The two month window of when to start solids (between 4 to 6 months) is a huge developmental span in a young infant's life.
Determining when is best for them can alter both your and your baby's first experiences with feeding dramatically. Set your family up for a strong start, then stay on course. Your baby needs you to assume your responsibility, so they can assume theirs.
When we were planning to start feeding our first daughter, we decided we would start on Father's Day. As the day approached, I made sure all our supplies were sterilized, set out, and ready to steam, puree, and serve.
My oh-so-first-time-mom checklist looked something like this:
Organic Pears (peeled and prepped). Check
Baby Food Maker (since over-achiever first-time mom mode was on point): Check
High Chair (which was actually waaaay too fancy considering all the food fights it would soon house): Check
Spoon (to serve with because that's what I was "supposed to do," right?): Check
Bib (to catch the many, many messes): Check
Camera (to snap a pic of her first bite): Check
The one thing I don't recall really checking however, was how ready our daughter really was.By Father's Day, she was 5.5 months and for all intents and purposes, she was "allowed" to start eating. Developmentally she was on track so setting this date on the calendar seemed as good of way as any to decide specifically "when" we gave her her first bite.
But now looking back, I ask myself - were we premature in our planning? Rather than basing our decision on some cutesy date on the calendar, what cues should we have undeniably seen before her first feeding? How would I start solids differently, now that I have the opportunity to again with our second daughter?
In this series, you are learning:
I. The expert opinions are on when to start solids
II. The health concerns of feeding babies too soon, too late, or right on target
III. The opportunities for how to start solids at the best age and stage
In this post, we will highlight the opinions you need to know before starting solids.
With all due respect, none of them will include your grandmother.
The Opinions to Listen to Before Starting Solids
If you're quickly scanning this post in hopes to find the "magic number," look no further. The reason is, it doesn't exist. Just like every other developmental milestone your child has, there is no clear cut way to put a calendar date on a developmental process. This doesn't mean that opinion to answer the question of "when to start solids" isn't EVERYWHERE though. Even if you're a first time mom, you've probably been inundated with inputs. From your neighbor to your coworker, your best friend to your Facebook "friends," your mother-in-law to your grandmother.
Everyone has something to say, but no one seems to say the same thing about when to start solids.
That makes trying to do this whole feeding solids thing "right," even more confusing...right?
Take a deep breath while reading what British pediatrician Martin Ward Platt has to say on the subject:
"The weaning debate has been largely predicated on the notion that there is some magic age at which, or from which, it is in some sense ‘‘safe’’ or ‘‘optimal’’ to introduce solids. Yet it is highly counter-intuitive that such an age exists. In what other area of developmental biology is there any such rigid age threshold for anything? We all recognize that age thresholds are legal inventions to create workable rules and definitions, and have no meaning in physiology or development, yet when we talk about weaning we seem to forget this.”
This remark reminds us that an exact date does not exist to date, even among the experts. There are evidenced-based opinions, however, intended to help inform parents on what's best for the health of their baby. I've put the most important of these opinions all in one place, making it easy for you to find the information you both need and want.
Expert Opinions - all in one place
According to American Academy of Pediatrics (AAP)
Since 2012 when the Section on Breastfeeding released this statement on "Breastfeeding and the Use of Human Milk," the AAP recommends exclusive breastfeeding (or bottle) for about 6 months. It isn't until after this 6 month mark that the AAP recommends "complementary foods" (ie. solids) be introduced, with continuation of breastfeeding (bottles) for 1 year or longer as mutually desired by mother and infant.
According to World Health Organization (WHO)
Unlike the AAP, WHO is commissioned with the task of providing health-related recommendations to the whole world. Factoring the cultures, resources, and lifestyles of people living all around the world, WHO recommends, "that all infants should start receiving foods in addition to breast milk from 6 months onwards." More specifically, WHO outlines "that infants start receiving complementary foods at 6 months of age in addition to breast milk, initially 2-3 times a day between 6-8 months, increasing to 3-4 times daily between 9-11 months and 12-24 months with additional nutritious snacks offered 1-2 times per day, as desired."
According to American Academy of Allergy, Asthma, and Immunology (AAAAI)
In a comprehensive summary titled, "Primary Prevention of Allergic Disease Through Nutritional Interventions," AAAAI states that "between 4 and 6 months of age, complementary foods are necessary to support growth and to supplement nutritional needs. The introduction of complementary foods should be delayed, however, until the infant is able to sit with support and has sufficient head and neck control." Additionally, this summary says that, "No current evidence suggests that the delay of introduction of solid foods beyond 4 to 6 months of age will prevent allergic disease."
According to Australian Government National Health and Medical Research Council
Although majority of my readers are in the U.S., I think it is always important to look at what other countries are doing as well, especially those that are industrialized and highly involved in similar areas of research (such as this).
In Australia, a thorough review on the subject of "Infant Feeding Guidelines" shares an opinion that follows after WHO recommendations. "At around the age of 6 months, infants are physiologically and developmentally ready for new foods, textures and modes of feeding and need more nutrients than can be provided by breast milk or formula. Delaying the introduction of solid foods beyond this age may increase the risk of developing allergic syndromes."
According to European Society for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN)
Commentary by the ESPGHAN Committee on Nutrition states that, "Exclusive breast-feeding for around 6 months is a desirable goal." This committee concludes, "there is at present no scientific evidence that introducing complementary foods to breastfed infants between 4 and 6 months of age is a disadvantage relative to introduction after 6 months.” Furthermore, a medical position paper by ESPGHAN says that, "Complementary feeding (ie, solid foods and liquids other than breast milk or infant formula and follow-on formula) should not be introduced before 17 weeks and not later than 26 weeks."
With the expert opinion of five different organizations from around the world, we see that in fact the opportune window appears to span from 4 -6 months. Based on most of their evidenced-based recommendations, 6 months is most often considered the more desirable target. If it doesn't quite make sense why six months is remarked as preferable to four, follow parts II and III of this series.
In the next post, we will identify the health-related outcomes associated with when solids are started. Considering such nutritional, allergic, developmental, and chronic disease risks helps parents better understand the research and thus rationale behind these recommendations.
Once we understand the expert opinions and health-related outcomes to consider before starting solids, the third and final part to this series will highlight the opportunities for starting solids at the most opportune age and stage.
From there, we will move into the real fun: actually introducing your infant to foods!