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When Should I Start Giving my Infant Solid Foods?

"When Should I Start Giving my Infant Solid Foods?" This is a question we hear a lot in parent groups.


While there is so much information out there not, all of it may be accurate or safe. This post will aim to summarize the various recommendations given by health organizations in Canada and from other organizations around the world.




This post will explain the following:

Scroll to the end for a summary


Guidelines for Introducing Solids in Canada


The World Health Organization (WHO) recommends exclusive breastfeeding for the first 6 months of life. Complimentary foods should be offered at 6 months in order to meet increasing energy and nutrient needs and support growth.


Health Canada

  • Recommends that infants are introduced to solids at 6 months of age.

  • Gradually increase the number of complimentary foods that are offered while continuing breast/formula feeding.

  • Infants should be supervised at all times during feeding

Canadian Pediatric Society

  • Start at 6 months

  • Offer lumpy textures no later than 9 months

  • Offer iron-rich foods a few times a day

  • Avoid hard, small and round or smooth and sticky solid foods as they can lead to choking

  • Prepare food safely and do not offer food containing raw or undercooked meat, eggs, poultry or fish.

Dietitians of Canada

  • Iron rich foods should be the infant’s first complementary foods and offered a few weeks before or just after the 6th month

  • Common food allergens can be introduced from about 6 months and then continued to be offered regularly

  • Practice responsive feeding which is feeding that is responsive to infant’s satiety cues

  • It is also a good idea to offer finger foods when possible, to promote self-feeding

Guidelines for Introducing Solids in the United States


American Academy of Pediatrics

  • Assess readiness

  • Exclusive breastfeeding for the first 6 months

  • Start with soft or pureed foods to prevent choking

  • Include foods that provide iron and zinc

  • Introduce one single ingredient new food every 3-5 days

  • Avoid hotdogs, nut, seeds, chunks of meat or cheese, whole grapes, chunks of PB, raw vegetables, fruit chunks such as apple or hard chewy or sticky candy.

Centre for Disease Control and Prevention

  • Start at 6 months

  • Look for signs of readiness

  • Start with mashed, pureed or strained food with smooth texture or foods easily dissolved with saliva and do not require chewing

  • By 7-8 months your child can eat a variety of different foods from each food group

  • Wait 3-5 days between new foods.

Eatright.org

  • Start solids at 6 months

  • Exclusive breastfeeding for first 6 months of life

  • Not recommended to start before 4 months or after 6 months

  • First foods should include pureed meats, poultry, beans and iron fortified cereal, especially is baby is primarily breastfed

  • Start with pureed or mashed foods around 6 months then progress to soft finger foods as chewing and motor skills develop

  • DO NOT feed solid foods from a bottle

Guidelines for Introducing Solids in the United Kingdom


Scientific Advisory Committee on Nutrition

  • All infants require solid foods from 6 months for adequate nutrition

  • Exclusively breastfeed for 6 months when possible

  • Solids should never be introduced before 4 months

National Health Service (NHS)

  • Assess readiness

  • No solids before 17 weeks of age

Guidelines for Introducing Solids in Australia


Eat for Health

  • At around 6 months infants are physiologically and developmentally ready for new foods, textures and modes of feeding

  • At 6 months infants need more nutrients than can be provided by breastmilk or formula alone

National Health and Medical Research Council

  • Introduce solids when the infant is physiologically and developmentally ready at around 6 but not before 4 months

Australian Society for Clinical Immunology and Allergy

  • Include common allergens before 12 months

  • Baby should start eating solids around 6 months and not before 4 months

  • Exclusive breastfeeding for the first 3-4 months of life has been shown to decrease risk of food allergies and eczema during first two years of life


Why do Some Guidelines Suggest Introducing Solids at 4 Months?


The consensus seems to be that starting solids at 6 months of age is ideal, yet many recommendations seem to mention the 4-month mark. Often parents get conflicting advice from different health professionals making this question even more confusing. Let’s explore some of the reasons for this discrepancy.


1. Teething

  • Most babies’ teeth appear between 4-6 months.

  • Teething is often mistaken as a sign of readiness for solid foods.

  • Some babies are actually born with teeth while others don’t get teeth until the 1-year mark.

  • It is important to look for other signs that your baby may be ready for solids.

2. Size

  • The American Academy of Pediatrics indicates doubling of birth weight or hitting 13 lbs. to be a sign of readiness for solid foods and this most often happens, you guessed it, around 4 months of age.

  • It is also important to consider other sign of readiness to be sure.


3. Risk of Allergies

  • Emerging evidence has shown that early introduction, between 4-6 months of age, of common allergens to high-risk infants may help prevent the development of food allergies.

  • There is limited information available on whether or not there is a benefit to introducing at 4 months vs 6 months.

  • The Canadian Paediatric Society recommends introducing non-choking forms of common allergens around 6 months of age.



Many of these guidelines also talk about assessing your child’s readiness. It would seem that the 6-month mark is more of a guideline as opposed to a hard and fast rule. As infants can differ in their rates of development, it is important to look for these signs to ensure they are ready:

· Sitting up with little to no support

· Holding up and controlling head and neck

· Taking an interest in food when others are eating

· Opening mouth and leaning forward when food is offered

· Reaching out and grabbing items and bringing them to their mouth

· When offered food on a spoon tongue does not thrust forward to push out food


Click here for more information on assessing baby's readiness for solids.


Pros. and Cons. of Introducing Solids Before 6 Months


There are some advantages and disadvantages to introducing solids to baby at 4 months of age.

It is a good idea to discuss the pros and cons with a doctor and dietitian to determine how to best meet your unique needs.



What the Research Says:


If your baby is showing signs of readiness at 4 months of age and they are not yet 6 months of age, it is ultimately up to you if you begin to introduce solids. It is important to consider your own unique needs as well as weighing the risks and benefits of your decision:

  • There are some studies that show the introduction of allergens like wheat or eggs at 4 months reduces the likelihood of the development of food allergies although there is not enough data to warrant recommending 4 months over 6 months.

  • Infants who experience sensory hypersensitivity may have increased food acceptance when introduced to solids earlier in the 4-6 months range rather than later.

  • A randomized control trial was conducted to compare iron intake and iron levels of breastfed infants offered iron rich complimentary foods at 4 months and infants who were exclusively breastfed until 6 months. The infants in the 4-month group were found to have higher iron intakes as well as increased hemoglobin, hematocrit and ferritin values than the 6-month group. However, in developed countries, iron deficiency is uncommon in normal birth weight infants who are exclusively breastfed for 6 months so introducing complimentary foods at 4 months may not be necessary.

  • Infants who are exclusively breastfed for 6 months are less likely to develop GI infections

  • Popular feeding techniques such as baby led weaning and other responsive approaches emphasize the importance of self-feeding finger foods as opposed to spoon feeding purees. Your baby may be more ready to self-feed closer to 6 months of age.

  • Mothers of infants who are exclusively breastfed for 6 months may experience prolonged lactation amenorrhea and more rapid postpartum weight loss

Summary

  • Ultimately, the safest option is to introduce solids at 6 months of age.

  • Emerging evidence found that introducing solids between 4-6 months may reduce the risk of developing food allergies, but the research is inconclusive.

  • If you feel your child is showing signs of readiness before 6 months, consult with your primary care provider to weigh out the pros and cons.

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Disclaimer: All the advice shared here is general information. Consult your doctor for personalized health information. Compiled November, 2021


Special thanks to Sabrina Mastrangelo and Bavina Sivayogeswaran, nutrition graduates from Ryerson University who conducted the research and helped with content development for this post.






References


Brown, A., Lee, M. D. (2015). Early influences on child satiety-responsiveness: the role of weaning style. Pediatric Obesity. 10(1), pp.62-63.


Canadian Pediatric Society (2014). Nutrition for Healthy Term Infants, six to 24 months: An overview.


Cohen, J. (2018). These are the dangers with the new study on solids and sleep for babies. https://www.kidspot.com.au/baby/feeding/weaning/these-are-the-dangers-with-the-new-study-on-solids-and-sleep-for-babies/news-story/f30c0ff845851cb972c22343b7a664fb


Dietitians of Canada (2017). Feeding Infants and Toddlers.


Dietitians of Canada (2017). Food Allergy Prevention in Infants.


Health Canada (2015). Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months.


Huh, Y. S., Rifas-Shiman, L. S., Taveras, M. E., Oken, E., Gillman, W. M. (2011). Timing of solid food introduction and risk of obesity in preschool-aged children. American Academy of Pediatrics. 127(3).


Otten, J. J., Hellwig, P. J., Meyers, D. L. (2006). Dietary Reference Intakes: The Essential Guide to Nutrient Requirements. Institute of Medicine of the National Academies. pp. 110, 386, 390.


Perkin, R. M., Bahnson, T. H., Logan, K., Marrs, T., Radulovic, S., Craven, J., Flohr, C., Lack, G. (2018). A Secondary Analysis of Randomized Clinical Trial. The Journal of the American Medical Association. 172(8).


Townsend, E., Pitchford, J. N. (2012). Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample. BMJ Open. 2(1).


World Health Organization (2018). Infant and Young Child Feeding.



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