Lactation Consultant Anne Smith Discusses Starting Solids Here

The American Academy of Pediatrics recommends starting solid foods at four to six months. What many mothers don't realize is that the four month recommendation applies more to formula fed infants, and the six month recommendation applies more to breastfed infants. Lactation Consultant Anne Smith discusses starting solids here.
Anne Smith, IBCLC

When a baby needs solids
Formula is not as complete a food as breastmilk, and formula fed babies are more likely to become anemic than babies who are breastfed, so they need iron-enriched food earlier. The most important thing to remember is that breastmilk is a nutrient-dense food and should be the primary source of your baby's nutrition throughout the entire first year of life while his brain is growing so rapidly.

It is the ideal source of nourishment, and it's composition changes to meet your growing baby's needs. For example, the levels of antibodies in your milk increase as your baby starts solids and takes in less volume of milk, and the fat levels in the milk decrease as your baby slows down on his weight gain in the second six months of life.

According to Ted Greiner, PhD and noted breastfeeding researcher, any foods other than breastmilk or formula given during the first six months have a displacement rather than additive effect because they displace the fat and calories the baby needs from milk.

From six to 12 months, babies need an "educational" diet, where other foods gradually begin to provide for nutritional needs that milk alone can't provide. Breastmilk or formula should be the main source (75 percent) of calories until the end of the first year.

From 12 to 24 months, the "complementary" diet goes up until at 18 months, milk provides 50 percent of the baby's calories, and by age two to three, up to 80 to 90 percents of the baby's caloric intake is provided by foods other than milk.

Fat is necessary
Some formula companies recommend "Follow-up" formula for babies 4 months or older who are eating solid foods. While these formulas are a little less expensive than regular formula, I don't recommend them because they are lower in fat than breastmilk or regular formula, and restricting fat during a period of rapid brain development is not a good idea. Foods like cereal and fruits also don't provide the fat needed during the first year and beyond, so it is important to make milk the most important part of the baby's diet while his brain is still growing so quickly.

There is no need for extra vitamins, iron, fluoride or any other supplements in the first six months as long as your baby is thriving on mother's milk alone. The American Academy of Pediatrics recommends that fluoride supplements be limited to children from six months to three years, and then only in areas where the drinking water has fluoride levels of less than 0.0 ppm (parts per million). They do not recommend fluoride supplements at all for babies less than six months old.

Breastfed infants rarely become anemic. The iron in breastmilk is better absorbed than the iron in formula (49 percent versus 10 percent). In addition, breastfed babies don't lose iron due to occult intestinal bleeding the way formula fed babies do. Giving iron supplements to nursing babies can cause intestinal upset, due to special proteins in human milk which bind iron in the babies intestines and keep harmful bacteria from multiplying. Excess iron can interfere with the functioning of these proteins, allowing "bad" bacteria to thrive.

Besides the fact that your baby doesn't nutritionally need any other foods until at least the middle of his first year of life, there are some other good reasons for not rushing into introducing solid foods into his diet.

Intestinal and developmental readiness vary widely from baby to baby. A baby's immature digestive tract isn't prepared to handle a wide variety of foods until at least six months, when many digestive enzymes seem to click in. This is especially important if you have a family history of allergies. The protective protein IgA, which coats the baby's intestines and prevents the passage of harmful allergen, doesn't reach peak production until around seven months of age.

Readiness for solids
So, how do you tell when your baby is ready for his first taste of solids? Remember to look at your baby, not the calendar. At some point between six and nine months, your baby will give you some signs of readiness.

  • Can he sit up by himself? Sitting upright is necessary in order for him to properly swallow substances thicker than milk.
  • Does he show signs of interest in what you're eating? Watching food go into your mouth and grabbing food off your plate are definite signs of readiness. My daughter Ashley (now 19) started solids at eight months, when she crawled up to the table, pulled herself up, grabbed a piece of toast crust off her brother's plate, shoved it in her mouth, and proceeded to chew. Her brother was indignant, but I just figured, "Well, guess she's ready for solids now." Of course, she was my third child and I was a little more laid back by then. With my first child I dutifully started shoveling baby foods into him at four months. He was not impressed.
  • Is he able to pick up small objects? Most babies are totally into this by around six months, and it indicates that he can finger feed and actually get some of the food into his mouth.
  • If you offer him a small taste of food, can he swallow it, or does he push it back out with his tongue? The tongue- thrusting reflex is a protective device that begins to diminish at around six months of age. When babies are really ready for solids, the muscles in their mouth and tongue are developed enough to transfer food from their tongue to the back of their mouth. This action has to be coordinated with swallowing, and most babies younger than six months are just not ready.
  • Is your baby teething? Teeth usually don't appear until he is six or seven months old, which is evidence that the tiny infant is designed primarily to suck rather than to chew. The increased salivation that accompanies teething can also aid indigestion. I have had two babies out of six who got their first teeth at four months, however, so the appearance of teeth is only one indicator of readiness for solids.

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