Pediatricians, along with emphasizing the benefits of breast-feeding over infant formula, have recently been pushing parents to delay the introduction of solid foods until a baby is 6 months old. But many parents haven’t gotten the message: More than 40 percent of mothers reported that they fed their infants solid foods such as rice cereal before age 4 months, according to a study by researchers at the federal Centers for Disease Control and Prevention.
This practice could be increasing their baby’s risk of problems later on, including diabetes, obesity, eczema, and celiac disease. For nursing babies, it means they’re not getting the full benefits of exclusive breast-feeding during those early months, which studies suggest leads to fewer respiratory infections, ear infections, and bouts of diarrhea.
Mothers who formula-fed their babies were more likely to give solid foods sooner, as were those who were lower income and less well-educated. These mothers said in government surveys that they thought the food would help their baby sleep longer at night or might satiate hunger better than a strictly liquid diet. Some said their doctors recommended that they start solid foods early in infancy.
“My take-away is that parents are ignoring us, and doctors aren’t doing a good job at getting their message across,” said Dr. Claire McCarthy, a pediatrician at Boston Children’s Hospital.
To be fair, the advice on infant feeding practices recently changed. The American Academy of Pediatrics began recommending last year that babies breast-feed exclusively for the first six months instead of recommending that babies start getting solid foods at four to six months.
“There’s a dose-dependent effect for breast feeding,” said Dr. Richard Schanler, interim director of neonatal services at the North Shore Long Island Jewish Health System and the chair of the pediatrics group committee that wrote the new recommendation. “The longer a mother breast feeds exclusively, the better the outcomes for reduced ear infections, hospitalizations, pneumonia, and gastroenteritis.”
When infants are very young, they’re not developmentally ready to eat solid foods, often spitting them out instead of chewing and swallowing them properly. “There are a lot of developmental steps that should happen first like sitting up and turning the head to indicate a preference for or against certain foods,” Schanler said.
Many doctors still give the green light to mothers who want to start their babies on cereal after four months. “I absolutely agree we’re a little fuzzy on that,” McCarthy said. “But I don’t know any of us who think solids should be given before four months.”
More than half of the 1,334 mothers surveyed in the study, which was published online in the journal Pediatrics, said they introduced solids between 4 and 6 months of age; just 7 percent waited until 6 months or beyond, but that’s likely because the survey was conducted a few years before the new recommendations were issued.
Interestingly, a recent study also published in Pediatrics suggests that introducing breast-fed infants to wheat at 4 months of age appears to protect them better from celiac disease—an autoimmune disease that causes an intolerance to wheat gluten—than waiting until 6 months to give them wheat. In Sweden where the study was conducted, infant feeding recommendations have swung back and forth on gluten.
In the mid-1970s, Sweden introduced a transitional wheat-based baby formula to be given at two months and saw rates of celiac disease skyrocket from 1 to 9 percent in a single generation; after that, Swedish doctors began advising mothers to breast-feed exclusively and to not introduce wheat until 6 months of age. Those recommendations were changed yet again in 1996 to 4 months of age, and the latest study data indicate that the latest recommendation has been associated with a drop in childhood celiac disease.
“The Sweden experience told us that the introduction of gluten too early definitely increases the risk of celiac disease, but we don’t know whether introducing gluten at 4 months rather than six months can prevent some cases or just delays the condition until later in life,” said Dr. Alessio Fasano, director of the Center for Celiac Research at Massachusetts General Hospital.
What’s likely more important, he said, is the breast-feeding itself rather than whether foods are introduced at four months or six months. “It’s almost universally accepted that breast-feeding is protective against celiac.”