There is a lot of recent new evidence on the introduction of solids, especially in the context of allergy prevention. A lot of confusion also still comes in as the World Health Organisation (WHO) advocates exclusive breast feeding for 6 months before introducing solids. But remember, the WHO is looking after the needs of children on a global scale, including those with poor access to boiling water and a lack of hygienic environment in which to prepare solid foods. So the WHO recommendations are based on prevention of infections. In an ideal world, solids can be prepared in a way which is hygienic and safe, so we should ask ourselves, at which stage should solids be introduced in order to co-incide with a child’s developmental readiness, and also to minimise the development of allergies?
Let’s look at developmental readiness
So evidence shows that most babies are developmentally ready for solids from 17 weeks onwards, that is from 4 completed months onwards. It may be a few weeks after this in some cases, but we currently do not advocate introducing solids before 17 weeks of age. Watch for signs of readiness in the baby, such as:
- Holding the head straight when in the sitting position (will likely still need to be supported in the sitting position)
- Being able to turn the head towards or away from food
- Appearing interested in food when other people are eating
- Opening the mouth when offered a spoonful of food
- No longer reflexly pushing a spoon out with the tongue
Let’s look at the development of allergies – what timing is best there?
The advice that delaying solids helps to protect against allergies is outdated, and ironically probably contributed to the allergy epidemic we are currently facing. Instead, we have new evidence that earlier is better. The LEAP study, which stands for Learning Early About Peanut, was a landmark study from the UK published in 2015. It showed that peanut allergy rates are much lower in children who were introduced to peanut between 4-11 months, than those who avoided peanuts until 3 years of age. A similar study, the EAT study, which stands for Enquiring About Tolerance, was published soon afterwards and also showed early introduction of allergenic foods such as peanut and egg in breastfed babies from 3 months of age onwards, had a trend towards lower allergy rates than waiting more than 6 months to introduce the solids. Further studies have suggested that introducing wheat between 4 and 7 months may protect against wheat allergy. So it seems that a younger immune system may be more “accepting” of highly allergenic foods than that of the older child. We do however have to warn mothers that if a child is already showing signs of allergies, such as eczema, then they need to consult a doctor first (ideally an allergy specialist) before introducing high allergy foods, to make sure that it is safe to do so.
In summary, the process of solids introduction would follow the principles below:
- The best time to introduce solids is between 4 and 6 months
- Watch for cues of readiness e.g. hungry, good head control, grabbing at your food when you are eating
- After introducing any new food, give that food for 3 days or so before giving the next new food so that you can watch for signs of intolerance, change in stools etc
- Start with 2-3 teaspoons of a bland, “low allergy” food: rice cereal/maize cereal/pear puree/apple puree, very finely pureed
- The best time of day to start solids is at lunchtime. Start with only this one meal a day for the first 1-2 weeks
- After 1-2 weeks, if baby is taking the solids well, introduce a second meal in the early evening (at about 5 pm). Use the same low allergy foods in various combinations, eg rice cereal mixed with pear; carrots and butternut etc.
- After about a month or so, if all is well, introduce some other fruits and veges eg potato; mango puree, consider banana, broccoli etc.
- Gradually increase the volume of the feeds according to your child’s appetite. Most children will be able to take around 60 mL solids per feed at this stage
- The baby will unlikely to be able to drop a milk feed before being on 3 meals a day, but may reduce the volume of milk feeds.
- The first few months of solids introduction are quite hard on the immature little gut and may be associated with constipation. Simple measures such as dropping rice cereal/ adding pro- and prebiotics/ giving 2-5 ml of flaxseed oil daily, giving some prune juice may suffice. If the constipation is resistant to simple measures, consult your doctor.
Toward 6 months of age:
- Introduce the third meal (breakfast)
- Introduce wheat cereal, as well as peanut protein (eg peanut butter mixed in the puree) and egg (can also be pureed in with other foods)*
- Introduce a protein eg chicken pureed in with the veges
- May be ready to drop one of the milk feeds
- Baby still needs at least 500-600 milk per 24 hour period
* We do however have to warn mothers that if a child is already showing signs of allergies, such as eczema, then they need to consult a doctor first (ideally an allergy specialist) before introducing high allergy foods, to make sure that it is safe to do so.
After 6 months
- Rapidly introduce a variety of new foods. No need to hold back on “allergenic” foods including yoghurt/cheese/egg/peanut
- Start introducing finger foods which the baby can play with and taste during feeding
- Gradually, over the next few months, puree the food a little less at a time to make it more lumpy and textured
- It may be worth offering a main course and then dessert e.g. vegetable and chicken puree as the main course; yoghurt or fruit puree for dessert.
- Gradually increase the total volume of the feed to 100-150 mL, so that it is able to “replace” a milk feed
- By a year to 15 months babies should be able to eat a modified version of “family food” eg pieces of potato, Cottage pie, Fish fingers.
- Babies become very fussy around 14 months- introduce as much variety as possible before then!
- After 2 years the baby should be eating family-type meals and needs 300-500 mL milk per day.
For further advice on solids, consult your healthcare practitioner or paediatric dietician .
