Weaning a baby is an incredibly complicated subject and a process that has serious implications for the child in later life. Problems such as eczema, food allergies and asthma are directly attributable to the timing of the baby’s weaning. Too early and there may be problems, too late and there can be problems. This is also an issue that is quite misunderstood by health professionals. Worse still, many advise practices which directly conflict with the best medical research available.
For timing purposes in this article, please use the birth date unless the baby was born prematurely. For preemies, it is important that timing is taken from when the baby was due, not when it was born.
So, before discussing how the process should be done, let’s have a look at what women presently do. The Center for Food Safety and Applied Nutrition concluded a study of over 2,000 mothers in the the US during 2008. What they found was that:
Approximately 21% of the mothers introduced solid foods before 4 months
Only 7% waited until after 6 months to introduce solids
29% of the mothers introduced >3 new foods per week to infants aged 5 to 10 months.
Approximately 20% of the mothers fed juice before 6 months, fed cow’s milk before 12 months, and fed infants less than 5 times per day after 5 months
14% of the mothers chewed food for their infant.
Approximately 15% of the mothers gave less than 1 serving daily of either a fruit or vegetable to infants aged more than 9 months
50% added salt to their infant’s food, and more than one third who added salt used non-iodized salt
Approximately 20% fed reduced-fat cow’s milk at 1 year
Nearly 50% of the 10-month-old infants had eaten restaurant food in a restaurant in the previous week
22% of the babies had eaten carry-out food and 28% had eaten either carry-out or restaurant food at least two times that week
All of the above are not recommended!
So, we have established that parents of preemies should consider starting to introduce solids at 4-7 months of corrected age. However, what solids should be introduced and in what sequence? Earlier studies indicated that many allergies, eczema and other sensitivities in children were a result of being exposed to the wrong food groups too early in the baby’s weaning process. More recent studies have found that lack of exposure to certain food groups is causing these complaints. That’s very confusing for parents! Couple that with the problem of having to age-adjust everything for a preemie and you’re in a world of confusion and misinformation.
So, it’s important that the different food groups are introduced at around 6 months of corrected age. A study at the University of Colorado monitored 1,612 babies and followed them until they were nearly 5 years old. The aim was to compare the effects of cereals such as wheat, barley, rye, oats in the babies’ diet and the development of wheat allergy. Their dietary habits were documented at 3, 6, 9, 15, 24 months and annually thereafter. What they found was that 1% of the children (16 in total) became wheat intolerant. All the children who became wheat intolerant had first been exposed to wheat in their diet later than 6 months of age. The conclusion of the study was that delayed introduction to cereals can increase the risk of later intolerance. The recommendation is not to delay exposure to wheat and other cereals any later than 6 months of age.
Another study in New Zealand followed children from birth to 10 years of age. In particular they were following the relationship between the introduction of solids to babies and eczema. They found that 7.5% of the children developed chronic or recurrent eczema in later life. They found a clear correlation between the baby’s exposure to different food groups during the first 4 months of its life and its subsequent development of eczema. Babies exposed to four or more different types of solid before 4 months of age had risks of developing eczema 2.9 times greater than those who were not exposed to early solid feeding. They also found that delaying the introduction of solids beyond 6 months did not help in preventing future allergies such as eczema.
Weaning Window of Opportunity
These studies clearly indicate the window of opportunity for weaning babies. Too early and they may develop allergies in future life, too late and the same might happen. The baby should not be given any solids before 4 months of age (corrected age for preemies). The baby should start to be given cereals by 6 months of age (corrected age for preemies). For preemies in particular this timing is doubly difficult. It’s a small 2 month window of opportunity yet the data on whether the timing should be age-adjusted or not is not abundantly clear.
What to Introduce and When?
Another study in Finland compared 994 children to examine how the timing of the introduction of solids during the first 12 months of life affected allergies in by the time the children were 5 years old. They found that on average mothers exclusively breast fed for 7 weeks. They then found that the late introduction of the following food groups could be directly correlated to an allergy to that group.
Potatoes (more than 4 months)
Oats (more than 5 months)
Meat (more than 5.5 months)
Wheat (more than 6 months)
Rye (more than 7 months)
Fish (more than 8.2 months)
Eggs (more than 10.5 months)
They found that in particular the late introduction of fish, meat, potatoes and rye was particularly associated with later development of asthma. They also found that the late introduction of eggs, oats and wheat related to food allergies in later life. Again, this all makes the timing of the introduction of solids a very delicate exercise for parents, more so for parents of preemies. In summary, the best collation of the different sources gives us the following table.
0 – 4 months (i.e. due date to due date plus 4 months for preemies) Breast feed or formula only.
4-6 months (corrected for preemies)
OK, so around month 4 it starts to get quite detailed and specific. From then on, the process is the same as a term baby, i.e., new foods are introduced in a logical sequence. Research indicates that iron-fortified infant rice cereal prepared with breast milk (or formula) is the ideal food to start the weaning process, along with common vegetables and non-citrus fruits. A soft-tip spoon with a long handle and a small head is ideal to use for feeding.
1. Gradually introduce complementary food to the baby at 4-6 months of age, 4-6 months from the due-date for a preemie.
2. Only begin if the baby shows an interest in solid food, appears hungry after breastfeeding or is not gaining ample weight according to the growth charts.
3. Do not introduce more than 3 new foods in any one week. (No more than 1 new food in any one day)
4. Only give complementary food after breastfeeding.
5. Lightly boil ground rice with breast milk and crush to a fine watery paste. A couple of spoonfuls once or twice a day is an ideal start.
6. Never add sugar or salt!
7. Always allow to fully cool and feed with a spoon, never put in a bottle.
Introductory Vegetables Broccoli, carrot, cauliflower, cucumber, green beans, parsnip, peas, potato, pumpkin, sweet potato (yam), zucchini (courgette)
Introductory Fruit Apple, apricot, avocado, banana, grapes, mango, melon, nectarine, peaches, pear, plums.
At this point in time, it’s probably a good idea to invest in some baby food containers and a good cookbook. This works out to be very cost effective, it’s difficult and time-consuming to prepare 2 oz (70 ml) meals individually! It’s also very expensive to buy baby-food pre-prepared. It’s a great idea to make your own. Make up a batch and freeze. A coffee bean grinder makes a great job of grinding down brown rice.
6-9 months (corrected for preemies)
Your baby will probably have a few teeth by now. Instead of puree, they can start to manage a more coarsely mashed texture now, even chopped and diced closer to 9 months. So, these are the foods that need to be introduced now. Drinks from a trainer cup can be introduced at this point. Most sources recommend water only, or maybe some expressed milk. It’s really just an educational exercise at this point. Babies shouldn’t get juice (especially citric juices) at this time, especially before bed-time. If you do decided to give fruit juice then make sure it is pasteurized.
Closer to 6 months they should be introduced to the following food groups; Meat (chicken, turkey, lamb, beef, pork) Porridge, rice, semolina, rusks, wheat & whole grain cereals, bread (preferably whole grain), pasta. Around 7-8 months the following can be given: yogurt, citrus fruits, berries, tomato, kiwi fruit. Closer to 9 months the following should be introduced: fish, cooked egg yolk (no whites), cooked dried beans, lentils etc., baked beans, tofu.
12 months onwards (corrected for preemies)
We’re now into the home stretch of food introduction! All dairy products can be given now.
Full-fat cow’s milk (2/3rd pint, 350 mls per day)
Whole Egg (yolk and white)
Smooth peanut butter.
Hopefully by this time you will now have a child set up for success with food! It’s a difficult and complicated process but it is very important to follow. Child allergies and eczema are constantly on the increase and there isn’t yet a good understanding of why that is. Asthma and food allergies can be terrible afflictions that can last for a lifetime. A little extra effort and trouble up-front will pay huge dividends in the long term.
Solid Food Introduction in Relation to Eczema: Results From a Four-Year Prospective Birth Cohort Study Pediatrics, November 2008
Timing of Initial Exposure to Cereal Grains and the Risk of Wheat Allergy Division of Allergy and Clinical Immunology Departments of Medicine and Pediatrics, National Jewish Medical and Research Center, Denver, Colorado June 2006
Early Solid Feeding and Recurrent Childhood Eczema: A 10-Year Longitudinal Study Christchurch Child Development Study, Department of Paediatrics, Christchurch School of Medicine, Christchurch Hospital, New Zealand October 1990
Age at the Introduction of Solid Foods During the First Year and Allergic Sensitization at Age 5 Years Pediatrics, December 2009 World Health Organization – Infant and young child nutrition March 2000