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When are breastfed babies ready for solids?

My baby is almost five months old and big and I really want to feed him solids. At four and a half months, our pediatrician asked if we’d started already and seemed to think it was fine to go ahead. But I’ve read that it’s a lot better to wait until at least six months. Whenever I hear this I also hear how breast milk provides more than enough nutrition and is so much better than solid food, etc. Is the attempt to hold off solids a part of the breast-is-best campaign? Is it to keep us breastfeeding for as long as possible? I just want to try a little cereal. – hungry for more

Dear Hungry,

Your confusion is understandable. Even within the almighty AAP, there is some internal disagreement over about the right time to start solids. Their book says that food can be introduced as early as four months. Their breastfeeding policy calls for six months of exclusive breastfeeding. This obviously does not compute.

The World Health Organization recommends exclusive breastfeeding until six months as well, but they’re taking into account polluted water and dodgy food sources, which aren’t generally issues in the developed world.

Most U.S. pediatricians operate within the 4-6 month time frame, and will begin asking about solids at that time. Some will push it early, others are fine with waiting even beyond that window. Although many people think big babies or small ones need solids sooner, the size of your baby actually has less to do with when he’s ready to eat than his gut maturity and developmental readiness.

Previous generations ate mashed everything from the time they could hold their heads up (one of us was on a diet of pureed boeuf bourguignon by four months). More recent science shows that a baby’s digestive system doesn’t produce the enzymes needed for digesting solids until four to six. The reasoning behind waiting the full six is that the enzymes are sure to be well established by then. Without the enzymes, the baby will not digest the food properly.

How do you know if the enzymes have started doing their thing? Lactation consultant Kate Sharp once told us, if the food comes out exactly as it went in, the enzymes are not working. There’s also the allergy factor to consider, as an immature gut is more susceptible to allergic reactions. If you have allergies in your family, or if you are concerned, you may want to wait the full six months.

There are also important developmental cues that show your baby is ready to eat. Young babies have a “tongue-thrust” reflex that makes them stick their tongues out to push food away. This may happen on the first couple of spoonfuls even at six months, but if your baby doesn’t adjust and swallow, then he’s probably not ready to eat. One clue that your baby may be ready for solids is her interest. If she starts eyeballing and trying to eat your food, she might be ready for some solids of her own.

Now, as for the breast-is-best conspiracy theory: from a nutritional standpoint, solid foods are all but irrelevant compared to breast milk or enriched formulas. Even after the introduction of solids, breast milk or formula will remain the primary component of a baby’s diet for quite a while. So the rah-rah breast milk stuff is probably about the enzyme and allergy issues combined with the fact that it is true that solid food at this age is less about nutritional need than experimentation. It is generally accepted that breast milk is a complete food that provides babies with all their nutritional needs.

But there is one area where this gets a little less black and white. There is the possibility that an older (9+ months) breastfed baby who doesn’t eat solids can test with low iron levels (anemia). In this case, a doctor may suggest iron-enriched cereal, other high-iron foods, or iron supplements. Anemia isn’t usually a big deal, but recent studies have made some disturbing associations between anemia in infancy/toddlerhood and learning issues later on. A diagnosis of anemia in an exclusively breastfed baby is rare, and somewhat controversial, because the iron in breast milk is much more bio-available than the iron supplements in formula. But it can happen, and when it does, it can really make all the propaganda about the infinite supremacy of breast milk seem extra-irritating. Believe us, we know.

We digress. But you brought up the conspiracy, and we couldn’t help ourselves.

Of course the idea of starting solids is exciting. It’s fun to try new things and see your baby’s reactions (both positive and negative). And we encourage you to start feeding solids if that’s what you and your baby are ready to do. But a few parting words of warning, this time on a purely logistical level: early feedings can quickly become as much of a hassle as a joy, especially for moms who are used to no prep, no clean-up breastfeeding. They’ll mean more outfit changes and (for possibly the first time in your baby’s life) a real need for a good bath. Also, the beginning of solids means the end of pristine poop. You may have thought your baby’s diapers smelled bad before, but solid-food diapers are a whole other ball of . . . poop.

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