Starting Infants On Solid Food Too Early
We made a great impact when we began publishing guidelines about how infants should sleep – incidence of SIDS death dramatically decreased. BUT, we just don’t seem to be getting through as well on guidelines for instituting solid foods to infants.
Starting infant solid foods, new research
Of course it may have something to do with the significance of the outcome risk; namely, go to bed face down and risk dying from SIDS versus start solid foods too soon and risk “islet cell autoimmunity, obesity, adult-onset celiac disease, and eczema.” The latter just doesn’t sound too scary – unless you have them.
Guidelines: Infant Solid Food
What one needs to understand is that the discovery of sleep positions relation to SIDS didn’t come without a lot of sweat, effort and some luck because we were trying to find a relationship with a lot of variables. But, in that case there was pretty much only one outcome we were relating too.
In the case of starting an infant on solid food, however, we are searching for the relationship between multiple variable AND multiple outcomes. It hasn’t been easy but some reliable data is beginning to evolve, enough that the American Academy of Pediatrics (AAP) published guidelines several years ago.
So how come we don’t seem to be having the same benefit on this as we did on the “Back to Sleep” program? That’s what the CDC wanted to find out with a study they conducted over the pat couple of years. Between 2005 and 2007 they sent detailed feeding questionnaires to lots of parents of new infants and it’s taken some time to analyze the complicated data.
Over 1,300 mothers participated in the Infant Feeding Practices Study II by returning answers to feeding practices about their introduction of solid foods and why. The results were published in the medical journal Pediatrics March issue (2013).
Too Much, Too Early – guidelines helpFor the reasons and diseases I mentioned above, the AAP advises breastfeed babies not to begin solid food until 6 months of age and those who are formula fed until 4 – 6 months. Of course when possible breastfeeding is preferred exclusively for the first 6 months. Breast milk contains all nutritional requirements until then (and doesn’t contain some questionable elements); but then delaying longer may cause deficiencies in zinc, protein, iron and vitamins B and D when the infant’s body mass begins to exceed secretion capabilities.
What did the study show? Well, that 40.4% of mothers introduced solid foods before their infants were 4 months old, and some did so earlier than 4 weeks of age. Additionally, they found that mothers were more likely to do so if they were younger, were unmarried, had less education, earned less, and participated in the Women, Infants, and Children program. [Huh? Somebody needs to find out who at WIC would give that advice.]
Further, they discovered that 52.7% of mothers who formula-fed started solid feeding before 4 months, compared with only 50.2% of mothers who reported mixed feeding and 24.3% of mothers who breast-fed.
The reasons given? Most (88%) merely said that “My baby was old enough to begin eating solid food.” Seventy percent said “My baby seemed hungry a lot of the time.” Mothers who formula-fed were almost twice as likely as mothers who breast-fed to give the reason “A doctor or other health care professional said my baby should begin eating solid food”
Now keep in mind that this was a “fill in the questionnaire” type of study and may or may not reflect the true rationale; but, it seems clear that the word just doesn’t seem to be getting out well – or that the risks haven’t been explained well enough to give credibility in the eyes of the parents.
I know that I used to follow standard understanding at the time and advise parents they could begin the rice cereal (iron fortified) at 2 months IF the baby wasn’t yet sleeping through the night. I (along with about everyone else) also advised that babies should sleep prone too; BUT, things change! It would be ridiculous not to act on new credible information, especially when the health of one’s child is concerned – wouldn’t it?
There’s just a lot of new understanding relating to infant feeding coming to the fore such as that “programming” for obesity and adult metabolic diseases such as hypertension, diabetes, and coronary artery diseases can possibly be resulting from both underfeeding and overfeeding in early infancy.
And the other recent finding that, although nearly all infant baby foods seem nutritious, 64 of 90 (71%) commercially prepared meals and two of four (50%) savory snacks surpassed sodium-content recommendations. Some toddler meals contained as much as 630-mg sodium per serving. A food is deemed to have excessive sodium content if it contains more than 210 milligrams per serving.
So what’s the problem? Toddler-hood is the very time that the child is learning and setting their thresholds about what “normal” looks, acts and feels like. Get used to sweets and salts etc. and they’ll be fighting it the rest of their lives.
So, spread the word. Evangelize a bit. Who knows what benefit we can give to the next generation if we loose some of our antiquated practices that have been shown to be detrimental.
[Pediatrics. Published online March 25, 2013]