For many mums introducing solid foods to their babies can be a difficult and confusing time. This isn’t helped by the fact that advice on when to introduce solid foods, what foods to include and how to begin seems to change all the time.
So what is the current advice and how did we get there?
Firstly, let’s start with some Quick Tips for parents:
Quick Tips – Parents need-to-know infant feeding guidelines
- The process of introducing solid foods is now referred to as ‘Complementary Feeding’
- Exclusive or full breast-feeding for about 6 months is a desirable goal
- It is recognised that some parents may wish to introduce solid foods to baby earlier than 6 months and is important to look out for signs that your baby is ready to start solid foods if this is the case
- Developmentally, infants younger than 4 months of age are not prepared for solid food and therefore the introduction of solid foods is never recommended before 4 months or (17 weeks) for babies born at full term
- When starting solid foods, allergy risk foods such as: wheat, gluten, nuts, peanuts, peanut products, seeds, liver, eggs, fish, shellfish, cows’ milk and soft or unpasteurised cheese should not be offered before 6 months of age
- After 6 months it is important that foods that contain gluten and others that commonly cause allergies are introduced one at a time, so you can spot if your child has a reaction
- It is not recommended to offer children the following during weaning: salt and added sugar or foods containing them (e.g. crisps, biscuits), honey (until 1 year of age), whole nuts (until 5 years of age) or cow’s milk as a whole drink (until one year of age)
- Vitamin drops containing vitamin A and vitamin D are recommended from around 6 months of age until your child reaches their birthday 5th birthday
(read below for more detailed information)
Further details on infant feeding practices:
What’s in a name?: What to call the process of introducing solid foods?
Even the name of this practice has caused controversy. The original label of ‘weaning’ has been questioned, as many believe that it suggests the process of ‘weaning off’ something. As breastfeeding is encouraged to continue throughout the first one to two years of a child’s life, the idea of ‘weaning’ onto solid foods mustn’t be confused with a time to ‘wean off’ of breastmilk.
A result of this debate is that in the last year or so the title ‘Complementary Feeding’ has replaced ‘weaning’ as a way of describing the introduction of solid foods. Complementary – meaning ‘at the same time as’ – is now used in order to encourage continued breastfeeding, whilst at the same time offering new foods.
When to introduce solid foods?
When I first delved into the world of infant nutrition the advice was to ‘wean’ babies onto solid foods from 4 months. Since then the government has changed its advice, advising parents to ‘exclusively breastfeed’ until baby is 6 months old, at which time food should then be introduced.
In reality babies are all very different and UK statistics show that around 2% of mothers actually stick to the 6 month recommendations(1). There are many individual reasons for this low percentage and it means that health professionals must be realistic in their recommendations to parents on when to start offering solid foods to baby. It also means that individual circumstances and situations must on all occasions be taken into account.
Current advice on the introduction of solid foods therefore allows for a little more flexibility for parents:
“Exclusive or full breast-feeding for about 6 months is a desirable goal. Complementary feeding (i.e. 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.” (2)
What foods to introduce?
Another controversial area of complementary feeding is considering which foods should be introduced and when.
The NHS recommends that parents avoid giving foods containing wheat, gluten, nuts, peanuts, peanut products, seeds, liver, eggs, fish, shellfish, cows’ milk and soft or unpasteurised cheese before six months of age.
However, a fairly recent position paper from ESPGHAN (European Society of Paediatric Gastroenterology, Hepatology and Nutrition) suggests that:
“There is no convincing scientific evidence that avoidance or delayed introduction of potentially allergenic foods, such as fish and eggs, reduces allergies, either in infants considered at increased risk for the development of allergy or in those not considered to be at increased risk.”
They also go on to recommend that:
“It is prudent to avoid both early (<4 months) and late (>or=7 months) introduction of gluten, and to introduce gluten gradually while the infant is still breast-fed”.
The underlying belief here is that this timing may reduce the risk of coeliac disease, type 1 diabetes mellitus, and wheat allergy in later life.
For parents this can be confusing. However it is important to remember that the Department of Health and other bodies such as the Food Standards Agency (Wales) still recommend that gluten and other allergen risk foods should not be introduced into the diet before 6 months of age.
Other foods to avoid during complementary feeding include: salt, sugar, honey (before 12 months) and consumption of cow’s milk as a whole drink, before one year of age.
More research is needed to form final conclusions on these controversial areas of infant feeding. Fortunately a review on infant feeding practices by the Scientific Advisory Committee on Nutrition (SACN) is due out in 2015!
Look out for my upcoming blogs on complementary feeding in the run up to Christmas…