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The Solid Food Debate - Could formula and solid foods prevent allergies?

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In 2001, the World Health Organization modified its guidelines on introducing solid foods, saying that infants should be exclusively breastfed for six months. The move was a long time in the making; even though public health data had supported the shift for years, it was an uphill battle to change the U.S.’s old-school tradition of giving rice cereal to four-month-old babies.

Many clinicians and researchers saw the shift to delay solids as a major coup. Meanwhile some baby food manufacturers fought the change, not wanting to let go of their hold on the youngest market. And now they are likely to emphasize recent studies indicating that early solids could be protective against allergies – a finding that runs counter to one of the central reasons to delay food in the first place.

I, for one, am hoping that the new data doesn’t confuse pediatricians and cause parents to slip back into spooning out food for small infants.

Evidence for early solids

This month in the Journal of Allergy and Clinical Immunology, scientists from Tel Aviv University reported that feeding a baby formula in the first 15 days of life reduced the risk of a later allergy to cow’s milk. The researchers go so far as to recommend a bottle of formula every day, starting at birth.

And another study published earlier this year in Pediatrics gathered data on 1,000 Finnish children from infancy to age five. The researchers looked at when specific foods were introduced and the children’s level of allergic sensitization later on. Surprisingly, waiting many months to give certain foods – for example, wheat after six months, fish after eight months, and eggs after ten – was associated with increased sensitization to food allergens at age five. Introducing rye after seven months, meat after five, and fish after eight was associated with increased sensitivity to inhalant allergens, like dust mites and cats.

The authors of the Pediatrics study say they reviewed 13 studies on solids and allergies and found that five saw a causal link between early foods and eczema, one linked early solids with pollen allergies, and the rest found no relationship between age of solid food introduction and allergies at all.

Old-fashioned feeding practices

The American Academy of Pediatrics maintains, however, that solids should wait, in part because the intestinal tract of an infant is still immature for the first six months. And some clinicians feel strongly that delaying foods is a step in the right direction – away from the tradition of early rice cereal feedings.

Rice cereal became the dominant starter food in the 1940s when breastfeeding fell out of favor. Because formulas were not fortified with iron, babies became severely anemic, so iron-rich cereal was prescribed by doctors as a supplement, beginning when a baby was four months old.

But now that breastfeeding is back and formulas are fortified, rice cereal isn’t necessary and, according to Cynthia Epps, an infant feeding specialist in Los Angeles, it’s not the healthiest option as baby’s first food, even at six months. She supports starting babies with samples of green veggies instead of getting them accustomed to cereal’s simple carbohydrates.

Furthermore, even if the jury is still out on early food and allergies, there are other reasons for delaying solids – for example, six months of exclusive breastfeeding has been shown to decrease respiratory and ear infections and lower the risk of a child being overweight.

Some baby food manufacturers have lobbied for decades to keep the recommended age for solid food early – they lose a lot of money in the two months moms are now waiting to give solids. And no doubt they could pick up the fight again using the argument that early foods actually fight allergies.

But I’m skeptical when anyone claims a baby needs more than milk for six months. I’ve heard pediatricians recommending rice cereal to boost weight gain and friends touting it for longer stretches of nighttime sleep. But historically (before the iron crisis), milk alone was the primary source of nourishment for the better part of the first year.

I wonder if what the allergy research is showing is that it’s natural to expose little babies to bits of food (to learn about flavor, not as a substantial source of nutrition). I imagine that as early humans we would naturally have given samples to our young ones, according to wisdom passed down through families, so maybe it’s okay to let babies have tastes early on (with a family’s allergy history in mind and a doctor’s thumbs up). But I’m pretty sure we can keep the rice cereal off their spoons until they pass the half-year mark.

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