When Should I Introduce Solids While Breastfeeding?

Dear SDBFC,

Thanks for responding to this question on Facebook the other day, but I would love to hear more on this topic: does breast milk start losing its nutritional value after 6 months? If the pediatrician states solids (in particular enriched rice cereal) twice a day are needed, are there any alternate opinions? I'm curious if the WHO or LLL have any alternate evidence.

Sincerely,

Abby

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Dear Abby,

Thank you for your excellent questions.  Solids are a huge topic of discussion in our weekly breastfeeding support group and pretty much every pediatrician in town has a different philosophy.  Here’s what the official organizations recommend:

The World Health Organization: “Infants should be exclusively breastfed for the first six months of life to achieve optimal growth, development, and health.  Thereafter, to meet their evolving nutritional requirements, infants should receive nutritionally adequate and safe complementary foods while breastfeeding continues up to two years or beyond.

The American Academy of Pediatrics: “Introduction of complementary feedings before six months of age generally does not increase total caloric intake or rate of growth and only substitutes foods that lack the protective components of human milk.”

 

Based on these recommendations, it is not that the breast milk is losing nutritional value at 6 months, or even a year!  It is that your baby is beginning to need additional nutrition, which is supplied by complementary foods.  Plus, complementary foods start out as little bites, not full bowls of food.  It is a very slow process.

So why do these organizations recommend delaying solid foods until your baby is at least 6 months? 

Here’s what the research says.....

  1. Your baby’s digestive tract is not fully ready to accept anything other than breast milk until she/he is at least 6 months old.  This is when your baby’s intestinal tract is finally sealed against allergens and will be able to digest a greater variety of foods.
  2. As stated on Kellymom.com, the pancreatic enzyme amylase does not reach adequate levels for digestion of starches until around 6 months, and carbohydrate enzymes such as maltase, isomaltase, and sucrase do not reach adult levels until around 7 months. Young infants also have low levels of lipase and bile salts, so fat digestion does not reach adult levels until 6-9 months.  When foods aren’t digested well, babies can have negative reactions (eczema, gas, constipation, etc.) 
  3. Most babies don’t need iron supplementation (see our article Do All Exclusively Breastfed Babies Really Need Iron Supplementation to see if your baby is one who is at risk for anemia), so the excess iron given through iron-fortified foods (cereals) actually DECREASES a baby’s efficiency in iron absorption when given before 6 months of age.  Most exclusively breastfed babies have enough iron stored in their bodies to last for at least 6-9 months.
  4. Delaying solids helps to protect a mom’s milk supply and decreases her risk of early weaning.

 

 

So, do you have to start with iron-fortified rice cereal when your baby is ready for solids?  NO!  Iron-fortified white rice cereal is almost completely void of nutritional value.  I am completely guilty of starting this with my oldest child, as I didn’t know any better, yet it was such a waste. 

Go for the whole grains and foods! 

Choose REAL food! 

 

What are your options for those first solid foods? 

 

One of my favorite websites, Wholesome Baby Food, gives a fantastic list of foods to start with your infant.  La Leche League gives similar recommendations, as well.  How much better does this list sound than boring rice cereal?

Avocado

Banana

Whole grain cereal

Pear

Squash

Sweet potatoes

 

Lastly, do you have to start solids the minute your baby turns 6 months old?  No.  Wait until your baby is showing signs of being able to tolerate solid foods, such as sitting up unassisted, developing a ‘pincer’ grasp, and is willing to gnaw and chew food.  For a detailed article about solid food readiness, check out Kellymom.com’s article, Is My Baby Ready for Solid Foods?,  as well as The Womanly Art of Breastfeeding.

 

Sincerely,

SDBFC

Do you have a question you would like answered by our lactation consultant? Please post it in the comment section, on our Facebook page, or to our Twitter Account (@SanDiegoBFC). We would love to feature it in an upcoming Help A Breastfeeding Mama Out article!