When DH came home from the hospital in 1981, the instructions were clear: introduce solids at 2 months. Rice cereal added to a bottle was the preferred method. 1990, my parents were told to introduce cereal mush and baby food purees between 4 and 6 months. WIC was working to discourage the use of cow’s milk before 1 year.
But our DD was born in 2011 and the recommendations have changed based on the most recent research for infant nutrition. When it comes to health decisions, our family prefers to follow evidence-based medicine rather than tradition or protocol. When my own daughter is making decisions on introducing first foods for her own babies, the recommendations will probably have changed yet again. But based on the information we had we chose a variation of baby led solids, introducing vegetables at six months followed by fruits and then high quality grains.
Our Doctor’s Recommendation
My daughter and I both see a Family Physician. I like being able to establish a relationship with one healthcare professional for my entire family. The American Academy of Family Physician’s policy statement on breastfeeding includes:
The AAFP recommends that all babies, with rare exceptions, be breastfed and/or receive expressed human milk exclusively for the first six months of life.
The WHO (World Health Organization) also recommends delaying solids for the first six months of life. Although the AAP (American Academy of Pediatricians) recommend introducing solids between 4-6 months, this contradicts their own recommendation for exclusive breastfeeding for six months.
So, why did we delay solids until 6 months?
Virgin Gut/Open Gut
Again, I defer to the AAFP. Their position paper on paper on breastfeeding says:
The evidence base also supports the importance of six months of exclusive breastfeeding (when compared with four months) as protective against gastrointestinal tract and respiratory tract infection, including otitis media and pneumonia.20-22
What does this mean? Supplementing between 4-6 months, although still common, can lead to stomach and breathing troubles. The general idea is that, if possible, you want to keep your babies “virgin gut” for as long as they have an “open gut”. Their GI tract is thought to close, or seal, between 4-6 months of age. Delaying solids for a full 6 months helps to ensure that the breast milk will continue to coat the intestines and provide passive immunity until the gut seals and babies begin to make the antibodies found in breast milk (such as sIgA) themselves. We all know that there is “good” bacteria and “bad” bacteria. Delaying supplementation also helps babies to grow “good bacteria” in their gut as it develops and matures. In fact, the infant gut is too immature to even properly digest starches until 6 months and other carbohydrates until 7 months. Fats can’t be properly digested until 6-9 months.
What are some other reasons introducing solids at six months?
- To ensure proper iron absorption
- Avoid Choking: Watching for signs of readiness (Tongue Thrust/Pincer Grasp)
- Avoid Choking: Never put rice cereal in a bottle