Having your first child introduces a lot of change to your life, and you start stressing about how you can best care for this precious new life. Now, you’re probably here because the time has finally come to move from breastfeeding to feeding your baby solids! Yet varying bits of information from our doctors, child health nurses and online resources often leave us overwhelmed and confused. So let’s spend some time today clearing things up!
First! Is YOUR baby ready?
Before we find out what the different recommendations are, let’s decide if your baby is ready for solids. Here’s a checklist to help you through:
Good neck and head control
Able to sit upright when supported
Shows interest in your food
Able to push food towards the back of their mouth with their tongue
Putting everything in their mouth
Have put their hands in their mouth
Frequently hungry, demanding more feeds, walking more
Premature babies (under 32 weeks) may not show these signs until their corrected 6-month age, so wait till then and refer to this checklist again to decide if your baby’s developmentally ready for solid foods.
Some say 4, some say 6! When I should start?!
If you have heard two different answers for when to should introduce solids, it is because the Australian Society of Clinical Immunology and Allergy (ASCIA) guidelines recommends introducing solids somewhere between 4 to 6 months; not earlier than 4, or later than 6. Whereas both the World Health Organisations (WHO) & National Health and Medical Research Council (NHMRC) recommends to exclusively breastfeed until 6 months.
Since the ASCIA guidelines were specially written for the Australian community, those are the guidelines that we have chosen to follow and recommend for patients at our practice.
Why 4 months?
Allergies have skyrocketed in Australia over the past 20 years, causing our community to take action in reducing their prevalence. Through our efforts, we began seeing evidence arising in support of the theory that introducing complementary solids as early as 4 months may decrease risks of food allergies and coeliac disease.
There is a critical period of time when the human gut learns to differentiate between foreign proteins and figures out whether they are dangerous (e.g. bacteria and viruses) or safe (e.g. eggs and nuts). This was previously believed to happen around 6 months until we started seeing more evidence that this critical period, in fact, occurs between 4 to 6 months.
Why do Australian centres recommend differently?
Introducing your infant to solids any later than 6 months can put your child at risk of iron deficiency. It has been found that the iron levels in breast milk will no longer be enough to sustain all of your baby’s nutritional needs by the time they reach this stage of growth.
Supporting this, the NHMRC amended their guidelines in 2011, stating “as many infants as possible be exclusively breastfed until around 6 months of age (22-26 weeks).” ASCIA also released new guidelines in March 2016, recommending the introduction of highly allergenic foods within the first year. Reassuring us that there is no reason to put off or delay their introduction to these foods.
Some other centres that also follow the ASCIA recommendations is The Department of Allergy and Immunology at the Melbourne Royal Childrens’ Hospital and The Australian Government Department of Health.
With affordable and quality healthcare within arms reach in Australia, we believe that the potential benefits of early introduction of highly allergenic foods outweigh any potential risks. However, we do not disagree with the global recommendation of introducing these foods at 6 months, especially when it comes to countries where amenities such as clean water and quality healthcare are not readily accessible. Many argue that in those situations, the early introduction of solids could cause risk of infection such as Gastroenteritis and Lower Respiratory tract infection.
First Foods and Tips
Saving the yummy details for last, here are some first foods tips for your little one:
Start with 1 meal a day, and slowly increase to 3.
Start with smooth purees (no lumps) at 4 months and gradually increase in texture as your child gets older and develops eating skills
For a more familiar taste, you can mix breast milk or baby formula with rice, cereals or vegetable purees
Delaying lumpy food for too long may increase the risk of later feeding problems. By 9 months they should be having pretty lumpy foods; By 12 months, they should be having a mushed up version of whatever the family is eating
Iron enriched foods - cereal/rice cereal
To improve absorption of iron, include fruit rich in Vitamin C - oranges, kiwis, other citric fruits and leafy vegetables like broccoli
Vegetables and fruits - carrots, sweet potatoes, pumpkins, apples, pears & bananas
Meat, chicken, fish & tofu/legumes
Dairy Products (full fat cheese/yoghurt)
Cow’s milk may be added to food, but should not be used as their main drink until over 12 months
Avoid ‘added salt’ or ‘added sugar’ products for children under 12 months
Some foods that pose choking risks: whole grapes/whole nuts (may have nut butter from 6 months)
There is no set order of foods - try a different kind of food every 2-3 days and observe for possible reactions
Australian Government, National Health and Medical Research Council, Department of Health and Ageing. Eat for Health, Infant Feeding Guidelines. 2012 https://www.eatforhealth.gov.au/sites/default/files/files/the_guidelines/n56_infant_feeding_guidelines.pdf
ASCIA Guidelines, Infant Feeding and Allergy Prevention. 2016. https://www.allergy.org.au/patients/allergy-prevention/ascia-guidelines-for-infant-feeding-and-allergy-prevention
World Health Organisation, Complementary Feeding. 2019. https://www.who.int/nutrition/topics/complementary_feeding/en/
Marks, K. Australian Family Physician, Problems that Worry Parents: 44 (12) DEC 2015