A reader writes:
So Tipat Chalav is now advising to give all babies tastes of food beginning at *4* *months*, because if we “wait” until 6 months some babies get more attached to the bottle and might resist integrating solids into their diet.Isn’t there some statistic about breastmilk-only for 6 months reducing chances of allergies?
There’s a lot of confusion surrounding the new Health Ministry guidelines about starting solids. The written statement makes it clear that starting at 4 months is optional, and should only involve tastes. But some parents are getting the message from Tipat Chalav, whether intentional or not, that they must start offering solids at 4 months. And the fact that tastes means less than a teaspoon throughout the day is not always mentioned.
There isn’t any harm in waiting a full six months before starting solids, although some babies may be ready a little earlier. On the other hand, it seems that offering solids at four months doesn’t increase the risk of allergies. The American Academy of Pediatrics examined the research and found:
There is also little evidence that delaying the timing of the introduction of complementary foods beyond 4 to 6 months of age prevents the occurrence of atopic disease. At present, there are insufficient data to document a protective effect of any dietary intervention beyond 4 to 6 months of age for the development of atopic disease.
There are still good reasons to wait a full six months, though. While tastes—an amount you can feed with your finger—aren’t risky, giving larger amounts too early can interfere with milk supply and growth. Babies don’t need anything else for about six months, and the nurse was misinformed. In fact, most babies are more willing to try solids at six months than at four. Artificially delaying solids can cause problems, as Shoshi Belkovitz explained in my interview with her at JewishMom.Com.
The Israeli health ministry changed its recommendations about when to start solids because of a couple of studies about gluten. Babies exposed to gluten between 4 and 7 months, and while they are still breastfeeding, may have a lower risk of developing celiac disease. Since more babies are still breastfeeding at 4 months than at 7, the health ministry decided to encourage tastes early. Further research is needed.
Contrary to popular belief, early solids won’t help babies sleep through the night. Breastfeeding and Human Lactation, Fourth Edition, states that “according to well-defined studies, babies who receive solids before bedtime have the same sleep patterns as do babies who are not given solids.”
Most solids, like vegetables and soups, are relatively low in calories. Breastmilk is high in calories, so when a baby receives solids instead of nursing, they fill up his or her tiny stomach. The baby may fail to gain weight properly. Early solids have also been implicated as a risk factor for adult obesity.
So what is the bottom line? If parents want to offer tastes starting at four months, there isn’t evidence of great harm as long as the quantities remain small. But there is also no harm in waiting a full six months or even a little longer, keeping in mind that the middle of the first year is the age that most babies enjoy feeding themselves. That is also when they begin needing additional calories and minerals from solid foods.
Babies are developmentally ready for solids when the tongue-thrusting reflex disappears and they can sit up more or less without support. In the early months, their tongue fills up the oral cavity. As they get older their cheeks get thinner, their palate rises and there is more space for food. Teeth usually come in at about this age as well, although teeth aren’t necessary for starting solids.
There is no advantage to withholding solids from a healthy baby older than 6 or 7 months.
A friend of mine has a theory that we are seeing more eating disorders caused by delay of solids, because some parents today are not willing to spend the time it takes to encourage their kids to eat solids. Spoon-feeding takes time as does preparation of special foods. Because kids make a mess when they are learning to eat with their fingers or with a spoon, some parents prefer to add powdered cereals to a bottle of formula for as long as they can.
While I agree with a lazy approach to offering solids as readers describe in the comments, I don’t think the parents my friend is talking about would be willing to do it that way either.
See also my interview with speech therapist Shoshi Belkovich on starting solids at Jewish Mom.Com.
My series on Feeding Babies Frugally at Cooking Manager.
Breastfeeding and Starting Solids: New Guidelines from Health Ministry
Breastfeeding Basics with Christina Smillie
I went the route of baby led weaning with my son and he basically refused solids until a year old. He’d taste things here and there, but nothing substantial. And even after a year he’d rather have nursed. I even tried purees to see if he’d prefer it. Some kids actually choose to not eat solids for longer than others. I don’t know why. The woman at tipat chalav never really seemed to think it was an issue (because he was fat and happy, I assume).
Chloe, what counts is that the baby is offered solids–not necessarily every day or even every week. If the baby doesn’t want and there are no underlying issues, that’s fine. I have heard of mothers who think it’s better to wait as long as possible before offering, and I think that’s problematic.
I’ve never seen anyone waiting simply because they are lazy or think it’s better for their kid not to even try, but I do know a lot of babies who aren’t interested well past 6 months, despite being offered – usually breastfed babies; in fact I’ve never really heard about this happening with formula fed babies, though I assume it’s possible. Maybe parents who use formula have more incentive to push because food is cheaper than formula (and I don’t mean that in a bad sense, just that breastfeeding makes it simpler to not push it at all, even when you probably should try more).
In any case, it actually worried me for a while that he wasn’t eating enough and that maybe he had mouth issues, but then we weaned and suddenly it was like, YAY food! He eats constantly.
I have definitely talked to mothers who deliberately did not give solids until quite late because nursing alone was “easier and simpler”.
NY, yes, that is part of the reason for some mothers.
I didn’t want to, but at 6 months, if he wants to eat other foods, it’s kind of cruel to say, “No, baby, you can’t have food because I don’t feel like preparing it and cleaning up.” Part of being a parent is getting over laziness to take care of your kids . . .
We actually gave him solids at 5.5 months, because he hadn’t been sleeping well, and was kvetchy a lot. We asked my MIL (a former pediatrician), and she said it could be that he needs solids, and to give banana or oatmeal as the first food. We gave banana, and bam! Problem solved! (OTOH, he was begging for solids at three months, and we told him he has to wait.)
Chloe, Mazal tov on your new baby! Babies refusing solids isn’t the same as parents withholding. Many babies just aren’t ready.
After mashing foods and spoon feeding my oldest (from 7 months), I vowed never to do it again! My subsequent children all got solids when *they* insisted, and could feed themselves. As long as they were happy to sit in the high chair and play with a spoon or toy while the family was eating, then I was going to continue with exclusive breastfeeding. #2 first got solids at 9 months, #3 first got solids at 10.5 months, and #4 got solids at 6.5 months – their different personalities showing through in how/when they “requested” solid food.
I don’t believe this “delay” to be the cause of any eating disorder on the part of my children. But perhaps your friend is referring rather to a parent withholding food from babies/toddlers who want to eat on their own and are being prevented because the parent doesn’t want to deal with the mess on the floor/tray/clothes/body…
The mess was never my issue – it was rather that I was working so hard to make all sorts of mushy food and serve it and my child just didn’t seem interested. I didn’t see why I had to make such an effort for something he didn’t want. Once he wanted it, he wanted pieces that he could hold on his own. It just all made a lot more sense to me that way…
Louise, I’m definitely talking about withholding food. I also hated mashing and spoon-feeding, although I did do it with my younger kids for a very short time.
I’m amazed any of my kids made it to adulthood. This definitely sounds better than the way we did it, but I guess the one above watches out for the fools. (I did not mind mashing food and spoon feeding though.)
With my second son I am definitely one of those lazy parents who couldn’t be bothered to prepare special foods, to spoon feed, or to clean up after messy solids. So my little one has always eaten only table foods, has always fed himself almost everything (I’ll sometimes spoondfeed him some soup or yogurt), and our floor is almost always a mess 🙂 Works for us.
I don’t think I’ve ever actually met anyone who withheld solids from a baby over six months who was interested in them. A much bigger problem among my friends is parents who obsess over getting their babies to eat some predetermined large amount of solids, and constantly fighting with the babies to get them to eat it.
Channa, you’re right that over-feeding is a bigger problem. But withholding is also an issue.
My oldest didn’t really start solids until 9 months or later – he simply was not interested and I wasn’t going to force feed him, he spit everything out. Even till 1 year old, if he ate more than a teaspoon in an entire day it was a lot for him. Ironically he’s my picky eater (though finally at age 12, getting much more adventurous) – I blame my mom for his tastes as she’s the worlds pickiest eater and never has been otherwise
My 2nd son (who also nursed till 14-15 months (as did #1) and self weaned) started solids around 4 months old by virtue of stealing food off my plate. His first solid was spicy peanut noodles that i was eating when out with my parents at a chinese restaurant – he swiped it while sitting on my lap and went back for 2nds. And he continued to swipe food regularly from that point forward. though he was also a very plentiful nurser – solids were definitely a supplement for him. And while he’s gotten pickier over time, he’s always been a very adventurous eater.
I rarely fed ‘baby food’ to my kids – they ate mashed up whatever we were eating at the time (or pureed of whatever it was). And i let them self feed whenever they wanted (which was ALL the time for #2 – he never ever allowed me to spoon feed him, insisting on feeding himself everything including gevina levana using his hands when the spoon didn’t work for him)
each took totally different approaches to food based on their own taste buds and personalities. And they were in the same day care setting from similar ages, etc (their daycare also didn’t do any ‘baby food’per say but just pureed or mashed whatever they cooked for the toddlers, mostly a lot of legumes and veggies)
I was lucky that my tipat chalav nurse was super pro-nursing and didn’t seem to care what I was doing with solids as long as I was responding to what my kids want.
Jarred baby food in Israel isn’t all that appealing. The variety is much less, most flavors appeal to the easy, sweet route of simple fruits, and many contain added sugar!
Shoshana–good examples of how individual babies can be!
Very good article! Our baby (you might remeber my comments and questions about Pessach and being due at that time) is now 6 months and we are going to start now slowly because since a week or so she really seems to want food. We are going to try babyled weaning, which she enjoys but I am a bit scared. But in the end, I am watchful and educated and I have to trust her instincts. Dont tell Tipat Chalav though, we already got into trouble for saying we dont want to do the taste thing and she will start when she is ready.
Hannah,thanks so much. Keep us posted. Yes, this post is just in time for all of the readers with the Pesach babies!
I want to add that this post (and the interview up at JewishMom.com: http://jewishmom.com/2011/10/25/dont-wait-too-long-to-start-solids-by-hannah-katsman/) are not directed at experienced, confident moms like much of my readership. I have no problem with rolling along with the baby who is taking his time.
i have never really encountered any moms who want to delay solids just like that. it seems the opposite, most parents are so excited to give their babies all these tastes, that they push them before they are developmentally ready. Does the WHO not clearly state to exclusively breastfeed until 6 months? I was under the impression that a baby’s digestive system is just not developed enough to process anything other than milk until around 6 months. I know many who have waited until 9 months or so to introduce food, following their babies cues, without any issues at all.
Rachel, I have encountered them. Delaying until 9 months is usually not a problem–the first couple of months of solids are for baby to get used to the idea. But there is generally no advantage to waiting. The WHO still says six months.
Maybe it’s a macho thing – to prove you can grow a baby exclusively from the resources of one’s own body even through the entire first year.
Update on our own baby – he jumped at those little tastes, and we very quickly moved to a half jar a day – first time one of our babies actually knew what to do with that mush when offered even at 6 months. But Hannah I think it was you who told me babies should still get nearly all their nutrition from breastmilk through the first year – something I didn’t realize before. As a result I’m not pushing him to take on more solid meals.
Yes, the majority of calories come from breastmilk until about a year.
But it’s hard to find evidence that “tastes” are a problem for babies after 4 months or so. The quantity is an issue, however.
My two oldest were born on kibbutz, and I think I remember starting them on tastes of solid food when they were four months old! (Maybe I’m remembering incorrectly and it’s really six, but the number four is definitely in my head. It certainly wasn’t in place of nursing, though, I nursed them both until they were 10 months old, but like you said, a taste a day. Anyway, they had an amazing way of doing it that I’ve never seen anywhere else, but it was a clean and easy way to feed: each day, the kibbutz mashed up some of the vegetables from the soup, and it was brought (very thick liquid) to the Beit Tinokot. We held our babies in our arms, and fed them from little cups! They drank their first food, no spoons or mess.
Raising a baby on the kibbutz sounds like fun, Toby!
How about instead of encouraging solids at an earlier age they encourage breastfeeding for longer? The latter is more beneficial in so many ways than the former. I hate it when they make these recommendations, so many people just blindly do what the Tipat Chalav tells them to.
Hi Bluma and thanks for your comment! I don’t think it has to be one or the other. There is evidence that 4-6 months might be preferable, but the WHO still recommends a full six months and not waiting much longer except in individual cases. Just pointing out that there is little risk in offering solids at 6 months, while there is a risk to delaying them.
The importance of breastfeeding longer is a separate but very important topic! And you are right about the influence of Tipat Halav.
Great idea! Yes, you are right. Too many people blindly do what the Tipat Chalav says. On the other hand, I also know quite a few people who take the Tipat Chalav nurses with a grain of salt.
1. Many working mothers who are nursing, actually like the possiblity of adding solids ASAP, from their point of view it makes it possible to leave the baby solid food which either saves pumping, or from leaving formula.
2. I think that possibly the idea of having totally liquidized food might be mistaken, as from 6-7 months many babies seem to prefer a much less fine consistency, leading mothers to become confused, when they refuse the “mush” and think the babies do not want solids at all.
3. In Israel they start with fruit and veggies (I personally think that this dates from the very very olden days when not BF babies did not get formula, but milk mixed with sugar and water!!!- so the system prefered to add things with vitamins in—I was told to give oranage juice at 3 months, MIL was told to give tomato juice at that age (even though we were nursing)), however, I understand that in England and the US they start with cereal, what is the difference and what is best?
Keren,
1. Yes, I agree–I encourage mothers to have the babysitter offer the solids, instead of the mother, so that there is less need to pump. And some mothers do run into milk supply issues at 4-6 months–if methods for increasing milk don’t work, supplementing with solids is usually a better option than formula.
2. Yes, at 6 months food mashed with a fork is good enough and finger foods shortly after (or from the start, whatever works although I personally prefer to offer mashed foods so baby gets the hang of swallowing it).
3. Fruit juice should be given rarely if at all, it is mainly sugar with not much else. The vitamin C dissipates quickly. I prefer fruits and vegetables to cereal, with iron-rich meat soon after. The cereals are enriched with iron which is why they are recommended but they are highly processed.
This is interesting, is it more common in Israel to exclusively breastfeed and delay solids? In the UK, only about 1% of babies are exclusively breastfed until 6 months and the main issue is early introduction of solids (ie lots of solids from much earlier than 6 months, not just tastes), not delaying solids. As others have said, it seems to be very common for babies to not be interested in solids until much later than 6 months, but these babies are generally all being offered foods, certainly from what I can see.
I am curious which women are more likely to delay solids? In the longer term breastfeeding community in which I have experience (online and in real life), I think I have only once heard of somebody withholding solids. Most families in these communities seem to do baby led weaning, from around the middle of the first year. Maybe it is just not very common here in the UK to do this? In the communities which don’t breastfeed as much or as often, solids tend to be introduced very early, usually on the recommendation of the health visitors or GPs. So I am struggling to think of who would be likely to be withholding solids. Certainly, from my experience, early introduction is a much more widespread issue than delaying solids. The people are are withholding solids, are they generally exclusively breastfeeding?
I think this is the beauty of baby led weaning; there is much less need to worry about whether a baby is ready to eat solids or not. If they choose to feed themselves, they must be ready. If they can’t feed themselves or are not interested, then they must not be ready. Obviously, as you say, as long as they are being given the opportunity to play with food and eat it, if they want.
From a personal perspective, my kids have been well past a year before eating much – second one is 2 and shocked me today by actually eating some egg! She will often go all day without eating anything (other than frequent nursing when she needs it). However, they have both been offered family food from the middle of the first year, whenever we ate, so it was not a case of me withholding food. Though I do generally refuse to spoon feed; I have taken the approach that if they are hungry and want to eat, then they can certainly find a way to feed themselves. I don’t mind the mess.
Very interesting discussion Hannah.
Who withholds the solids?
If someone can easliy afford formula, and does not like the “mess”, they will withold the solids
Breastfeeders who think that if exclusive breastfeeding is so good (and it is), doing it for longer must be better. And it delays the return of fertility.
Emily, sorry for the slow reply! I don’t know how common it is, but I hear about delaying solids enough that I thought it was important to show the other side of the story. Doctors pushed early solids for so long (as a result of formula that lacked specific nutrients, and got extrapolated to nursing babies too), that there was a backlash as it were.
I’m sure you are right that withholding solids is not as common in the UK. In Orthodox communities here, it is sometimes seen as a way to increase the period of breastfeeding infertility among women who don’t want to use birth control.
I believe as long as they swallow some foods there is no need for concern (and of course, if they are growing and developing well).
Hi there,
I just happened on this. In Canada in the mid sixties when I had my daughters (1966 and 1967), solids were introduced in the form of rice pablum at about six weeks. My doctor advised me to give the solids first and follow with the breast. (When I started to breasfeed my first baby, I knew no one else who was doing so; many of my friends also had babies, but bottlefed them exclusively.) Neither my doctor nor I knew what we were doing, my milk dried up at around the baby’s fifth month, and she was switched to cows milk at six months.
The younger daughter I successfully fed until she self weaned, at around nine months. She refused a bottle and went straight to a cup at that age.
My daughter successfully breast fed exclusively for six months.
The weird thing about this is that neither of my girls has any kind of food allergy or sensitivity, but the grand child has a tree nut allergy.
Mary, are you the one who used to visit and comment occasionally a long while ago? If so you had a beautiful blog.
Yes, we have really been shortchanged with the bad advice. My mother said she nursed me for only a month because she didn’t have enough milk, but back then women were told not to nurse more than every 4 hours. I was born in 1964. But my older sister recalls my mother being proud of having nursed her children so she must have had more success with my siblings.