The recommendation is still 6 months: When should I start solids 4 or 6 months? By Adult and Child Nutritionist Mirna Sabbagh
It seems like the question of starting solids at 4 or 6 months remains a controversy today. Perhaps this year in 2020 more than ever, we've been hearing the recommendation changed to 4 months. Did it? The answer is NO by most health authorities and I will show you why and how below.
Please note the below applies to the average healthy child. In some cases such as reflux, extreme allergy, growth problems or other cases the pediatrician may recommend starting solids before 6 months for the child's health. Please discuss with your pediatrician the decision to start solids for your baby.
Let's start with what do the experts ALL agree on:
1. The baby DEFINITELY should not start solids before 4 months because it causes allergies, eczema, lowered immunity, inflammation and higher risk of diabetes.
2. The baby should be ready :
- The baby is able to hold his or her head alone
- The baby lost the tongue thrust reflex. The tongue thrust reflex is a protective mechanism where the baby sticks his tongue out and pushes food out when he is still not ready for solids.
- Babies may be ready if they watch you eating, reach for your food, and seem eager to be fed.
- AAP double birth weight or around 6 kilos
NHS discusses readiness signs for solids here
What is the recommendation by the global experts on starting solids as of May 10, 2020?
WHO (World Health Organization) 2020: 6 months
WHO recommends starting solids at 6 months.
Qoute from WHO "Around the age of 6 months, an infant’s need for energy and nutrients starts to exceed what is provided by breast milk, and complementary foods are necessary to meet those needs.
Before I continue with the official recommendations from other expert health agencies, I would like you to know that I have created a digital course with ALL the information you need about starting solids for your baby.
AAP (American Academy of Pediatrics) 2018: 6 months
AAP recommends starting solids at 6 months.
The AAP recommends breastfeeding as the sole source of nutrition for your baby for about 6 months. When you add solid foods to your baby's diet, continue breastfeeding until at least 12 months. You can continue to breastfeed after 12 months if you and your baby desire. Check with your child's doctor about the recommendations for vitamin D and iron supplements during the first year.
AAP on Allergy: If the child has extreme eczema 4 to 6 months is appropriate however if it is mild or no eczema then 6 months
"An expert panel has advised peanut introduction as early as 4 to 6 months of age for infants at high risk for peanut allergy (presence of severe eczema and/or egg allergy).
For infants with mild to moderate eczema, the panel recommended introduction of peanut-containing foods at around 6 months of age, and for infants at low risk for peanut allergy (no eczema or any food allergy), the panel recommended introduction of peanut-containing food when age appropriate and depending on family preferences and cultural practices (ie, after 6 months of age if exclusively breastfeeding)."
UK: 6 months March 2019
UK recommends starting solids at 6 months
Quote from the NHS:
"Introducing your baby to solid foods, sometimes called complementary feeding or weaning, should start when your baby is around 6 months old."
They also add:
- Breast milk or first infant formula provide the energy and nutrients your baby needs until they're around 6 months old (with the exception of vitamin D in some cases).
- If you're breastfeeding, feeding only breast milk up to around 6 months of age will help protect your baby against illness and infections.
- Waiting until around 6 months gives your baby time to develop so they can cope fully with solid foods. This includes solid foods made into purées, cereals and baby rice added to milk.
- Your baby will be more able to feed themselves.
- Your baby will be better at moving food around their mouth, chewing and swallowing it. This may mean they'll be able to progress to a range of tastes and textures (such as mashed, lumpy and finger foods) more quickly, and may not need smooth, blended foods at all.
Australian association: 6 months
Australian Association recommends 6 starting solids at 6 months
"1. What age should a baby be introduced to solids?
Currently the WHO and NHMRC recommendation of around 6 months for introduction of solids is current and backed up by research."
A consensus agreement, supported by published evidence, was accepted at this Summit and included the following recommendations:4
- When your infant is ready, at around 6 months, but not before 4 months, start to introduce a variety of solid foods, starting with iron-rich foods, while continuing breastfeeding.
- All infants should be given allergenic solid foods including peanut butter, cooked egg and dairy and wheat products in the first year of life. This includes infants at high risk of allergy.
What about what the Australian Association says about allergy:
"It is important to note there has been no good evidence to suggest there is any greater chance of allergy in babies not fed solids until 6 months compared to those who start solids at 4 or 5 months.
Also, allergy is not the only consideration in timing of solids.3 There are also nutritional issues, risk of illness, risk of the baby receiving too little breastmilk and developmental readiness. Many people think that risk of illness from formula-feeding or dirty solids is only a problem in poor countries. However, there are many studies showing that breastfeeding protects babies from illness in Western countries as well.3 This supports keeping the timing for exclusive breastfeeding to around 6 months."
What does The Cochrane review say? 6 months
The Cochrane review also recommends starting solids at 6 months
"We found no evidence to disagree with the current international recommendation that healthy infants exclusively breastfeed for the first six months."
I did find that the European Food Safety Authority says something different. It says you "may" start solids before 6 months with indication on it being more harmful or beneficial.
"We found no evidence that shows introducing complementary foods before 6 months of age is either harmful or beneficial for health. This includes introducing allergenic foods such as egg, cereals, fish and peanut, and gluten."
Nutritional reasons – The majority of infants do not need complementary foods before 6 months of age as exclusive breastfeeding provides sufficient nutrients up to that age. However, infants who are at risk of iron depletion may benefit from complementary foods that are a source of iron introduced before 6 months of age. Infants at risk of iron depletion are those born with low iron stores (i.e. whose mothers had low iron status during pregnancy, or whose growth was restricted in utero and were born too small, or whose umbilical cord was cut too quickly after birth and preterm infants) or used existing iron stores up quickly because they grew fast during the first months of life, and are exclusively breast fed.
But Mirna, how about all the spoons and food items in the supermarket saying 4 months?
I can't answer you on why they do that, but I can tell you that they can basically say 4 months if they wish, no-one is checking what is written and we should not AT ALL take food brands or food accessory brands as sources of nutrition information for our babies.
I have a course about starting solids 6-12 months course the answers moms questions about solid foods from A to Z. It's a best seller and you can watch it from the comfort of your home as it's a fully digital video course.
Mirna Sabbagh, an adult and child dietitian, nutritionist, and lactation consultant. She also has several digital courses: breastfeeding course, starting solids 6-12 months course, feed with confidence course for ages 1 to 7 years, and also Pregnancy Nutrition Course, that you can sign up for from the comfort of your home.
The courses are pre-recorded. As soon as you make the course purchase, you will receive a link to watch the course from your phone or laptop.
You can also e-mail Mirna for questions on firstname.lastname@example.org
If you would like to book a consultation in person or via Zoom with Mirna El Sabbagh - Licensed Dietitian in Dubai - Contact her on email@example.com