I recently heard the term “open gut” or “virgin gut“. This is how a baby’s stomach is described before 4-6 months of age. It means that the spaces in the small intestine are larger, and allow for the passage of bigger molecules (macromolecules) into your baby’s blood. This can be good, but there are risks as well, including the passage of pathogens. This is why the general recommendation from the American Academy of Pediatrics and the Canadian Paediatric Society is to introduce solids around 6 months of age (case dependent), depending on the advice of your own practitioner/paediatrician and your baby’s particular situation (some advise 4-6 months is OK). So lets look more into why this is the recommendation, because I see a lot of chatter on social media about feeding babies solids before 4-6 months (the misinformation this post will be looking at) – and there are many studies looking at why this is not a safe idea.
Why do babies need solid food at ~6 months?
Breastfeeding or formula is recommended up until this point as the only source of nutrition for our babies, so why is it recommended to begin solids at 6 months? Per Kellymom, one of my favourite resources as a new mom myself because it is evidence-based, you actually don’t HAVE to introduce solids right at 6 months in some cases. If your baby is doing well without and demonstrating normal growth (per your child’s healthcare provider), or they are not showing interest in solids yet, waiting a bit longer is an option (generally 6-8 months) – but it’s something you would need to discuss in detail with your HCP, because each child’s needs are different and there would be things you would need to monitor if you took this path.
The primary reason that 4-6 month is the recommended start time period pretty much across the board is because of micronutrient need increases – specifically nutrients like iron, zinc, and Vitamins A, D, and E to name a few (x). Progressive introduction of solids can help to supply these need nutrients to your baby’s growing body, whilst you continue to feed your baby by breast milk and/or formula as well.
What are the risks of introducing solids before 4 months?
Some risks include:
- Allergies (note that this is <4 months, not at 4-6 months!) and increased risk for certain diseases (pathogens can more easily enter the bloodstream) (x)
- Imbalances the gut biome a.k.a. dysbiosis (the natural flora of the gut may change – a type of organism that is normally very frequently seen may be replaced by another organism and so on) (x)
- Obesity – generally seen later in childhood (between ages 2-12) as a result of early introduction (potentially – it may be more related to duration of breastfeeding however – this is something that is currently debated in the literature) – see newer study from Australia debating this
- May lead to shortened length of breastfeeding (x)
I was unable to find any reliable benefits to beginning early – but as usual, if you know of any, please share your information with me via Twitter.
What are the risks to introducing solids late?
Nutritional deficiency – as I mentioned above, some later introductions may be OK, please discuss any concerns with your healthcare provider.
Regarding benefits, it would just be that if your child is not ready to eat solids, you would be working with their developmental readiness by waiting, however *again* this is something that should be discussed with your provider or paediatrician who knows your child and their development well.
What factors may impact when food is introduced?
There are a variety of reasons why parents may choose to introduce foods outside of the recommendations such as socio-economic status, cultural practices, personal beliefs, peer recommendations, misunderstanding of readiness/hunger cues, lack of support (returning to work, single parent, etc.) and so on (x). That’s why it is important for you, as a parent, to discuss any concerns or limitations you may have at home with your provider – they can work with you to build a plan that works while also providing you with evidence-based recommendations for solid introduction.
Does early introduction of solids help with sleep?
One study that was actually looking at early introduction of allergenic foods also found that early introduction (3 months) of these foods (solids) led to longer baby sleep with less wake-ups. The children being studied were also being breastfed. They were compared to a group that started at 6 months. That study can be found here.
*Keep in mind these are the results of one study, and there are still many risks to early introduction. Something that can be discussed with your HCP*
Should I be worried about being able to provide adequate nutrition to my baby up to the 6 month mark by either breast milk or formula?
Up to 6 months, your baby is covered by either of these – hence the recommendation! If you notice your baby is not gaining weight well, contact your healthcare provider.
There are also lots of recommendations to continuing breastfeeding in particular up until the 6 month mark, which can be found here on Kellymom in great detail.
I’m formula feeding, so are the recommendations different?
No! Formula fed babies, for the same reasons listed earlier on, should also have solids at around the 6 month mark (again, discuss with your HCP). Actually, there may be more risks to introducing solids early to a formula fed baby. Discuss with your healthcare provider to determine the right time of introduction for your baby.
Aren’t all babies different?
They are! That’s why I’ve constantly said – speak to your healthcare provider. I sound like a broken record but I will say this in EVERY POST I write. Your HCP is your best resource and they will also know current recommendations, your child’s needs and growth and be able to formulate a plan with you that keeps all of these things in mind. I am simply providing you with information – and most of that information is just saying “go speak to your HCP about this”.
I’m a healthcare provider working with this population, what can I do?
Do what you probably already do best – continue to offer support and resources to your parents. Provide anticipatory guidance regarding solid introduction specifically. Take time to specifically review the benefits and risks of early or late introduction of solids. Hunger cues and signs of readiness. Explore your patients beliefs and expectations to help build plans that will work for them. Make sure your recommendations are based on current evidence and demonstrate cultural consideration when providing care! You’re probably already doing a great job but it’s just a few things to think about.
As usual – if anything is out of date or incorrect, or you have additional questions, @ me on Twitter!
I’ve linked all journal articles and additional resources above!