No topic has inspired more conflicting advice and controversy–not even vaccination, mind you– among relatives, healthcare practitioners, “expert” authors and well-meaning strangers than the question of when and what to introduce beyond breastmilk.
Here is a sampling of the advice I’ve encountered, paraphrased:
- ‘For exclusively breastfed babies, wait until 6 months to start solids’ (-Pediatrician)
- ‘Start now. They’ll start sleeping through the night once you start them on (rice) cereal because they won’t wake up hungry’ (-Babysitter)
- ‘When you kids were little, the doctors told us to start feeding applesauce and pears as early as 2-3 months, and you turned out fine.’ (-Mom)
- ‘Skip rice cereal altogether. The poor quality of today’s grains can contribute to food allergies. The first food should be a ‘superfood’ like winter squash.’ (-Occupational therapist)
- ‘White rice cereal, a refined grain, should not be a baby’s first food. Start with an unpackaged food, like a banana or an avocado.’ (-Dr. Alan Greene)
- ‘Breastfed babies may benefit from pureed meat as a first food for the iron and zinc content’ (-Expert baby feeding book author/registered dietitian)
- ‘Risk of developing celiac disease was lower among high-risk infants exposed to gluten between 5-7 months of age versus earlier or later than that window’ (-Recent research)
A Dietitian’s Take on Starting Solids, and Some Nutrition Myths Busted
As a relatively self-confident RD by day and a relatively neurotic new mom by night, here’s what I make of it all:
- Let’s start with the official position of the American Academy of Pediatrics (AAP), which is that ideally, infants should be breastfed exclusively for the first 6 months (26 weeks) of life. My guys are 22 weeks and currently exclusively breastfed. We will probably start solids some time between now and 26 weeks, at a point when the stars all align as follows: (1) babies both well-rested; (2) neither baby acutely teething and miserable; (3) husband home with a camera to document it all. You can see why I’ve given us a 4 week window for this perfect constellation of conditions to occur.
- Further research published in the AAP’s journal, Pediatrics, supports the recommendation that for all babies–formula-fed or breastfed– complementary foods (solids) should not be introduced before 4 months of age, period. Studies have linked the early introduction of solids to certain health conditions later in life, namely an increased risk of childhood obesity (particularly among formula-fed infants), and a possible increased risk of food allergy.
- Next, there’s a lot of opinion on the topic of first foods and very little hard evidence to back it up. Cultural food traditions vary widely, and I’m guessing the majority of the world’s infants aren’t starting with iron-fortified rice cereal. There is no evidence basis for a “right” first food, assuming that what you choose is of an appropriate texture and fed when baby is developmentally ready. Don’t let anyone tell you otherwise. The right first food for your baby will vary based on a variety of factors, including whether s/he is breast or formula-fed, what foods your family typically eats, and what is convenient/available to you. Remember: for the first few months of solids, your baby’s primary source of nutrition–including both calories and protein– will remain breastmilk or formula. First foods are just as much (if not more) about getting baby acclimated to the mouthfeel of solids, the practice of swallowing textures and introduction to a variety of flavors as they are about delivering a substantial portion of nutrition. So there’s really no need to overthink the first food decision. Just pick one and go for it!
- Furthermore, unless your child actually has a diagnosed food allergy, there is virtually no evidence to support the commonly held practice of delaying introduction of certain ‘allergenic’ foods until 12 months or later for the purpose of food allergy prevention, even though many pediatricians–and some dietitian/authors of infant feeding books– still advise it. This includes wheat and eggwhites. Moreover, this appears to be true even for infants at high risk for food allergy based on family history. Emerging evidence suggests–but is far from conclusive– that such food avoidance practices may actually contribute to an increased risk of food allergy.
- The exception to this rule is that liquid cow’s milk as a beverage should be delayed until 12 months, though this is more about preventing iron deficiency than it is about avoiding dairy allergy; in fact, there’s no reason dairy foods such as yogurt can’t be introduced as an early/first food if desired so long as the texture is thin enough. The objection isn’t to milk protein itself per se, but rather the fact that drinking cow’s milk –which has virtually no iron–would displace relatively iron-rich breastmilk or formula in baby’s diet and can lead to iron deficiency and anemia. Furthermore, cow’s milk is high in calcium, which can interfere with iron absorption from other foods. Lastly, in younger infants, drinking cow’s milk has been linked to increased risk of small bleeds in the small intestine, and the subsequent loss of iron-rich blood can further contribute to iron deficiency. For all these reasons, it makes sense to avoid giving babies younger than 12 months milk to drink. A common myth I see perpetuated in many online parenting forums, however, is that cow’s milk need to be completely avoided in mixed dishes as well until 12 months of age. In fact, older infants under age 12 months may start to share family meals that include mixed dishes which contain some milk as an ingredient; this should be perfectly fine and there’s no reason to avoid such foods.
My Solids Introduction Strategy
So taking all of this into account, here’s what I plan to do for my little people. As you can see, it’s a strategy tailored to their unique needs, and may differ from what makes sense for other peoples’ kids. If you’re still perplexed, talk to a registered dietitian about what makes sense for the little people in your life.
- We’ll probably start with either iron-fortified organic brown rice cereal (a leftover box from our friend, the “Everything Borrowed Baby“) or ripe, mashed avocado as a first first food, since both are very convenient. Organic butternut squash will probably be the second veggie they get, since it’s super nutritious, easy to buy frozen and pre-cut to facilitate quick cooking/pureeing, and will blend into the color of our living room rug when it inevitably winds up all over the floor.
- Because my kids are at increased risk for Type I Diabetes and Celiac Disease due to their family history (read: my stellar genes), my goal is to get some gluten into the babies at around the 6 month mark (which is why I plan to start on cereals first): we’ll advance from rice cereal to barley cereal, and I’ll aim to get some wheat cereal into them before 7 months of age. My goal is to also continue to breastfeed them during the introduction of gluten and wheat to help further reduce their risk of developing these autoimmune diseases.
- We’ll aim for some iron-and-zinc rich foods relatively early on in the process, since babies’ needs start to outpace breastmilk’s content of these important nutrients sometime around the 6 month mark. (Because formula is fortified with these nutrients, formula-fed babies have more latitude with timing when it comes to introducing foods with these nutrients.) I’m thinking some pureed, ground organic lamb will be the first protein food we introduce, since red meat is high in bioavailable iron (and zinc), lamb is relatively easy to digest, and my husband will delight in the opportunity to make merguez with the leftovers.
- The next protein foods we’ll probably go for will be Wild Alaskan Salmon and either Pasture-raised or DHA-enhanced eggs, due to their high omega-3 fatty acid contents. While there’s no reason to only feed babies the egg yolk rather than the whole egg (as some experts advise), the fact is that the yolks contain the majority of vitamins and omega-3 fats whereas the whites have a higher relative amount of protein. Therefore, if you wanted to maximize the amount of these necessary nutrients baby gets given their relatively small tolerance for volume, feeding them yolks-only could be a reasonable practice if you wished to do so. (Once again, they get most of their protein at this stage from formula or breastmilk.) Note that many premium infant formulas are enhanced with DHA, which means some formula-fed babies are already getting a steady stream of these essential fatty acids. Omega-3 content of breastmilk, however, will depend to some extent on the mother’s diet.
Beyond this, it’s anyone’s guess where we’ll go. There will surely be some mashed banana in the mix, and likely a good number of summer fruits and veggies that find their way into our kitchen in these coming months. Plain greek yogurt with fruit will almost certainly enter into the fray, as will hummus and canned, refried beans–since they’re easy, nutritious and a regular part of our family’s diet.
A Quick Note of Caution: Canned Foods
Speaking of refried beans, if you plan to feed them–or any other canned food–to baby, I recommend buying brands that do not use Bisphenol-A (BPA) in their can liners. Recent research has shown that over 90% of canned foods sampled contained BPA, with the highest levels found in certain brands of green beans and peas–common baby-friendly foods. Currently, national brands that do not use BPA in their can liners include Eden Foods (beans), Native Forest (veggies and fruits) and Muir Glen (tomatoes). If you plan to make your own baby food from canned ingredients and can’t access these brands, it’s best to use fresh or frozen fruits and veggies instead.Did you like this? If so, please bookmark it, RSS feed.