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The Solids Controversy

Tuesday, December 30, 2008

WHO's recommendation

Some years ago, the World Health Organisation (WHO) recommended that solids not be introduced to infants until they were at least 6 months old. The National Health and Medical Research Council (NHMRC) followed with a similar advice in Australia.

 The previous recommendation had been to introduce solids at 4 to 6 months. For many mothers, the change was counter-intuitive, as many infants appear to be interested in solids before 6 months. For some breastfeeding mothers, use of solids such as stewed fruit is a preferred option to formula when they are not immediately available. Surveys have confirmed that majority of mothers in Australia did not follow the revised recommendations with many introducing solids to their children at 4 or 5 months without ill effect.

The 6 month recommendation was based on the belief that exclusive breastfeeding for at least 6 months was best. The evidence for this was limited with only one or two studies in developed countries showing less gastroenteritis in infants exclusively breastfed. Exclusive was defined as only breastfeeds with no other fluids or solids. It may have been better to focus on avoiding formula as supplementing breastfeeding with formula will reduce duration of breastfeeding. Formula-fed infants generally have worse health and developmental outcomes than breastfed infants.

Problems arose

Unfortunately, it is possible that the recommendation to delay the introduction of solids not only did not benefit infants but also may have done some harm. It has become clear that delaying the introduction of a variety of foods to young children may have long-term effect on their food preference. It is best to introduce a variety of tastes and textures over the first year of life to develop healthy food choice and avoid fussy eating habits.
 

Food allergies and intolerances

More recently, another consequence of delayed introduction of foods has become apparent. The incidence of allergies of all types, especially food allergies, is increasing and research suggests that delayed introduction of solids has interfered with the normal immune development in infancy reducing food tolerance and increasing allergies.

Doctors who specialise in allergies from around the world have written a joint recommendation that solids should be introduced from 4 to 6 months and not delayed until 6 months or older. Breastfeeding is of course encouraged for the first year of life.
Breastfeeding combined with gradual and steady increase in the variety of foods results in the lowest incidence of allergies.
Always when introducing solids, the parents need assess safe risk and infants need be developmentally ready. Young children can choke on solids. This is an important reason for not introducing solids at 2 or 3 months of age. When solids are started from 4 months, early foods should be soft and mushy and only one new food each week. From 6 months new textures can be included but not hard foods, such as uncooked carrot or raw apple, which can lodge in the infant’s trachea or wind pipe.
 
All parents should be aware that young children may choke on solids.  Parents need know that if they believe a young child in gagging or choking on food that a firm hit on the back may help dislodge the obstruction. (Cradle 2 Kindy Parenting Solutions suggests all parents and care givers complete their First Aid - St John has a 'Course in Caring for Kids' that is highly recommended)

The Solids Controversy was written by Professor Karen Simmer PHD FRACP. Professor of Newborn Medicine, University of Western Australia.

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