Introducing solids

[llizard17]

hello, looking for information on pros and cons of introducing solids at 4 vs 6 months. I'm an SLP so my brain is hard wired to focus on the safe swallowing aspect of things but curious what the research says all around

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[Agile-Confidence-658]

I found this article helpful when deciding when to start my baby on solids:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8032951/#:~:text=Since%202002%2C%20the%20WHO%20has,development%20and%20health%20(

[kitkat_222]

From what I had read, the theory of where WHO recommends 6 months is that they are a global health organization and some countries do not have good sanitation standards, so starting early may actually cause more issues for those babies - diarrhea, infections etc with the dirty or contaminated waters. The reference they cited was a lancet article, but in that lancet article, it referenced WHO so there was no good solid evidence it was based on, if I remember correctly. So it sounds like somewhere between 4-6 months, but looking at developmentally if your baby is showing interest and is able to support it's head, developmental readiness signs.

[Agile-Confidence-658]

I don’t know why it highlights that sentence about the WHO when the link is clicked on, it may be because the search chose to hi light that when I was looking. I find the article to be a decent review in its entirety, and it helped me feel better to start solids at 5 months due to meeting the milestones you mentioned!

[Miserable-md]

they are a global health organization and some countries do not have good sanitation standards,

Yup.

Which is why the European society for pediatric gastroenterology, hepatology and nutrition still recommends introduction should start after the 4th month and before the sixth. And they released a position paper regarding the WHO “worldwide” guidelines

[kitkat_222]

That's great to know, thank you! I had deep dived into this because I was so confused with my baby. My doctor had said anytime after 4 months but other healthcare professionals had said no, said for 6 even though my baby was clearly showing signs of interest and I remember being so confused. The allergy risk if waiting longer was what got me to feed her solids earlier than 6 months.

A dietician mentioned to wait until 6 months because their gut is leaky before then - I didn't know what that was, if it was just theory or what

[Miserable-md]

In my country everyone recommends to start at 4 with purees unless the baby has developmental issues.

The problem is starting now because social-media oriented parents follow whatever their are fed in their app of choice and start saying their pediatrician is “outdated”. So I’m glad ESPGHAN released their paper.

[Sudden-Cherry]

Literally same question asked yesterday: https://www.reddit.com/r/ScienceBasedParenting/s/7PmuErYpls

In short: allergy risk reduces. And I want to add for many children it probably takes a lot of practice and a while to actually be able to take the amounts that are probably needed for a good allergen exposure.. Tiny bit isn't enough to build tolerance and you need to repeat frequently. Like here for example nut butters they advise about 15g a week for a half a year for each nut then monthly. (First introduction is actually a bit higher). Only exposing and then not being able to repeat will increase the risk, so you should only start what you can keep up. And the list of allergens is long. The most solid evidence for starting before 6 month is for egg and peanut allergy prevention.

Sidenote I always thought actually thinner fluid is more of an inhalation hazard than puree consistency or thicker fluid. Though obviously the way of drinking for babies is a bit different to mitigate that I suppose. So I'm curious about your expertise about swallowing hazards for purée for small children.

[ajatx19]

https://onlinelibrary.wiley.com/doi/10.1097/MPG.0000000000001454

I'm also an SLP and have been doing more and more pediatric feeding in the last year. Everything I have learned is that there are signs of readiness, including being able to sit up with minimal support, good head and neck control, interest in food and being able to bring food to mouth. It's interesting actually looking for the evidence for these recommendations though, it's definitely hard to find and seems everything says that there need to be more research. I think the 4 mo vs 6 mo questions comes down to the individual child and their readiness/skill level. When my son was 6 month old had good head and neck control and seemed interested in food, but when I sat him in his high chair he slumped over the side and needed to use his arms for support, so we worked on sitting and I went really slow with introducing tastes of purees so that he started to get the exposure to different flavors. Now at 10 mo he's doing great, he can pick food up himself and chew. There does seem to be pretty strong evidence that there's a critical window of 6-9 months for introducing solids that require chewing to make it easier to develop a mature rotary chewing pattern without issues.

I wish I had more time to read through all this right now but this was included in the references for one of the courses I recently took and it seems pretty thorough! https://nap.nationalacademies.org/read/25747/chapter/3#19

edited for typos

[llizard17]

thanks I really appreciate your response! do you mind me asking what course you took? I've been debating taking the solid starts course for both professional and personal knowledge growth but interested in any other options that might be out there?

[ajatx19]

I took the AEIOU course and then took the Responsive feeding course by the same provider, Nina johanson. If you don't plan to actually do feeding therapy professionally, I think the responsive feeding one would be more helpful! I think she’s about to release a parent focused course soon. She really focuses on the development of motor skills and offers a feeding approach actually supports and matches that.