Introducing solids: 4 months or 6 months, is one better?
I recently had my 4 month baby visit with my pediatrician and got an information package that suggested introducing solids anywhere between 4 and 6 months. As a dietitian and family food expert, who has done additional training in infant feeding, I have always suggested parents start closer to 6 months. However, in my infant feeding workshops there is always TONS of confusion about when to start and parents have received different information from different health care providers. During my own visit I experienced this first hand, I mean 4-6 months can be a huge range, especially when it comes to babies and their growth. That being said, my pediatrician is wonderful and was confident I could make the right decision for my little one and I want you to feel the same for your little one!
Let me start by saying, you are the parent and you know your baby best, so I recommend you do whatever you feel is best for your baby. In addition, you should listen to your health care providers, especially if you trust their opinion and they have taken the time to explain your options.
The purpose of this post is to share some of the evidence behind the 4 versus 6 month debate and signs to know your baby is ready for solids.
How do I know my baby is ready for solids?
I go more in depth during my baby led weaning workshop, but essentially these are a few of the signs you should look for. For some babies, this might be 5 months and others after 6 months, but generally it is around the 6 month mark. This is the time when babies are both physiologically and developmentally ready to start solid foods.
They can maintain a sitting position with little assistance (this is very important when thinking about safety and reducing the risk of choking).
Can grab toys and bring them to their mouth with control and precision
Shows interest in food
Opens mouth when food is placed in front of them or when food is placed on spoon and brought towards his/her mouth
It should be noted that most of the health organizations recommend exclusive breastfeeding (and/or formula) for the first 6 months of life. This is recommended by the World Health Organization, Health Canada, American Academy of Pediatrics, UNICEF, etc.
Bottom line: your baby will get everything they need from breastmilk or formula during the first 6 months of life!
Why wait until closer to 6 months?
1. Babies digestive system is more mature at this time compared to 4 months.
At 4 months your baby’s digestive system isn’t mature yet, this is why early introduction to solids is often associated with GI issues such as, constipation, gas, upset tummy etc. Around 6 months the gut begins to close (aka matures) and allows for more optimal digestion and absorption of nutrients.
2. If breastfed, baby will have greater protection from your antibodies.
One of the most amazing things about breastmilk is the antibodies mom is able to pass to their baby. However, research suggests that immunity is strongest when exclusively breastfed. Therefore, the longer this happens exclusively the more immune protection for your little one.
3. Baby will be more advanced developmentally and therefore able and ready to eat solids not just liquids.
I teach a baby led weaning approach to introducing solids, which means offering whole pieces of food to your little one (I know it sounds scary). Starting with this approach does require a mature digestive system and your baby’s ability and readiness to ingest solid pieces of food. Research suggests that around 6-8 months babies are developmentally ready to manage solid foods and move beyond the suckling action for feeding. They learn to bite, chew, and then swallow, this learning process takes time, but is best learn with textured food items (not just purees).
So where did this 4 month recommendation come from?
The 4-6 month recommendation has been around for a long time, I know my parents started us on pablum (infant cereal) at 3-4 months (with the hopes we would sleep through the night….some parents get lucky and others not so much). It is actually a myth that solids lead to sleeping through the night, BUT it does help your little one ingest more calories during the day, which can lead to less hunger at night.
One of the main reasons pediatricians recommended introducing solids (or purees rather) at 4 months is to prevent the development of allergies. Below I am going to answer some frequently asked questions when it comes to early introductions based on a recent literature review.
The USDA (U.S Department of Agriculture) recently conducted a systematic literature review on pregnancy and birth to 24 months, which includes reviewing all the latest research on introducing solids/complementary foods and developing a general consensus on what the current research suggests.
Frequently Asked Questions:
1. Will introducing complementary foods aka solids early (i.e., at 4 months) reduce my child’s risk of developing an allergy, eczema, or asthma?
They found that moderate evidence suggests no relationship between the age of introduction and the risk of developing a food allergy, eczema or asthma during childhood. That being said, introducing allergens as soon as you start solids is a good idea, however the research appears to suggest that whether it’s 4 or 6 months won’t matter, so look for your baby's readiness cues! Click here to read more.
2. What about the types of allergens introduced? Is there stronger evidence for introducing some early versus others?
The 10 common allergens include:
General recommendation: introduce allergens as soon as you start introducing solids. However, make sure you introduce one allergen at a time and wait 2-3 days before introducing another. This is to ensure your baby doesn’t have an allergic reaction and to be able to detect what potentially caused the reaction.
Note: your baby might not have a reaction at first, so be sure to continue exposing at least another 2-3 times and monitor for any reactions. If they do NOT have a reaction then continue offering that food as part of their regular diet (at least once each week).
An allergic reaction typically occurs within 20 minutes of ingesting that foods, this could include swelling around the mouth and tongue, red dots around the mouth or other body parts, diarrhea, vomiting etc. If your baby has an allergic reaction, seek medical help immediately.
When it comes to peanuts, tree nuts, and seeds there is strong evidence to suggest that exposure before the age of 1 and after 4 months of age may reduce allergies to nuts. The evidence appears to be strongest for infants at higher risk of developing an allergy (those with severe atopic dermatitis or eczema and/or an egg allergy).
Bottom line: introducing common allergens during the first year of life (after 4 months) is recommended, however the evidence appears to be the strongest for reducing risk of peanut/tree nut allergies. You can read more by clicking here.
3. Is there any relationship between introducing solids and weight gain or growth?
In my experience working with families, sometimes parents have been pressured to introduce solids early because, 1) they have a big baby, so they are told they need more food/calories to keep them satisfied, or 2) they have a small baby and growth is a concern, so they are told to start solids early.
The latest evidence review found moderate evidence that suggests the first introduction of any complementary food or beverage between 4-5 months compared to 6 months of age is NOT associated with weight, length, body composition, or general health in healthy full term infants.
In addition, there was some evidence (although limited) to suggest that introducing complementary foods (solids) before 4 months was associated with higher odds of being overweight in childhood. You can read more by click here.
Bottom line: your baby’s growth shouldn’t be influenced by whether you start solids at 4 months versus 6 months.
4. Will introducing solids early (4 months versus 6 months) improve my babies nutrient status or offer any nutritional advantages?
The moderate evidence reviewed so far found no long term advantages or disadvantages in terms of iron status in healthy full term babies who were breastfeed, formula fed or a combination of both, whether solids were started at 4 or 6 months. Unfortunately, there is not enough evidence to report on other nutrients such as, zinc, vitamin D, B12, and others! You can read more by clicking here.
Bottom line: there is no right or wrong answer when it comes to introducing solids, follow your baby’s cues to decide when they seem ready to progress to solid/complementary foods. If 4 months seems too soon, don’t feel pressured to start then, the research suggests it really doesn’t make a difference and your baby has a little extra time to allow their digestive system to mature!
Remember when starting to introduce solids, they are complementary to your little ones milk (whether that be breastmilk or formula). Start slow and if your baby isn’t interested try again another day. For the first 1-2 months of introducing solids, expect your milk feeds to be quite similar, as that is still their main source of nutrition (and don’t worry it is providing everything they need).
Comment below or connect with me if you have any questions. I would also love for you to share your experience, did you start solids at 4 or 6 months? How did you feel doing that?
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Ps. If you are interested in learning more about baby led weaning, click here to see when my next workshops are!
Until next time,
Eat Right Feel Right – Angela XO