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the Breastfed Baby
Is my baby ready for solid foods?
Health experts and breastfeeding experts agree that it's best to
wait until your baby is around six months old before offering solid
foods. The American
Academy of Pediatrics, the World Health Organization, and many other
health organizations recommend that babies be exclusively breastfed
(no cereal, juice or other foods) for the first 6 months of life.
Some doctors may recommend delaying solids for the first year if
there is a family history of allergies. I'm not going into the many
health benefits of delaying solids here; see Why
Delay Solids? for more information.
Solids readiness depends on both the maturity
of baby’s digestive tract and baby’s developmental
readiness for solids. Although the maturity of baby’s digestive
system is not something that we can readily observe, research indicates
that 6 months appears to be ideal for avoiding the allergies and
other health risks of too-early solids. After this point, different
babies are ready for solids at different times -- developmental
readiness for solids cannot be determined using a calendar. Most
babies are developmentally ready for solids somewhere between 6
and 8 months.
Signs that indicate baby is developmentally ready for solids include:
- Baby can sit up well without support.
- Baby has lost the tongue-thrust reflex and does not automatically
push solids out of his mouth with his tongue.
- Baby is ready and willing to chew.
- Baby is developing a “pincer” grasp, where he picks
up food or other objects between thumb and forefinger. Using the
fingers and scraping the food into the palm of the hand (palmar
grasp) does not substitute for pincer grasp development.
- Baby is eager to participate in mealtime and may try to grab
food and put it in his mouth.
We often state that a sign of solids readiness is when baby exhibits
a long-term increased demand to nurse (sometime around 6 months
or later) that is unrelated to illness, teething pain, a change
in routine or a growth
spurt. However, it can be hard to judge whether baby’s
increased nursing is related to readiness for solids. Many (if not
most) 6-month-old babies are teething, growth spurting and experiencing
many developmental changes that can lead to increased nursing –
sometimes all at once! Make sure you look at all the signs of
solids readiness as a whole, because increased nursing alone
is not likely to be an accurate guide to baby’s readiness.
More on developmental readiness...
In April 2001, a literature
review (
)
"of the developmental readiness of normal full term infants
to progress from exclusive breastfeeding to the introduction of
complementary foods" was jointly published by Wellstart International
and the LINKAGES Project. Per the authors,
"The review does not focus on health outcomes associated with
discontinuing exclusive breastfeeding at a particular age but rather
on the biologic/developmental readiness for this complex experience.
Four processes or functions were selected for inclusion: gastrointestinal,
immunologic, oral motor and the maternal reproductive processes
that relate to the continuation of lactation and the provision of
breastmilk."
Following are some of the conclusions of this review:
- "Thus, exclusive breastfeeding to about
six months allows the infant to have greater immunologic protection
and limit the exposure to pathogens at a vulnerable age. This
in turn permits the energy and nutrients that might otherwise
be diverted to provide for immunologic responses to be available
and utilized for other growth and developmental processes."
- "These clinical reports indicate that
the majority of normal full term infants are not developmentally
ready for the transition from suckling to sucking or for managing
semi-solids and solid foods in addition to liquids until between
6 and 8 months of age."
- "Using this available information on the
development of oral motor function, maternal reproductive physiology
and development of the infant’s immunologic and gastrointestinal
function, the expert review team concluded that the probable age
of readiness for most full term infants to discontinue exclusive
breastfeeding and begin complementary foods appears to be near
six months or perhaps a little beyond. The also felt that there
is probable convergence of such readiness across the several relevant
processes."
- "The consensus opinion of the expert review
group was that given the available information and the lack of
evidence of significant harm to either normal mothers or normal
infants, there is no reason to conclude that exclusive breastfeeding
should not continue to six months."
Medical research tells us that exclusive breastfeeding allows babies
to thrive for the first 6 months and often beyond. In the words
of the World Health Organization,
“Breastfeeding is an unequalled way of
providing ideal food for the healthy growth and development of
infants… A recent review of evidence has shown that, on
a population basis, exclusive breastfeeding for 6 months is the
optimal way of feeding infants.”
Breastmilk should make up the majority of baby’s nutrition
through the end of the first year. At some point toward the end
of the first year, most babies will gradually begin to need more
iron and zinc than that provided by breastmilk alone - at that point,
additional nutrients can be obtained from small amounts of solids.
Some babies thrive on breastmilk alone until 12 months or later
- as long as your baby is continuing to gain weight and grow as
he should, your milk is meeting his needs well.
Four- to five-month-old babies are sometimes very eager to participate
at mealtime, but it doesn't necessarily mean that they are ready
to eat solids - more often it's just the normal developmental urge
to do what everyone else is doing. Research studies tell us that
there are many health advantages to delaying solids for about 6
months for all babies, not just the babies who are not yet
interested in mealtime.
There are a number of things you can do to let baby participate
in mealtimes without starting solids:
- Let baby sit with the family at mealtime - in a lap, booster
seat or high chair.
- Give baby a cup of water or expressed milk. Your baby can entertain
himself at mealtime while learning to use a cup. 1-3 ounces of
water in the cup should be plenty (often for the entire day).
Many moms choose to use only water or a small amount of breastmilk
to avoid wasting the "liquid gold" while baby learns
to use the cup.
- Offer baby sips of water from your cup or straw. Even if baby
hasn't figured out how to use a straw yet, you can put your straw
in water, block the top end of the straw with your finger to trap
a little water in the straw, then let baby drink the water from
the lower end of the straw (unblock the top end once it's in baby's
mouth).
- Offer baby spoons, cups, bowls and other baby-safe eating utensils
to play with during mealtime.
- Give baby an ice cube (if it's a baby-safe size & shape)
or ice chips to play with.
- Offer baby a momsicle
(popsicle made from breastmilk) or slushy frozen breastmilk to
eat with a spoon.
There are many myths and outdated information regarding how to
tell if baby is ready for solids.
MYTH: Baby's weight has reached a "magic" number
Just because your baby achieves "x" number of pounds, or
has doubled birth weight, (or however much your baby
weighs) does not mean that she is automatically ready for
solids - particularly if she is under 6 months.
The American Academy of Pediatrics/World Health Organization
recommendations for starting solids at 6 months or later has
no exceptions for babies who weigh
more. The research that I've seen on the health
benefits of starting solids at 6 months and later holds
for all babies, no matter what their weight.
It's the maturity of the digestive tract and baby's developmental
readiness that makes the difference, not baby's weight.
|
It's rather interesting to note that moms are told to start solids
for both big and small babies. It's not even uncommon to hear opposite
arguments for both sides from the same person!
MYTH: "Your baby is big so
you need to start solids."
Moms might be told to start solids for differing reasons
when they have a large baby.
Some are told that since baby is big, they won't be able
to produce enough milk to satisfy baby. This is quite untrue
- almost all mothers have the ability to produce enough milk
to exclusively breastfeed twins and even triplets. If you
allow your baby to nurse on cue, your body will make enough
milk for your baby.
Other moms are told that baby is eating too much, so mom
should reduce baby's intake by limiting nursing and/or starting
solids. There is absolutely NO evidence that a large breastfed
baby will become a large child or adult, and limiting nursing
can be quite dangerous for a baby. Read more here: Is
my exclusively breastfed baby gaining too much weight?
|
MYTH: "Your baby is small so you need to start solids."
Another reason often given for starting solids is because
baby is small (see Normal
Growth of Breastfed Babies). I really don't see the sense
in this. Ounce for ounce, breastmilk has more
calories than most baby-safe solid foods and significantly
more nutrients than any type of solid food that you can feed
your baby. In addition, starting solids will quite possibly
reduce the amount of milk that your baby is getting overall,
rather than increase overall intake. One of the first recommendations
for a baby who genuinely has slow weight gain is to decrease
or eliminate solid foods and nurse more often. |
MYTH: Baby needs to start solids because there is not
enough iron in breastmilk.
An additional reason given for starting solids is the "lack
of iron in breastmilk." Breastmilk does have lower
iron levels than formula, but the iron in breastmilk is more
readily absorbed by the baby's gut than the iron in formula.
Also, formula-fed babies tend to lose iron through fissures
that develop in their intestines as a result of damage from
cow's milk. Breastfed babies do not lose this iron. Sometime
after the first 6 months (much later for a lot of babies),
most babies will require an additional source of iron other
than mother's milk. This can most often be obtained through
small amounts of solid food. Read more on iron and the breastfed
baby here: Is
Iron Supplementation Necessary?. |
MYTH: If you don't start solids by "x" months,
then baby will have problems with solid foods
This is another myth that is not supported by research for
normally developing, healthy babies. Keep reading for more
on this... |
Is there a "window of opportunity"
for starting solids?
There is certainly a "window of opportunity" for starting
solids, but this varies widely from baby to baby. At some point
(usually around 6-8 months) baby will become developmentally ready
to eat solid foods (able to sit up, chew, pick up food, etc.). At
around the same age, the gastrointestinal tract is physiologically
mature enough to handle a diversity of foods. At this point, most
healthy babies will be ready and willing to eat (even if it's only
occasionally and in tiny amounts).
Occasionally, parents will be told that baby must start
solids by 6 months (or 8 months, or 10 months) or baby will have
problems learning to accept and eat foods that require chewing.
This "limited window of opportunity" idea is widely believed,
but unproven.
I've not been able to find any research data to support the idea
that there is a limited window of opportunity for introducing solids
in normally developing, healthy children. There does appear
to be some limited evidence that babies who have been tube-fed long-term
or have serious developmental delays may have problems learning
to eat if they don't get a chance to practice eating solids between
6 & 10 months. A small study involving case studies of several
mentally retarded children was done back in 1964 (Illingworth RS,
Lister J. The critical or sensitive period, with special reference
to certain feeding problems in infants and children. J Pediatr 1964;65(6)
part 1:839-48.). This study suggested that there may be a "critical
and/or sensitive" period for introducing chewable textures
to these children, and if solids are not introduced during this
time, an important developmental milestone may be missed (possibly
leading to rejection of solids later on). This study is the only
one I've found referenced with regard to the "limited window
of opportunity" claims regarding the normal development of
children.
I asked a speech & language pathologist I know about her experiences
with this. She has worked with many young children who have feeding
problems, including developmental delays and problems with chewing
and oral texture aversion. She said that she could not think of
any reason that delaying solids would cause feeding problems, and
said that the the problems in the children she had worked with had
generally started at birth or relatively soon after. None of these
children had a feeding problem caused by a delayed start to solid
foods.
Page last modified:
08/03/2005
Written: 5/21/98
