Introduction of Complementary Foods

The introduction of solids (also called weaning or complementary feeding) has become quite a complex topic for both healthcare professionals and parents. This is most probably related to the fact that although we have the World Health Organization (WHO) guidelines on complementary feeding many other health organizations have published their own guidelines on weaning, which do not reflect the same information as the WHO. Add on to this the worry about the increase in food allergy and confusion when to start solids to prevent the development of these and you have a perfect recipe for confusion.

So lets start with the basics: the WHO recommends that weaning is commenced at 6 months of age, with this recommendation being  backed up by a very good systematic review of many studies indicating that breastfeeding exclusively until this age provides a baby with all the nutrition that they need and has the added benefit of reducing infections (see blog post on the benefits of breast milk). So the ideal from the WHO perspective is to breast feed exclusively until 6 months and then introduce solids. This is the advice currently also supported by the Department of Health in the UK. However, the European Society of Paediatric Gastroenterology Hepatology and Nutrition and the American Academy of Pediatrics both recommend introduction of solids occur between 4-6 months of age, when the child is ready. The latter recommendations are also based on really good research indicating that too early (< 17 weeks) or too late (> 26 week) weaning can also introduce a multitude of problems, which I will discuss under feeding difficulties, food allergies and micro-nutrient deficiencies in future blog entries.

So what are parents supposed to do? For me as a healthcare professional the most important aspect to commencing solids in any infant is not to do any harm, so DEFINITELY no solids < 17 weeks and it is important NOT to delay solid introduction beyond 26 weeks. In between this age, each baby will indicate whether they are ready to be weaned. Generally this would include being able to sit upright and hold their head in a steady position, having eye-hand-mouth coordination with food (looking at food and wanting to grab it) and lastly that they are able to manage food in their mouth (babies who are not ready will push their food back out with their tongue). It is important not to miss these cues with your baby and rather follow your baby’s development for readiness for food introduction.

Babies start mouthing usually from 3 months of age, this means they are putting their fists/fingers in their mouth and can often be associated with a lot of salivation. This often gets misinterpreted as either early teething or that they are hungry. In fact, this is a wonderful developmental stage that all children go through, desensitizing their mouth for future solids and also learning to explore. In future you will not only see them explore their fingers in this way, but foods and toys as well. Similarly often parents interpret night time waking, when they have slept through as a sign to wean, when there are none of the other signs (i.e. eye-hand-mouth coordination ect)  present. Babies will go through these periods naturally, so it is not necessarily a sign that they need food.

So look and listen to your baby’s cues and start when your baby is ready, but remember never before 17 weeks! I will guide you through weaning with future posts.

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