for the grand majority of infants, their guts will be immature for solid or more complex foods prior to 6 months of age. Could there be exceptions? Sure, of course. But for safety’s safe and their comfort, it's best to wait until 6 months before introducing solid foods.

If this is the case, why are parent’s interested in introducing solid food earlier than 6 months? A lot of interest has to do with misinterpreting what their babies are doing and thinking that their babies want to eat solid foods. I think it might be a good idea to see how this happens. Babies will start to become interested in what their parents are doing, including eating, around 4 month of age. This happens because, developmentally, our baby's eyesight is better, they are more social, and are awake for more time during the day. So it’s only natural that they start paying more attention to what's going on around them. However, it’s important that parents do not mistake this natural interest in their surroundings as a petition for solid food. Instead, it is better to understand this natural change in development and support it without putting their little gut at risk.

So, how do we do this? I think it's a good idea to allow young infants to participate at meal times. Breastfeed or formula feed just before everyone sits down to the family meal to make sure they aren’t hungry. Then have them sit with the family at the table, in a highchair, to explore the sights, sounds, and smells of mealtime. Of course they are going to be looking and reaching for everything, because that’s what babies do at that age. But they aren’t asking for food. They are asking to touch and explore what their eyes are seeing. Give them a plastic spoon to hold and bring to their mouth. Smile and talk to them. Place a plastic plate in front of them that they can explore. All they want is to be part of the action and connect with everyone else at the table.

By 6 months infants have the motor skills for solid foods in addition to their guts being colonized and ready for more complex foods. 6 month old babies are able to sit up, hold their head up, and control their mouth and tongue movements to effectively move food from the front of their mouth to the back for swallowing. This helps avoid the risk of choking. Additionally, they fully understand that their hands are under their own control and can begin to practice the complicated coordination of picking up food from a tray and transferring to their mouth. They love to have control over feeding themselves and take great pride when food reaches their mouth. Of course it’s messy, but their joyful faces make it totally worth it.

Lastly, no research has confirmed that feeding infants solid foods prior to 6 months helps a baby “sleep through the night.” A study that came out about two years ago shows that babies who were fed solid foods prior to 6 months of age slept approximately 20 minutes longer than infants who were exclusively fed breast milk or formula. A small improvement, but nothing that will change a family’s nighttime baby routine. Even with the positive findings of sleeping an extra 20 minutes, this study found that infants who were fed solid foods were more constipated. This may have been related to a lack of sufficient bacterial colonization and gas production to move the solid foods through the gut, but the researchers were not investigating infant constipation, so they couldn’t come to a conclusion about the reason.

That said, sleeping through the night is a learned behavior. To get our babies to sleep for long stretches, they must learn and practice self-soothing to stay asleep. Filling their belly with food won’t necessarily increase night sleep and, at best, it will only add an extra 20 minutes. But it may cause constipation that could also affect the quality of sleep. So it seems like a toss up.

On a slightly different but related note,  childhood obesity has increased 5 fold since the 1970’s. Some researchers investigated if introducing solid foods before 6 month had an influence on later obesity. The good new if you've already introduced solid foods early is that the research showed that introducing solid foods before 6 months had no link to increased childhood obesity.

All major pediatric groups, including the AAP and European Pediatric Association, as well as the CDC, continue to recommend exclusive breastfeeding or formula feeding until 6 months of age. We know that at that time, the baby’s gut is ready to digest and expel the more complex nature of solid foods as well as being developmentally ready with sufficient motor skills to make eating safe.

Now, this information hasn’t changed since the 1990s and continues to be supported in the scientific literature. However, new information is being published about food introduction and food allergies. A new study out of Northwestern University Center for Food Allergy & Asthma looked at children with peanut and milk allergies and when they were first introduced to those foods. The results showed that children who were exposed to these foods earlier had less allergic reactions to them. It appears that when our kiddo’s body is introduced to potentially allergic foods early, at 6 months of age, they have less risk of developing an allergy to that food than if they were introduced to the food later, say around 11 months.

Breastfed babies can be introduced to a wide variety of foods through their mother’s milk. Mom’s who are breastfeeding can eat foods that tend to be allergy causing and their babies will get trace amounts of that food in the breast milk. This is a very easy and gentle way to introduce babies to a variety of foods prior to 6 months when solid foods are generally introduced.

Now, while previous recommendations were based on avoidance or delaying the introduction of allergy provoking foods, new data is showing that early introduction may actually be protective against the development of allergies. Of course, more research needs to be conducted, but it appears the guidelines for peanut introduction will be modified as more information becomes available.

As always, if your family has a history of food allergies, especially if severe, it is wise to seek the guidance of an allergy specialist to know how to best proceed in your family. However, for families without histories of food allergies, talking with your primary care provider will help you know when to offer peanuts, eggs, and milk to your little one. Regardless of what the final recommendations are, working purposefully to reduce food allergies in children is good for the health and well-being, as well as quality of life.

Another interesting study that came out recently published in the American Medical Association’s open access journal called JAMA Network Open. In this study, researchers looked at how long pediatric care providers were recommending to wait between the introduction of new foods in comparison to the AAP and CDC recommendations on this topic. Previous recommendations from the AAP advised waiting 3 to 5 days before introducing a new food. So, if we followed this guideline, we would introduce a banana to our baby today and then we would have to wait 3 to 5 days before introducing pears. If parents strictly followed this recommendation, a baby could only be introduced to between 36 and 61 foods in the first year of life, if solid foods were started at 6 months.The reasoning behind this recommendation was to allow sufficient time between new foods so that any allergy or reaction would be seen and the likely culprit identified. It was seen as a safe thing to do.

However, in today’s modern family, we eat a diverse diet with many different types of foods. Plus, as we just talked about, introducing foods earlier may actually help decrease the likelihood of food allergies. So waiting 3 to 5 days between new foods may actually be more risky than what was previously thought.

So when researchers surveyed doctors, resident physicians, and nurse practitioners who cared for babies, they found that they were giving different recommendations that what the AAP said. Overall, they found that about 40% were following the AAP recommendation for 3 or more days between new foods, about 20% were recommending a 2 day wait, and just under 30% were recommending a wait of just one day. The researchers also found that these providers were giving different advice on when to introduce solid foods. So in the end, there seems to be a disagreement between the recommendations and what providers are recommending to families. Further research will be needed to fully understand the prudent time needed to wait between new foods as well as the importance of early introduction of potentially allergic foods. There seems to be a need to look at these issues more closely so that clear, research-based recommendations can emerge.

In the meantime, we, as parents, can support healthy growth and development of our babies through good nutrition that starts in infancy. If we are able to recognize infant nutritional needs, not confuse natural development around the age of 4 months as a sign of hunger, and make sure that our babies have mastered the necessary motor and coordination skills prior to introducing solid foods will make the experience healthy and happy for both baby and parents.

This topic always sparks a lot of interest and opinions because food is really personal issue in families. Please feel free to share your ideas or experiences. Since this is a big issue, it comes around quite often as researchers are always looking into ways to make sure everyone is eating a healthy diet. So if this didn’t quite get at what you wanted to hear about, don’t hesitate to reach out and let me know what you want to know. That said, we’ll be talking more about this topic in the future because there is so much more to explore. Don’t hesitate to leave comments or questions; you can email me at: deanna@proactiveparenting.com. And if you want to find out more about me and what I do at my website, www.proactiveparenting.com

You can also find me on Facebook and Instagram by searching for my name - Deanna Marie Mason, where you can connect with other parents just like you. Finally, if you would like to purchase any of my books or online courses, you can do so on my webpage. Again, that’s www.proactiveparenting.com.

Thanks so much for listening, I hope you found this episode useful and interesting. If you did, please leave a comment or review, and tell a friend so they can become a Proactive Parent too!

Well, I’ll close here. This is Dr. Deanna Marie Mason signing off, for now. I look forward to seeing you again soon. Until then, take care and be well. Bye!