Why wait to 6 months before introducing solids?
By Cordelia Uys, NCT Breastfeeding Counsellor September 2021
The WHO and the NHS recommend exclusive breastfeeding for the first 6 months, with solids introduced from then on, alongside continued breastfeeding. In this article I explore the evidence behind the recommendation to wait until your baby is 6 months old before introducing solids.
Parents are often told, sometimes by family members, and sometimes by health professionals, to introduce solids to their exclusively breastfed baby before 6 months, in the belief that the baby needs more calories. This makes no sense since breastmilk and formula have 22kcal per fluid oz, whereas typical weaning foods are very low in calories. For example, an ounce of puréed carrots only has 7kcal per fluid oz, puréed apples has 13kcal per fluid oz, and pear has 16 kcal per fluid oz.
Gill Rapley, the Health Visitor who coined the term Baby-Led Weaning, says: “There is no rationale for pushing solid foods at the expense of breastmilk (or, indeed, formula). No solid food comes close to the concentration of nutrients in breastmilk, so, spoonful for spoonful, breastmilk will always provide better nutrition (and more calories) than any other food. Seeking to replace breastmilk in a child’s diet risks them being less well nourished, not more. All that human babies need, once they’re over six months, is access to small amounts of other foods – in addition to breastmilk – to make sure they’re getting enough of the smallest nutrients.”
Another common reason for suggesting solids is to help a baby sleep longer stretches at night. In fact, introducing solids usually has the opposite effect: babies wake up more often because their body needs to get used to digesting foods they aren’t accustomed to. Sleeping longer stretches is developmental and has nothing to do with how much a child has eaten.
In 2003, following a systematic review for the World Health Organisation on the optimal duration of exclusive breastfeeding, infant feeding guidelines in the UK were changed to recommend exclusive breastfeeding for the first 6 months, with solid foods introduced from then on, alongside continued breastfeeding:
“Infants who are breastfed exclusively for 6 months experience less morbidity from gastrointestinal tract infection than infants who were mixed breastfed as of 3 or 4 months of age. No deficits have been demonstrated in growth among infants from either developing or developed countries who are exclusively breastfed for 6 months or longer”.
In 2018, the Scientific Advisory Committee on Nutrition (SACN) considered evidence relating to feeding in the first year of life, and reached the following conclusions:
‘The totality of the evidence reviewed for this report supports current guidance to breastfeed exclusively for around the first 6 months of an infant’s life and to continue breastfeeding for at least the first year of life. Each makes an important contribution to infant and maternal health.’
‘By around 6 months of age, infants are usually developmentally ready to actively accept foods other than breast milk (or infant formula). The available evidence indicates that the introduction of solid foods or infant formula before 6 months of age reduces the amount of breast milk consumed and is associated with greater risk of infectious illness in infants.’
In addition, according to the independent public health nutrition charity First Steps Nutrition: ‘there is increasing evidence that breastfeeding is protective against the development of overweight and obesity, with recent evidence from WHO Europe, after consideration of data from over 100,000 children in 22 European countries, concluding that: ‘Breastfeeding has a protective effect: obesity is less frequent among children breastfed for at least 6 months.’ This is supported by evidence from the UK Millennium Cohort Study which reported that study participants who were breastfed as infants had lower odds of being overweight or obese at age 14.’
In March 2018, at a conference entitled “Infant feeding: Policies, politics and best practice’ at the Royal Society of Medicine, Professor Charlotte Wright, paediatrician and epidemiologist, stated: "Early solids doesn't enhance growth but displaces milk and puts baby at risk.
The world over, parents view the starting of solids as evidence of their child maturing, developing, moving on, and because of this are tempted to start them early. It is really important to resist this assumption, the danger being that introducing solids early will reduce the child’s intake of breastmilk, which is really all they need for the first six months. Introducing anything else before this age increases the child’s risk of infection, with a number of UK cohort studies showing that exclusively breastfed infants are healthier than partially or non-breastfed babies.
There is a push, particularly from the formula industry, for the recommendation to be changed from six months back to four-six months. We’ve reviewed all of the challenges and found no evidence for them. One argument is that waiting to six months to introduce solids runs the risk of children not having enough to eat and particularly not enough iron, but it actually has been found to have no increase risk of adverse weight gain or iron deficiency anaemia.”
As well as waiting until a baby is 6 months old, it’s also recommended to wait until a baby is showing all the developmental signs of readiness.
Developmental signs of readiness for solids include:
Baby can sit up well without support and hold their head steady.
Baby can co-ordinate their eyes, hands and mouth so they can look at the food, pick it up and put it in their mouth by themselves.
Baby has lost the tongue-thrust reflex and does not automatically push solids out of his mouth with his/her tongue.
Baby is ready & willing to chew.
Baby is developing a “pincer” grasp, meaning they can pick up food or other objects between thumb & forefinger.
Baby is eager to participate in mealtimes & may try to grab food & put it in their mouth.
Showing interest when adults eat doesn’t necessarily mean a baby is ready for solids. Anything parents do is fascinating to their baby. A baby who has never had solid food doesn’t know what it is, so can’t know what they’re missing. In this video: https://youtu.be/FefI1J-iDY4 4-month-old baby Sofia is interested in her mother’s glass of wine, but that doesn’t mean she’s ready for alcohol.
Understandably new parents are eager to start their baby on solids as it’s an exciting new stage. However, preparing food on a daily basis is hard work, and requires much more planning than when a baby is only drinking breastmilk or formula. The novelty soon wears off. A big advantage of delaying solids until your baby is completely ready, is that it means less work, especially as at 6 months babies will be developmentally ready and able to eat many of the same foods as the rest of the family.
Links:
https://kellymom.com/nutrition/starting-solids/babyfoodcalories/
https://www.ncbi.nlm.nih.gov/pubmed/15384567
https://www.gov.uk/government/publications/feeding-in-the-first-year-of-life-sacn-report
https://www.karger.com/Article/FullText/500425
https://cls.ucl.ac.uk/wp-content/uploads/2017/12/MCS6-Briefing-02-Overweight-and-obesity.pdf
http://www.rcpch.ac.uk/growthcharts/
Is baby ready for solid foods? (Developmental signs of readiness) • KellyMom.com
Your baby's first solid foods - NHS