Baby Started Solids and My Milk Supply Went Down

Science of Mom reader Roxanne left a comment on my postal service about the recent peanut allergy study. She wondered nigh starting solid foods with her four-month-old baby boy:

"Do y'all have an stance on starting solids at 4 months versus vi months? I noticed that many of the studies on allergy include babies in the four-6 calendar month range, but I call back that the current recommendation is to wait until 6 months. I enquire because my baby Will NOT drink out of a canteen while I'm at work. He is miserable all twenty-four hour period. I'm merely gone 8-3 including travel time, so if he could just get a little something at 11am, I think he might actually nap and not cry all day. Nosotros have tried everything. If you know of any studies please let me know. He is 18 weeks old."

I totally understand Roxanne'southward defoliation, because there's lots of conflicting advice on this topic. This is a question that I tackled in-depth in my book (due out in July!), but I wanted to offer some of this information on my blog as well.

Let'southward outset by getting our terminology straight.

Starting solids is simply the beginning of a slow transition from an exclusive milk diet to a nutrition of table foods. In some countries, this is also called "weaning," which is confusing since the aforementioned term means stopping milk feeding in the U.Due south. (i.e. weaning from breastfeeding, weaning from a bottle). "Complementary feeding" is often used in the research and public health worlds. This is an apt term, because the goal with feeding solids to babies is to complement chest milk or formula, which will continue to provide about of babies' calories through at to the lowest degree the end of the get-go year.

Should you lot give your baby solid foods at 4 months, 6 months, or somewhere in betwixt? The research on this question is complex.

What is the history of starting solids?

In that location is a common assumption that longer exclusive breastfeeding – and longer delay in starting solids foods – must exist more natural, and hence, healthier. Just looking at traditional human cultures, with no admission to commercial babe nutrient, mod pediatricians, or divisive Internet forums, tin can give united states of america valuable perspective on what is "natural." A survey of childbirth and breastfeeding practices in 186 non-industrial cultures reported that solid foods were routinely introduced before 6 months, a finding that surprised the writer:

"Reverse to the expectation of a prolonged period of breast-milk as the sole source of infant diet, solid foods were introduced before one month of age in ane-third of the cultures, at between one and six months in another third, and was postponed more than 6 months for only i-third."¹

A more than recent cross-cultural analysis of 113 nonindustrial populations from around the world found that parenting introduced solid foods before half-dozen months in more than one-half, with 5-6 months being the nearly common time for introduction.²

Human being diets and infant care practices vary tremendously around the earth, and then it'south impossible to say if starting solids at four months or 6 months is more natural. As to which is healthier – well, that'southward where we need to look at the science.

What is the official advice most starting solid foods?

Public health and professional organizations fall into ii camps when it comes to recommendations about solids foods: they either recommend starting between 4 and vi months OR at six months. There are well-respected organizations on both sides.

The World Health Arrangement (WHO), tasked with making recommendations for the unabridged earth, "recommends that infants start receiving complementary foods at six months of age in addition to breast milk." They also go far clear that solid foods are of import, equally the period of tardily infancy is a time of rapid growth and evolution, and breast milk lone merely isn't enough for most babies. "Complementary feeding should be timely, meaning that all infants should starting time receiving foods in add-on to breast milk from vi months onwards." The government recommendations in Commonwealth of australia [PDF] and the U.G. mirror the WHO's advice.

The European Order for Pediatric Gastroenterology, Hepatology, and Nutrition (ESPGHN) calls 6 months of EBF "a desirable goal." Merely they too add, "In all infants… the introduction of complementary foods should non be before 17 weeks merely should not be delayed across 26 weeks."³ [PDF] In their statement on breastfeeding [PDF], the same committee writes, "In industrialized countries, in that location is at present no scientific evidence that introducing complementary foods to breastfed infants between 4 and 6 months of historic period is a disadvantage relative to introduction after 6 months."⁴ The European Food Safety Authority came to similar conclusions [PDF].^five

In the U.S., the American Academy of Pediatrics (AAP) 2012 Policy Statement, "Breastfeeding and the Use of Human Milk [PDF]," written by the AAP's Section on Breastfeeding, recommends "sectional breastfeeding for about half-dozen months, followed by continued breastfeeding as complementary foods are introduced…"^vi

However, scroll effectually the AAP's website for parents, and y'all'll discover that the advice there focuses on developmental readiness (holding caput up, sitting upwardly, opening mouth for food, etc.) rather than historic period. Simply afterwards, in an italicized note, do they mention, "The AAP recommends breastfeeding as the sole source of nutrition for your infant for nearly 6 months." There is no mention of what to do if you lot aren't exclusively breastfeeding or of why it might be important to wait on solids until 6 months if you're breastfeeding but not if you lot're feeding formula (or some combination of the 2).

As well within the U.S., the American Academy of Allergy, Asthma and Immunology recommends starting solids between iv and half-dozen months based on some data (discussed below) that this may decrease the risk of developing food allergies. You lot can read their recommendations on preventing allergies here [PDF] – information technology's a keen summary of the current research. (This paragraph added 5/15/xv after reminder of this from a reader.)

One affair that'southward certain is that what families actually practice when it comes to starting solids is all over the map. Co-ordinate to the 2014 CDC Breastfeeding Report Carte [PDF], but 19% of babies are exclusively breastfed at half-dozen months. A survey of 1,334 U.Due south. mothers, published in 2013, found that 40% introduced their babies to solids before iv months, and but seven% waited until 6 months.^seven

Just about anybody agrees that is all-time to expect until 4 months to start solids. Studies have shown that introducing solids earlier 3-4 months tin increase the risk of eczema at age ten, celiac affliction, blazon 1 diabetes, wheezing in childhood, and increased torso weight in childhood.^8–11

However, the debate over starting solids at 4 versus 6 months continues. Which is improve? Let's accept a await at what the scientific discipline says.

How does starting solids affect nutrition?

As far every bit I can tell, at that place have only been 3 randomized controlled trials (RCTs) of starting solids at four versus half dozen months. The RCT design is the gilt standard for a clinical trial, and it gives us the best chance at determining how historic period of starting solids might crusade different outcomes in babies' wellness. (Most studies of infant feeding use observational study designs, which are always complicated by confounding factors and can but show correlations, not causation.)

The start ii of the RCTs were conducted in Republic of honduras in the 1990s.^12,13 In both studies, mothers of infants were randomly dissever into two groups. Researchers asked one grouping to exclusively breastfeed (EBF) their babies until half dozen months. They asked the other group to get-go solids at 4 months (while continuing to breastfeed) and gave them jarred commercial foods and advice on sanitary feeding practices, reducing the risk of foodborne illness. This was an of import role of the study pattern in a setting where families might lack access to refrigeration or make clean water, only we still have to exist conscientious almost applying these data to more adult countries, because factors such as maternal malnutrition and baby growth rates may exist different. Happily, a third RCT with a similar design was conducted more recently in Iceland.¹⁴ It turns out that all three of these studies had similar findings:

• Effects on babe growth: Whether babies started solids at 4 months or 6 months did non affect their growth during this time, suggesting that either method provides enough calories and nutrients for normal growth. The Iceland study also followed babies out to eighteen months and three years, and they found no difference in growth at these ages (weight, length, caput circumference, BMI, risk of overweight).¹⁵

• Effects on free energy intake: The Republic of iceland trial included careful measurement of chest milk and solid food intake at 6 months. Non surprisingly, the babies that started solid foods at four months ate a fiddling less breast milk (average of 818 yard/d) compared to those EBF through vi months (901 g/d). They made upward the departure with solid foods, however, so total calorie intake was not different (560-570 kcal/d).¹⁶ Similar results were seen in the Honduras studies. This is exactly what we'd await given the similar growth between groups, and it shows that infants are practiced at cocky-regulating calorie intake to meet their needs.

• Effects on nutrient status: The master food of business organization during the second half of the showtime year of life is iron. In one of the Honduran studies, starting solids at four months gave babies higher hemoglobin, hematocrit, and atomic number 26 stores (measured by plasma ferritin) at half dozen months of historic period compared to the 6 month EBF babies.¹⁷ In the Republic of iceland study, the 4-month solids grouping also had higher fe stores than the half-dozen-month group.¹⁴ However, ferritin levels were adequate in both groups of Icelandic babies, and the number of babies with iron deficiency or atomic number 26 deficiency anemia was not significantly dissimilar. Thus, an earlier start at solids may requite breastfed babies a little heave in iron, only information technology isn't clear that this is really clinically relevant – that is, it may or may not brand a departure to babies' health. (The same cannot be said for delaying solids beyond 6 months; adventure of fe deficiency does seem to increase in this state of affairs.)

Observational studies support the conclusion that babies abound and develop well whether they start solids at 4 or 6 months. A 2012 Cochrane review looked at 23 studies (from both developing and developed countries) and concluded that half-dozen months of exclusive breastfeeding is usually sufficient to support healthy baby growth.¹⁸ The authors are cautious about applying this conclusion to every baby, though: "The data are insufficient to dominion out a modest increase in risk of under nutrition with exclusive breastfeeding for six months and grossly inadequate to reach conclusions virtually the effects of prolonged (more 6 months) exclusive breastfeeding."

How does starting solids bear on take chances of infection?

In developing countries, where many families may lack access to clean water and/or refrigeration, the run a risk of illness dramatically increases when babies start solids. With the introduction of solid foods comes potential exposure to pathogens that may contaminate nutrient, water, or utensils. For case, one study in the rural Phillipines found upwardly to a xiii-fold increased run a risk of diarrhea with feeding solids. This factor alone justifies the WHO's recommendation for 6 months of exclusive breastfeeding in these settings.

But with admission to make clean food and careful feeding practices, the risk of infection with solids appears to be much lower and maybe not a business concern at all. In a report of sixteen,000 U.Thousand. infants, tracked for the first eight months of life, starting solids didn't increment their risk of hospitalization for diarrhea or lower respiratory tract infection, regardless of the historic period they took their first seize with teeth.¹⁹ Strangely, the Republic of honduras RCTs found that the 6-month EBF babies were actually a little more likely to get sick (upper respiratory tract infections in one report¹² and diarrhea in the other¹³) compared with those starting solids at 4 months.

I study, conducted in Republic of belarus, found no difference in respiratory tract or ear infections merely an increased risk of gastrointestinal infections in babies EBF to 3-4 months compared to those EBF for 6 months.²⁰ The difference amounts to one extra case of diarrhea per 42 babies introduced to solids earlier. All the same, there was no deviation in hospitalization for GI infections, and so this increase seems to be in small-scale illnesses. It too includes some babies that were just 3 months quondam, and at least some of these infections could probably be prevented with more than careful food prep practices.

So does starting solids increase the likelihood that your baby will get sick? About studies say no, but one says that at that place may be a minor increment in episodes of pocket-size diarrhea.

How does starting solids touch on the take chances of allergies and chronic diseases?

When babies get-go eating solid foods, new proteins bombard their GI tracts. The immune system needs to learn about these proteins and recognize them as acceptable passengers through the GI tract rather than pathogenic invaders. Nutrient allergies represent a failure to tolerate these food proteins.

For allergies and some chronic immune diseases, there appears to be a sweetness spot for when to innovate solid foods. For example, one study found that children showtime exposed to wheat betwixt 4 and 6 months (versus after six months) had a 4-fold decreased risk of wheat allergy.²¹ Some other found that children who first had cooked egg at four-half dozen months had the lowest incidence of egg allergy, whereas those starting egg at 10-12 months had a 6-fold increased chance.¹⁶ These studies were observational – not randomized – and there are a host of confounding factors that tin can muddle the waters of baby feeding research. Yet, the contempo peanut study (an RCT, explained in my post here) clearly showed that exposure early on in life reduces allergy, although timing and amounts of exposure volition need to be divers for different allergens.

There is some testify that a window of opportunity may exist for gluten as information technology affects the development of celiac disease. Earlier observational studies showed that infants who ate gluten after iii months of historic period just before vi-vii months had lower risk of celiac illness. Nevertheless, two RCTs (explained in my postal service hither) published in 2014 showed that age of introduction of gluten (at 4 months, 6 months, or 12 months) didn't ultimately affect the development of celiac. An observational written report also showed lower risk of blazon one diabetes when cereals (including rice and gluten-containing grains) were introduced between iv and 6 months.²² Yet, an RCT comparing gluten introduction at 6 or 12 months found no difference in risk of developing islet autoimmunity (ref 22a – this sentence added 5/15).

Either way, the research here suggests starting solids – particularly these potentially allergenic foods – by around six months may reduce allergy risk. Or it may not, but it doesn't seem to injure.

How does starting solids touch on mom's wellness?

In the Honduras studies, moms that exclusively breastfed their babies for half-dozen months were more likely to still have lactational amenorrhea (i.e., not accept their periods) compared with those starting solids at 4 months. In one of these studies, 6 months of EBF resulted in more weight loss for moms (a difference of 0.half-dozen kg or ane.3 lb between iv and 6 months).²³ Depending on your personal situation, these differences may or may not be benefits to you. Either way, exclusive breastfeeding or even amenorrhea is no guarantee that you won't go significant, and so don't count on information technology as birth control.

What if I'thousand not breastfeeding?

Many of the studies I've discussed so far were specifically focused on when to introduce solids to breastfed babies. Is the decision unlike for a formula-fed baby? Non actually. Some of the studies on infection and allergy hazard included formula-fed babies, and then those findings apply to both groups. If you're feeding an atomic number 26-fortified formula, you don't really need to worry about iron deficiency. Factors such as lactational amenorrhea and weight loss are obviously specific to breastfeeding.

We've covered a lot of ground, so let's put these considerations in 1 place:

Reader Roxanne's bottle-refusing baby inspired this post. In her situation, she has a baby who is hungry, and given the mix of risks and benefits of starting solids, information technology seems reasonable to requite solids a effort. Roxanne's pediatrician told her the same affair, and she gradually started introducing some solids to her baby.

Each situation is different. Public wellness recommendations are intentionally simple and piece of cake to understand, merely babies and their families are circuitous. If you've read this far, and so you sympathise that the research backside this question is besides circuitous and doesn't give us a clear right or wrong answer. This post focused on wellness outcomes related to starting solid foods, but information technology ignores what may be the near of import factor of all: each baby's developmental readiness and interest in solids. In my next post, I'll write about how to tell if your baby is ready for solids.

Click here to read 4 Signs Your Baby Is Fix for Solid Foods.

Share your experience in the comments. What advice did yous receive almost starting solids? What did yous actually practise?

References:

1. Lozoff, B. Birth and Bonding in Non-Industrial Societies. Dev. Med. Child Neurol. 25, 595–600 (1983).
2. Sellen, D. Due west. Comparison of infant feeding patterns reported for nonindustrial populations with current recommendations. J. Nutr. 131, 2707–2715 (2001).
3. Agostoni, C. et al. Complementary feeding: a commentary by the ESPGHAN Committee on Nutrition. J. Pediatr. Gastroenterol. Nutr. 46, 99–110 (2008).
4. ESPGHAN Committee on Diet: et al. Breast-feeding: A Commentary by the ESPGHAN Committee on Nutrition. J. Pediatr. Gastroenterol. 49, 112–125 (2009).
5. EFSA Console on Dietetic Products, Nutrition and Allergies. Scientific Opinion on the appropriate historic period for introduction of complementary feeding of infants. Eur. Food Saf. Auth. J. seven, two–38 (2009).
6. American University of Pediatrics Section on Breastfeeding. Breastfeeding and the use of human milk. Pediatrics 129, e827–841 (2012).
7. Clayton, H. B., Li, R., Perrine, C. G. & Scanlon, G. Due south. Prevalence and Reasons for Introducing Infants Early to Solid Foods: Variations past Milk Feeding Type. Pediatrics 131, e1108–e1114 (2013).
8. Fergusson, D. M., Horwood, 50. J. & Shannon, F. T. Early Solid Feeding and Recurrent Childhood Eczema: A ten-Year Longitudinal Study. Pediatrics 86, 541–546 (1990).
9. Norris, J. M. et al. Chance of celiac disease autoimmunity and timing of gluten introduction in the diet of infants at increased risk of disease. J. Am. Med. Assoc. 293, 2343–2351 (2005).
10. Norris, J. M. et al. Timing of initial cereal exposure in infancy and risk of islet autoimmunity. J. Am. Med. Assoc. 290, 1713–1720 (2003).
11. Wilson, A. C. et al. Relation of infant diet to childhood health: 7 yr follow up of accomplice of children in Dundee infant feeding study. BMJ 316, 21–25 (1998).
12. Cohen, R. J., Dark-brown, K. H., Dewey, K. One thousand., Canahuati, J. & Landa Rivera, Fifty. Effects of age of introduction of complementary foods on babe breast milk intake, total energy intake, and growth: a randomised intervention report in Honduras. The Lancet 344, 288–293 (1994).
13. Dewey, Chiliad. G., Cohen, R. J., Dark-brown, K. H. & Rivera, 50. 50. Age of introduction of complementary foods and growth of term, low-nascence-weight, breast-fed infants: a randomized intervention written report in Honduras. Am. J. Clin. Nutr. 69, 679–686 (1999).
14. Jonsdottir, O. H. et al. Timing of the Introduction of Complementary Foods in Infancy: A Randomized Controlled Trial. Pediatrics 130, 1038–1045 (2012).
15. Jonsdottir, O. H. et al. Exclusive breastfeeding for 4 versus 6 months and growth in early childhood. Acta Paediatr. 103, 105–111 (2013).
16. Wells, J. C. et al. Randomized controlled trial of four compared with 6 mo of sectional breastfeeding in Iceland: differences in breast-milk intake by stable-isotope probe. Am. J. Clin. Nutr. 96, 73–79 (2012).
17. Dewey, 1000. Thousand., Cohen, R. J., Rivera, 50. L. & Brown, Chiliad. H. Effects of age of introduction of complementary foods on iron status of breast-fed infants in Honduras. Am. J. Clin. Nutr. 67, 878–884 (1998).
18. Kramer, M. Southward. & Kakuma, R. Optimal duration of exclusive breastfeeding. Cochrane Database Syst. Rev. 8, CD003517 (2012).
19. Quigley, Grand. A., Kelly, Y. J. & Sacker, A. Infant feeding, solid foods and hospitalisation in the commencement 8 months after nascence. Arch. Dis. Child. 94, 148–150 (2009).
20. Kramer, Yard. S. et al. Infant growth and health outcomes associated with 3 compared with 6 mo of exclusive breastfeeding. Am. J. Clin. Nutr. 78, 291–295 (2003).
21. Poole, J. A. et al. Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy. Pediatrics 117, 2175–2182 (2006).
22. Frederiksen, B. et al. Infant Exposures and Development of Blazon 1 Diabetes Mellitus: The Diabetes Autoimmunity Study in the Young (DAISY). JAMA Pediatr. 167, 808–815 (2013).
23. Dewey, Grand. G., Cohen, R. J., Chocolate-brown, K. H. & Rivera, L. L. Furnishings of sectional breastfeeding for four versus six months on maternal nutritional status and infant motor development: results of two randomized trials in Republic of honduras. J. Nutr. 131, 262–267 (2001).

(22a). Hummel, S., Pflüger, M., Hummel, Thou., Bonifacio, E. & Ziegler, A.-1000. Chief dietary intervention study to reduce the risk of islet autoimmunity in children at increased run a risk for blazon 1 diabetes: the BABYDIET written report. Diabetes Care 34, 1301–1305 (2011).

Here'south another post, from a weblog I beloved, on this topic: When Is Information technology All-time To Introduce Solids at Expecting Science.

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Baby Started Solids and My Milk Supply Went Down

Source: https://scienceofmom.com/2015/05/14/starting-solids-4-months-6-months-or-somewhere-in-between/

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