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Hi There
I saw my GP yesterday and she said that the data suggesting that exclusive breast feeding for six months reduces the risk of allergies has now been disproven and it is reasonable to start solids from 5 months of age.
Just wondering if anyone has heard this before and peoples thoughts about starting at 5 months
Cheers
Just found this on a Med-line search - still interested in peoples opinions though
Is 6 months still the best for exclusive breastfeeding and introduction of solids? A literature review with consideration to the risk of the development of allergies. [Review] [46 refs]
Anderson J. Malley K. Snell R.
Breastfeeding Review. 17(2):23-31, 2009 Jul.
[Journal Article. Review]
UI: 19685855
Check list of Print and Electronic Journals held by RGH Library
ISSN Print
0729-2759
AB Health professionals advising mothers on the introduction of solid foods to infants need evidence-based guidelines. A literature review on this topic was undertaken to examine the current international recommendations of expert bodies and evidence-based research published since 2003. Particular reference in this review is made to the timing of introducing food allergens and the risk of development of allergy in the child. Recommendations in developed countries of reducing this risk by avoidance of allergenic foods until the child is of varying ages past 6 months have been challenged by recent population studies. Where the risk of allergy is a key consideration, currently-available research suggests that introducing solids at 4-6 months may result in the lowest allergy risk. When all aspects of health are taken into account, the recommended duration of exclusive breastfeeding and age of introduction of solids were confirmed to be 6 months, but no later. [References: 46]
Ask for the data ;) To my knowledge what has been disproven is delaying the introduction of foods AFTER 6 months. It does not appear to alter rates of allergy. For example, giving egg can now happen when solids start as opposed to delaying it until 9months (or whatever the latest says :lol:)
WHO still recommends exclusive breastfeeding to 6 months prior to the introduction of solids.
This is common information being given out thanks to aggressive marketing by baby food manufacturers to MCHNs. However, as Michelle says, the current guidelines, based on many, many studies around the world, is to exclusively bf for 6 months and then continue to provide bm while introducing complementary foods - ie solids.
Two new things have been shown by the lastest studies:
1. Introducing solids while the baby is still bfing provides strong protection against allergies by helping to support the immune system at this time of stress.
2. Delaying "high allergy" foods such as egg, dairy, nut products (whole nuts are still a choking risk) might contribute to allergies, so therefore these foods shouldn't be delayed much beyond 6 months.
There is still a lot of evidence to support the fact that introducing solids before 6 months can cause a number of problems including, but not limited to, allergies.
In the end it's up to you and no amount of the right research is going to persuade or dissuade you.
I believe that it is not necessary for a child to be on solids before six months... My child did not begin to consume them to be of any benefit until almost 9 months of age. So regardless of any research I am not about to start my children on solids at 4 months. I will do it when I believe they are ready and when I am ready. They don't need the food. "Food is FUN until I am one" sentiment ...
This is not to say that someone else' child won't react to solids differntly, or that when they choose to start solids should change - just that the research i choose to peruse and believe backs up my choice. And if the research helps you sleep at night when you introduce solids at 5months instead of six in the hanging hope your baby will begin to sleep at night - that's your choice ;)
Many thanks for your replies guys - it is much appreciated.
Just feel the need to clarify a couple of things:
Firstly the question has arrisen because, as with you all, I want to do the very best I can for my daughter - and I feel it is always wise to look closely at the evidence and to make sure I have the very latest evidence at hand when making my decisions. I am still undecided as to when to introduce solids and will continue to explore and read before making my decision. Most importantly if i decided to introduce solids at 5 months it would NOT be because I want more sleep and DD to sleep through the night. I would gladly continue to get up at night for the next hundred years :-) if that was what she needed and was the best thing for her. The high incidence of allergies in children at the moment is more of a concern to me.
I had a look at the WHO site and while their recommendations are of course based on best possible evidence - but this is best possible evidence at time that guidelines where written and from what I can see (and if I am wrong someone please let me know) they were written in 2003. The article I referred to earlier looks at the evidence since this time. From what I can gather so far (granted I need to do more research) is that the studies to date have many limitations and certainly do not provide clear answers on this issue.
MantaRay - re the introducing eggs, nuts etc no later than 6 months - do you know where I can read more about this and how it should be done?
Once again, many thanks
For those interested in the current evidence and debate discussed above see the following from allergy experts
http://www.allergy.org.au/images/sto...vice_oct08.pdf
I have also heard that WHO will be changing/updating their recommendations, so keep your eye out!
WHO have been *changing their guidelines* for the past 2 years after the baby food company sponsored *education sessions* for GP's and MCHN. I will be interested to see this when it occurs.
ASCIA suggests there is no need to delay any foods but the introduction of foods / solids is *when the child is ready*. If you follow the BLS path as opposed to the puree path, this is closer to 6 months due to the development of motor skills. It also makes it easier than the preparation of purees ;)
In the end, you make choices on your own level of comfort and knowledge when it comes to introducing solids. Some choose puree, some choose BLS. Some introduce before 6 months, others after. Whatever works for your family and child.
BM, I think you are doing a fantastic job hun. I love that you are researching and trying to make the best decision for your little one. Good on you, and whatever decision you make, I know that it will be very well considered.
I do urge you to be careful about verifying the source of your information though. Some sites have more accurate information than others.
And to clarify the WHO recommendations. Yes, these were made a few years ago, but they are constantly being reviewed, and all the latest studies have been included in the reviews (including several which have not been publised by the formula companies and therefore not able to be found in the media - they are in medical journals however). As recently as last year, a WHO scientist involved in the reviews spoke at conferences in Australia and she was very clear. The WHO has no intentions of changing their guidelines. On the basis of all the information around (not just relating to allergies, but other considerations as well), there is just no evidence that starting earlier is beneficial, and there is plenty of evidence that it can be harmful.
I might add that a leading US allergist spoke at the same conferences. I was lucky enough to meet him and hear his presentation. He explained that there is no "quick fix" to solving the increase in allergies. If it was as simple as putting a time on starting solids, then it would be easy, but there are so many factors. His experience and research has shown that there are many factors. However, he said that the biggest factor in increasing the risk of allergies for an individual baby is giving formula or solids before they are ready for the proteins - so waiting until 6 months is the safest option. Other factors include avoiding antibiotics during pg (not always possible), having a vb (not always possible), and not having a cat at home.
If you are really keen to get the latest reliable research, you can pay for information from the LRC (Lactation Resource Centre) run by the ABA. They are the leading source of medical information relating to infant feeding and well being in Australia. There is a link to the LRC from the ABA website.
Best of luck with your decision hun.
On the contrary I'm considering (not yet deciding) introducing solids because I want to be able to sleep. I'm so tired I've been sick and cannot function very well lately.
With my first baby I didn't start introducing solids until she was 6 months old, and it was fine then because I had abundant milk. It seems now my milk supply has been compromised by lacking of rest during the day for looking after my 4 year-old, though she goes to preschool 3 times a week I still feel very tired.
In the past 3 weeks my now 4.5 months old baby has not been sleeping well. Up to when he was 3 months old he was sleeping beautifully, 4-5 hours which gave me enough time to sleep well.
When I spoke to an early childhood nurse during this sleepless period around 2 weeks a go the subject was brought up, that now it is thought that it is save to introduce solids between 4-6 months.
So, reading my baby correctly and also I now that I have lower milk supply compare when I had my first baby, my choice is to top it up with formula or starting to introduce solids.... I'm reluctant to give formula because it will only compromise more the bm supply.
Again, I'm still undecided. I'm going to consult the nurse again tomorrow and perhaps I'll see a paed if I still can't decide what I'm going to do.
I think at the end of the day, as some of you already said it, it is what works best for you and your baby... Isn't it? As long as we're not doing any harm to them...
I think that allergy people are saying that while breastfeeding does offer protection against allergies, it does'nt seem that delaying solids till 6 months makes a differences.
HOWEVER, you have to bear in mind that about 1% of babies are actually exclusively breastfed till 6 months. 99% will receive formula and/or solids prior to this age, so I don't see how the theory has been disproven at all - it hasn't even been properly tested. And like MR says, there are a great many factors that can influence whether people develop allergies.
I do think another important consideration is whether your baby really needs solids and whether their digestive systems are ready to handle it. These things are baby-specific and I think you have to be led by your baby's cues here.
And yes, I've been hearing about the WHO changing guidelines since before DS started on solids.... so at least 2 years now....
It's great to do all the research and take everything into account, though. No doubt your decision will be very well considered.
I think it needs to be remembered that the reason for not introducing full solids before 6 months is not just related to allergies, but also to the fact that the digestive system in infants is not fully developed, can be easily irritated and is simply not capable of digesting certain foods.
The delay allows the gut to develop correctly before the irritants of food are introduced.
Not going to make much comment on the original question as i believe the the PP have said everything that i would add to these comments... other than, look into BLS - if you think that your baby is ready to eat, hand them the food themselves, they will only be able to consume what they are ready to eat - which at 6 mths is not much at all
Lady Noor - did you find that your fist baby slept better after solids? I didnt... and i dont know loads of people that did notice a great increase in sleep or any at all!:
I would be exceptionally hesitant to start solids early based on this reason alone.
I'm with SJ - made no difference whatsoever. I actually don't think I know anybody IRL who's had an improvement in sleep after starting solids... I guess it must happen for some or else this theory wouldn't be doing the rounds.
Lady Noor - being tired won't affect your milk supply. Is there any other reason you feel your supply is insufficient? No doubt it's very tring with 2 to take care of :hug:
It's so hard as mums to know what is the right thing to do. I personally overloaded myself with research and still found it hard to decide so just went with the WHO and ABA recommendations.
Manta, I had thought that you should delay the introduction of nut based foods till after 12 months. By the sounds of things I must be on the wrong track (probably all that research I did months ago has left me confused). DH has been dying to give DS some peanut butter, I guess I should let him....
Lady Noor I tend to agree with what the other posters have said about introducing solids at 4.5 months, I definately didn't see any improvement in DS's sleep when I introduced them at 6 months, if anything his sleep actually deteriorated. Like your LO my DS was a fabulous sleeper until he reached the 4 month mark. Before that he would sleep through pretty much every night. I tend to think that at around 4 months they develop a much greater sense of awareness and the sleep issues are related to that. Are his weight gains good and is he having plenty of wet nappies? If he is I would take that to be a very good indication that he is getting enough iykwim?
Thank you Gals for all the kind words.. At this stage it's hard to think clearly after almost 3 weeks waking up every 1.5-2 hours every night to feed him. I'm still hoping this phase will pass, it's very exhausting. I salute you ladies who have 3 kids and more!
Marcellus,
Now that's one statistic I've never come across before. So basically only 1% of the population start off with "an ideal start"..
Now Miss E, after you pointing it out DS does have good amount of wet nappies so you ladies are most probably right, he still is getting enough milk..
I don't really remember with DD, you're probably right SJ she didn't suddenly sleep after solids..
DD was breastfed until she was 15 months old, and I'm planning to continue breastfeed DS until around 12 months, that's the only thing I know for sure..
Thank you for all the inputs, I keep open-minded in deciding what to do with DS.
Hi again,
LadyNoor - you doing a good job, waking every 1.5-2 hours will be exhausting for you, remember to get a est when ever you can and when your DD is at day care/kinda, make sure that you take time out for you to rest in the day - house work can wait! :)
Miss E - MJ had peanut butter at about 6 or 7 months, we went down the BLS track and started with veggies, fruit and toast with hommus and then moved to peanut butter (only cos this is what daddy was eating).
The only thing that i delayed was honey and that was because of the botulism risk - dont know if that is current anymore, but that was the only thing i withheld.
But you have to be comfortable in everything that you do, if you are concerned, wait until you are happy as your bubba will pick up on the way that you feel :) HTH
It took me a couple of days to remember what website the ECHC's nurse quoted, it was from The Australasian Society of Clinical Immunology and Allergy - Home.
When asked when baby's digestive system is ready for solids, she only said every baby is different. Well that's probably why the experts will continue researching :D...:
More research is needed to determine the optimal time to start complementary solid foods. Based on the currently available evidence, many experts across Europe, Australia and North America recommend introducing complementary solid foods from around 4-6 months. Solid foods should not be introduced before 4 months.
The Australasian Society of Clinical Immunology and Allergy - ASCIA INFANT FEEDING ADVICE
Exactly right, every child is different. But how do you honestly know if the digestive system is ready? I would rather wait a little longer and make sure that its is fully developed.
The other signs need to also be in place as well thou - decreased gag reflex, lost tongue thrust, good head and neck control etc
On the question of when babies are ready. I reckon that if your baby can sit up, grab some food, put in their mouth and eat it, then they're probably ready.
Found my good old Robin Barker's Baby Love (2005), page 356;
She didn't have to wait for ten years now that experts' recommendation has changed again to 4-6 months... Very interesting, as she said, isn't it?:
The optimum time to start solids changes every decade or so. In the 1920's it was nine months, in the 1970's it was six weeks, in the 1980's it was three to four months, in the 1990's it was four to six months and now it is six months.
Previous recommendations were mostly based on whim, fashion and whatever foods was around at the time; now they are mostly based on reliable research and greater scientific knowledge of nutrition, physiology and baby development (we hope). However, cynic that I am, it will be interesting to see what the story is in ten years' time.
SJ & Marcellus,
My 4.5 month old baby has shown all the signs mentioned. He loves to chew anything in that regards! :D
Lady Noor, in fact the recommendations have not changed to 4 - 6 months at all, as per the previous posts in this thread. The quote from the allergists website is a recommendation only made by allergists - the official guidelines have not changed. The World Health Organisation and Australian National Health and Medical Research Council, and many other organisations, still recommend solids not be introduced before 6 months. And I have heard some leading international allergists speak and who agree with this!
There was one study done which suggested that delaying solids beyond 4 months "might" increase the risk of allergies, and that is the basis of the allergists association suggesting 4 - 6 months. However, many in the scientific community have concerns about the way the study was conducted and there are certainly some questions marks about it's validity. There are many other studies which show that there are several risks, not just an increased risk of allergies, to introducing solids before 6 months.
Another argument used to support lowering the age that solids be introduced (funnily enough the baby food companies are all in favour of this and very vocal about it), is that the incidence of allergies is still increasing despite the guideline age being raised to 6 months. Which would be logical if mums actually were delaying the introduction of solids until 6 months. The latest studies suggest that the vast majority of babies are still being given solids before 6 months. So this argument is fundamentally flawed.
The research is very clear that solids should not be introduced before 4 months. Whether or not a mum decides to introduce solids between 4 and 6 months is an individual decision and I am sure most mums make the best decision they can based on the information they have. This is why I believe it is important to get the right information out there - because there are many with a vested interest in putting misleading information out there. A friend of mine has a DD with severe food allergies (to several foods) and is devasted that she didn't know not to introduce formula or solids before 6 months. When the allergist told her that was a likely factor she was so upset that she hadn't known before, because she wouldn't have done it.
it's so confusing knowing what to do. My MCHN told me last month that i need to introduce solids before 6 months and certainly no later than 6 months claiming the allergy thing that it's made no difference (the previous guideline of starting at 6 months).
In the last 4 years, i've been given different advice for each child. That being said, my babies responses have been different too. DD1 refused all solids of any kind until she was 11 months old. I offered, she wasn't interested at all, until she was ready. DD2 was a keen eater from 5.5 months when she first tried some food. DD3 keeps putting everything in her mouth and i'm wondering about waiting another 2 weeks or to let her suck on a piece of pear.
It was recommended to me (by a pediatrician) that babies need to be started on solids at four months as 'new research' had found that starting earlier than six months actually reduces the likelihood of developing allergies.
My bub was actually 3 months and 3 weeks old and the pediatrician wanted me to get him started... I didn't feel comfortable with this, I couldn't find any info about this 'new research' and my baby really wasn't interested in anything except his boobies til just recently, at around 7.5 months. I wasn't about to force feed him, so we have taken it easy and I think he really has shown me when HE was ready to start. My daughter was the same.
Goodluck, it's really hard to make the 'right' decision in regards to lots of topics when it comes to parenting, especially with all the conflicting information out there :)
Oh and Lady Noor.. Neither my son or daughter slept better after starting solids.. Unfortunately!! :)
Stoked, if something doesn't feel right then that is a good sign that it might not be. Even the allergists who are going against the guidelines and suggesting starting solids earlier than 6 months, are adamant that solids should not be started before 4 months. That is universally accepted and borne out by research. The grey area is the time between 4 and 6 months. However, there are very good reasons why all the official guidelines still say 6 months. One study (with some questions over some of the methods) should not be a basis on its own for changing what we do.
If babies seem to be showing the signs earlier than 6 months and a mum really wants to go ahead with it, one idea might be to try Baby Led Solids so that it's up to the baby whether they eat any or not. Gil Rapley who is the Baby Led Solids expert doesn't recommend this because she finds that once food is in front of a baby, an adult will often help the food into the baby's mouth at some stage, whether the baby wants it or not. If you are aware of this risk and want to go ahead, it is probably a better idea than putting a spoonful of food in the baby's mouth and not knowing whether they really wanted it or not.
I'm all for holding off until at least 6 mths (I intend to wait until DS is showing all the signs of being ready as I did with DD) but I have been told by a couple of GPs and CHNs that babies need extra iron for brain development from 6mths. Any thoughts on that?
Are you BF Jandals?
If you are, it is rubbish - your baby will take all it needs from the BM and you - and you will get what is left - your body will automatically nourish its young as required at the detriment to itself itms. So they will always get the nutrition they need. (You need to eat a balanced diet and make sure you are taking a multi or something if you are feeling you aen't, and look after yourself, because it will take what it wants and leave you wanting, not the baby - same as during pregnancy)
Thanks LimeSlice. Yes, I'm B'feeding and intend to continue for a while yet. I really should be better at taking my vitamins and iron tablets but I just get busy and forget :doh:. I think one of the reasons I'm so tired is that I stay up far too late cruising BB :lol:
I'm really not too worried about when to start solids but the 'iron issue' is in the back of my mind. I'll know the right time for DS to start eating - he's pretty clever so I'm sure he'll let me know ;)
Honestly I dont believe developing allergies has anything to do with the age that you start solids. My DD started solids at 8 weeks old because she wouldn't drink milk. She refused the breast and when offered a bottle would only drink a total of 300ml in a 24 hour period, no one ever knew why but she devoured solids and quite nicely put on weight, and has absolutely no allergies. My DS was breastfed for only 8 weeks (long story) but he refused all solids until he was near 8 months old, and he has no allergies. Yet my friends little boy was breastfed until the age of 12 months, and she started solids at the magical age (at the time) of 6 months and he is allergic to just about everything.
I do wonder why there is such an increase in the amount of allergies we have these days, I cant remember a single child at school that had a food allergy 30 years ago, now it seems children are allergic to just about everything.
Jandals, the information your MCHN gave you about iron at 6 months is basically true. At some point between 6 months and 12 months, a baby's iron stores will start to deplete, and they need some solids, especially meat, to start replacing them. But there are two key points here. The first is that it doesn't just magically happen at 6 months. There are a few factors which determine how much iron babies have stored (one of which includes how much cord blood babies get - early cord clamping is not how nature intended things!). This is where watching for signs of readiness and Baby Led Solids are helpful, because a baby will know by instinct when they are ready for the food, and will eat at the right time. The other issue is that solids replace breastmilk. Breastmilk is not high in iron, but the iron in the breastmilk is nearly all absorbed. Commonly babies are started on rice cereal and purees as first foods. Purees have next to no iron, and while rice cereals are iron fortified, the iron is not in the right form, so very little of it gets absorbed by the baby. So when these foods replace breastmilk, iron levels can actually drop rather than increase. This is particularly of concern when solids are stared early, but at any time, meat is highly recommended as one of the first foods for a baby. As well as being high in iron, the iron is well absorbed, and it's also high in zinc which is also critical for brain development.
Clare, the allergy issue is really complicated. There is no "one cause", and it is still not well understood, even by the allergy researchers, exactly why the incidence of allergies are so high and increasing. What is known, from numerous studies, is that there are a number of things which do increase the risk of a child developing an allergy. Genetics (family history) is the biggest one of these. The next biggest is the introduction of formula or solids before 4 - 6 months. Other factors include a c-section delivery, antibiotics during pg and having a cat at home with your baby. Of course some babies will be exposed to all these factors and never develop an allergy, while others will have none of the key risk factors and still be allergic. This is a complex area. There is also the very plausible theory that it is related to how clean we are now and our immune systems becoming sensitive to the wrong triggers. However, it would naive to say that we should ignore the known and proven risk factors because of the exceptions. In a large number of babies allergies can be avoided because of what we know, and I know that as a mum, I would rather know about the risks and do my best to avoid them then to not be told about them and find out the hard way.