Advice on how to best wean a baby onto solids has changed many times over the years and often been subject to the whims of fashion. Even the medical professionals find it hard to agree. Conflicting advice regarding weaning abounds so what is the most up to date, research based recommendation?
In the 1920’s it was thought that babies should have only milk for the first year of life. In the 1950s - 1970’s it was common practice to introduce solids as early as 4 weeks of age with everything from rusks to raw eggs being added to bottles.
For the last 10 years the general medical advice, including that of the World Health Organisation (WHO) has been that the optimum nutrition for babies is with exclusive breast feeding ideally up to 6 months with solid foods being added thereafter as a compliment to breastmilk.
Public practice has been slow to change however and although this number is falling studies had recorded that the majority of babies were already commenced on solids by 17 weeks despite advice that this is the earliest time for any solids to be considered.
There is a lot of interest in the current advice for introduction of high allergen foods both in the general population and in those at risk e.g. family history of peanut allergy or coeliac disease. Peanuts, cow’s milk, eggs, fish, sesame and gluten are the most common true allergies encountered (and should be distinguished from food intolerances).
Prolonged breastfeeding, to at least 6 months, has been shown to be advantageous in reducing rates of eczema/asthma in those with a family history of these conditions and it is also beneficial throughout the weaning process as a protective measure when introducing high risk allergen foods.
Major studies (EAT study, LEAP study) have recently published findings and although it is not clear how this new information will affect medical guidelines there is some hope that the earlier introduction of allergens such as wheat, fish and peanut may be beneficial in reducing rates of allergy. The current thinking is that they should definitely be commenced as part of weaning by 6-7 months at the latest.
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‘Breast is best’ until solids begin and does not need to stop then, ideally should be continued up to 1 year and beyond as a compliment to a more varied solid diet.
Introduction to solids should not occur before 17 weeks and ideally should be as close to 6 months as possible. Prior to this breast milk (or formula) is only complete food for baby’s nutritional requirements.
However, experts recognise that babies have a significant range of development at this stage in terms of weight, tone and physical milestones – an individual approach should be considered between 4-6 months. Weaning should not be delayed beyond 6 months.
In general, physical signs that a baby is ready for solids include being able to sit up to feed, grasp a spoon, have hand eye co-ordination for both spoon or finger foods, and be able begin a chewing motion. Foods should not be introduced in purees into bottles with widened teats.
Pureed vegetables, in all their varieties, are the best foods to start with and present a low allergy risk. Iron rich foods are important after 6 months to meet the babies need for growth and Vitamin D should be supplemented from birth.
Both development of a normal gag reflex and chewing is important and if foods are kept too smooth it may be problematic for babies to accept them after the age of 9 months. Texture and lumps should be added quickly from 6 months and soft finger foods such as cooked vegetables or soft fruit can be offered alongside purees/mashed food. (Baby led weaning is outside the scope of this article)
New evidence may suggest that introducing allergen risk foods early decreases rates of allergy but is not yet conclusive enough to change guidelines.
The advice is that these foods should be started somewhere between 4 and 7 months, alongside breastfeeding throughout the weaning process. Each new food should be added at 3 day intervals to assess for reaction and then continue to be offered regularly in the diet. At present the guideline for families with a history of specific allergy is still to wait until 6 months unless directed otherwise by their doctor.
Superficial reaction, such as a contact rash to high acidic/histamine content of some fruits such as kiwi, tomatoes or strawberries is common and is not a true allergy. These foods need not be avoided. If unsure however consult a doctor.
Drinks such as water in a cup can be commenced, although milk (breast or formula should remain the main drink until age one)
Ideally as they grow babies should start eat what the family eats but remember all adult food is not suitable for them. Some elements of adult meals should be avoided; particularly anything processed which is often high in salt and sugar content.
With a little common sense, and a lot of patience this messy new chapter in baby’s development can be an exciting and rewarding experience!