I was surprised to learn about the new feeding guidelines for infants presented at the American Academy of Pediatrics Conference this month. The session title, Throw out the Rice Cereal certainly got my attention. What? No Rice cereal? But it is hypoallergenic and sticks to those little baby ribs keeping the food from regurgitating. What could be better? Well, clearly, I had a lot to learn about infant feeding and a lot of advice and folk wisdom from doctors and grandmothers to sort thru.
It turns out that deciding on the best time to starting solids is not based on science but more on tradition and culture. In the United States during the 1920’s babies were commonly fed vegetable soup that had been strained in a sieve. By the 1960’s, it was common to begin feeding a baby solids between 3-6 weeks of age During that era, 70-80% of babies were fed cereal by one month of age. By the 1980’s, rice cereal was favored as the best "first food" with the idea that it was well tolerated and hypoallergenic. More recently, there has been an emphasis on adding nutrient rich food to the diet and delaying the introduction of baby food until 4-6 months. More recently, 40% of US infants have started solids by 4 months of age, and by 6 months of age, 81% have started solids. And guess what? The most common first food is rice cereal followed by fruit, vegetables, eggs, fish and peanut butter.
New infant feeding guidelines are going to be released in the coming months and meat, fruits and vegetables will be recommended as first foods for infants between 4-6 months of age. More recently, there has been an emphasis on adding nutrient rich foods to the diet so rice cereal will be off the list since it is low in protein and the iron is not well absorbed. With new concern and awareness of childhood obesity, watching the intake of empty calories may be important for some children.
So what about your baby with Gastroesophageal Reflux Disease (GERD) who needs a special formula and medical treatment to digest and grow? What should you feed her? When should you start solids? You still need to discuss diet and nutrition with your child’s doctor because some babies with GERD need extra calories to gain weight while others have food allergies or intolerances along with GERD necessitating a special diet. We know that food allergies are on the increase so dietary restrictions may be related to allergies instead of GERD. Research is showing there may be a critical "window" between 4-6 months of age when exposure to foods is actually protective against the development of food allergies. For those at risk for food allergies, continuing to breast feed while introducing solids may be protective. There is even some evidence that avoiding foods may be unsuccessful at preventing allergies and even make the situation worse.
Some babies with reflux are not ready to begin solids due to a delay in learning feeding skills so be sure to check out: Is it time to try baby food? to look for other signs of readiness.