Starting Solids… When is the right time?

 By Andrina Wilson, Sleep Coach & Midwife

Health professionals and breastfeeding experts agree that breastmilk or formula is all your baby needs until six months of age. It is important that your baby is both developmentally and physiologically ready to eat solid foods. This is generally between the ages of 6-8 months.

Parents often decide to introduce solids earlier than recommended for a multitude of reasons. Often they are guided by what other parents are doing, their WellChild service has recommended it, they think it will help their baby sleep longer or, the most common reason I hear – “my baby stares at me when I’m eating”. Babies are inquisitive creatures, they learn by watching the world. Following your mouthful or grabbing food from your plate does not mean that their tiny, immature gut is ready for solids.

Below is a list of just a few of the organisations that recommend that all babies are exclusively breastfed (no cereals, juice or other foods) for the first six months of life:

  • World Health Organisation
  • UNICEF
  • Ministry of Health NZ
  • American Academy of Pediatrics
  • American Academy of Family Physicians and Research
  • Australian National Health and Medical Council

 

Immunity and Allergies

Babies are born with what is often referred to as an ‘open gut’. This means that the spaces between the cells of the small intestines are large enough for macromolecules including whole proteins and pathogens (disease causing cell) to pass directly into the blood stream. This is beneficial for breastfed babies as it allows antibodies to pass through and gives the baby passive immunity via the mother. However, if a baby is given solids before the gut closes, around six months of age, it can predispose the baby to allergies and allow large, disease causing pathogens to pass through.

Exclusive breastfeeding for at least the first three to four months of life reduces the risk of allergic disease, coeliac disease, Type 1 Diabetes, respiratory tract infections, ear infections and Sudden Unexpected Death in Infancy (SUDI). The risk further decreases for babies exclusively breastfed for the first six months of life. Furthermore, introducing solids prior to six months of age is also associated with an increase in body fat in adolescents and adults.

Do I need to worry about my baby’s iron levels?

Healthy babies born at term (>37 weeks gestation) have enough iron stores to last at least six months. Breastmilk is rich in iron and is easily absorbed by babies gut. Approximately 50-70% of iron that is available in breastmilk will be absorbed (3-12% in formula), compared with only 4-10% of iron fortified cereals.

Babies born prematurely (<37 weeks gestation) may be at risk for iron deficiency anaemia, as a significant amount of babies iron stores are laid down in the last trimester of pregnancy. It is important that you discuss this with your pediatrician at birth. In New Zealand it is common for an iron fortifier to be added to expressed breastmilk and given to babies born prematurely. Prematurity is not an indication that your baby will need to start solids before six months.

 

Will solids help my baby sleep through the night?

This may not be what you want to hear, but giving your baby solids will not help them to sleep longer.

A 2010 study showed that babies who were given solids prior to four months of age slept, on average, half an hour less each day than babies who were not given solids. Babies wake in the night for many reasons, hunger often being way down the list. Around five months of age, babies sleep patterns change significantly. All babies will wake 4-6 times in the night and without knowing how to self-settle, they will need your assistance to get back to sleep. Click for more info.

 

But my baby keeps grabbing my lunch!

Babies explore the world by touch and taste. They will put almost anything they can get their tiny hands on to their mouth, but this doesn’t mean they necessarily want to eat it! Showing interest and/or grabbing the food on your plate doesn’t mean your baby is hungry or needs additional foods. It’s simply their way of exploring their environment and being a part of the fun!

Babies LOVE to be involved in meal times – have them sit with you at the table with some clean, baby friendly utensils like plastic spoons, bowls etc. and let them learn by watching. They may imitate your chewing actions which is fantastic for when they do start eating solid foods. You could also give baby a cup of expressed breast milk or “momsicle” (frozen expressed breastmilk) for something new to try.

 

At the end of the day, you as a parent know what is best for your baby. However, it is important to consider the reasons for starting solids – is your baby truly ready to start solids (both developmentally and physiologically) or are they just interested in what’s on your plate because it is colourful and smells different? Could they be waking in the night because they’re trying to master a new skill like sitting unaided or crawling, rather than being hungry? It is also important to consider the future implications on your baby’s health – the evidence that starting solids prior to six months increases the risk of allergies and infection is black and white.

It’s so cliché, but your children grow up so quickly. Blink and you’ll miss it! Sometimes we need to slow down and enjoy the present. When they start critiquing your culinary skills, you’ll look back fondly on the day when they nuzzled into your chest, staring into your eyes and that beautiful milk-drunk haze spreads across their face… savour that image, just a little bit longer.

 

References:

Cameron, S., Taylor, R., & Heath, A. (2013). Parent-led or baby-led? Associations between complementary feeding practices and health-related behaviours in a survey of New Zealand families. BMJ open, 3(12), e003946.

Kramer, M., Guo, T., Platt, R., Sevkovskaya, Z., Dzikovich, I., Collet, J., Shapiro, S., Chalmers, B., Hodnett, E., Vanilovich, I., Mezen, I., Ducruet, T., Shishko, G., & Bogdanovich, N.(2003). Infant growth and health outcomes associated with 3 compared with 6 months of exclusive breastfeeding. American Journal of Clinical Nutrition, 78(2):291-5.

Ministry of Health, NZ. (2015). Feeding your baby. Retrieved from http://www.health.govt.nz/your-health/pregnancy-and-kids/first-year/6-12-months/feeding-your-baby

Nevarez, M., Rifas-Shiman, S., Kleinman, K., Gillman, M., & Taveras, E. (2010). Associations of early life risk factors with infant sleep duration. Academic Pediatrics, 10(3):187-93. doi:10.1016/j.acap.2010.01.007

World Health Organisation. (2011). Exclusive breastfeeding for six months best for babies everywhere. Retrieved from http://www.who.int/mediacentre/news/statements/2011/breastfeeding_20110115/en/

World Health Organisation. (2001). The optimal duration of exclusive breastfeeding: A systematic review. Retrieved from http://www.who.int/nutrition/publications/infantfeeding/WHO_NHD_01.08/en/

 

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Should I give my breastfed baby formula at night/before bed?

By Andrina Wilson, Sleep Coach & Midwife.

Every sleep deprived parent is searching for the magic bullet that will help their baby to sleep through the night so they can get some much needed ZZZ’s. You’ve mentally prepared yourself for the lack of sleep that comes with having a newborn, but then the fourth trimester is over and you’re still a walking zombie!

One topic that pops up frequently on our Sleep Store Facebook group is giving a bottle before bed to help baby sleep through the night. Surely this must help, right?! If they’re full to the brim, they’ll sleep for longer, right?!

Will giving my baby formula keep them fuller for longer?

Short answer – yes and no.

Breastmilk and formula both contain carbohydrates, fats, protein and minerals which babies need for physical and mental growth and development. Aside from the obvious differences, breastmilk and formula contain differing types of these components which significantly sets them apart.

Protein is the molecule in milk which we consider to be important for satiety (feeling full). Breastmilk protein consists primarily of whey. Whey is easily absorbed by the baby’s immature gut and provides important nutritional factors which contribute to overall gut health. It also contains sleep inducing factors which actually encourage babies to sleep. However, because breastmilk is so easily digested, babies wake to feed more frequently. Formula protein consists primarily of casein which is harder for babies to digest and therefore, keeps them fuller for longer. However, formula increases the risk of an inflammatory response in the gut which can give babies excess wind, bloating and pain – all of this means no extra sleep for poor mum and dad.

Will giving my baby formula help them sleep longer?

Short answer – no.

As mentioned above, breastmilk is so easily digested that breastfed babies will wake frequently to feed in the early months. They are biologically programmed this way for their survival. However, it is possible to reduce the amount of night waking and eventually, help baby sleep through the night. All babies will need to feed during the night for the first few months. However, once babies are over five months old, their stomachs are larger and they are able to last longer stretches without milk. Also, sleep patterns change considerably and ALL babies will wake 4-6 times during the night. The key here is to teach baby to settle without needing to feed (and ideally without your help). For more information on teaching your baby to self settle, click here.  In fact, a recent Harvard University study has shown that babies who are breastfed but do not wake to feed during the night sleep significantly longer than breastfed babies who wake to feed during the night.

Giving formula as an alternative when breastmilk is available is no guarantee that your baby will sleep longer. In reality, you’re playing Russian roulette as it could potentially have unwanted side effects for your baby and cause them to wake even more frequently for comfort.

It’s also worth mentioning here that whether babies are breastfed or formula fed, night waking in the early months is a protective factor against Sudden Unexpected Death of an Infant (SUDI).

I’m confused, should I do it or not?

Short answer – if you feel it’s the right decision for you and your baby, go for it!

Only you know what is best for you and your baby, it is no one’s place to judge you for any decision you make. Now you have the information, you can make an informed choice.

References:

Ask Dr Sears. Comparison of human milk and formula. Retrieved from http://www.askdrsears.com/topics/feeding-eating/breastfeeding/why-breast-is-best/comparison-human-milk-and-formula

Brown, A., & Harries, V. Breastfeeding Medicine. June 2015, 10(5): 246-252. doi:10.1089/bfm.2014.0153

Haig, D. Troubled Sleep: Night waking, breastfeeding and parent-offspring conflict. Evolution, Medicine and Public Health. March, 2014. doi: 10.1093/emph/eou005

McKenna, J. Night waking among breastfeeding mothers and infants: Conflict, congruence or both? Evolution, Medicine and Public Health. March, 2013. doi: 10.1093/emph/eou006