This week the Israel health ministry issued new guidelines on introduction of complementary foods (solids) to breastfeeding babies. Unfortunately, the media got hold of the information early and published misleading information.
There is nothing especially new or radical in the guidelines, which are based on information from the World Health Organization.
The main difference is in the statement that the first taste of complementary foods may begin at four months instead of six. In other words, exclusive breastfeeding should begin from birth and continue for at least four to six months. Mothers can give tastes of solids, including meat, fruits, vegetables, and grains containing gluten, before six months. Quantities should be limited to two tablespoons a day from the mother’s finger. After six months quantities can be gradually increased but breastfeeding should continue for at least a year. Solids given before six months may have a developmental, but not a nutritional, benefit.
There are several reasons for the change:
- Recent studies have shown that the increase in celiac disease—sensitivity to gluten as found in wheat, barley, and oats—is related to too-early or too-late introduction of gluten in the baby’s diet. For lowest risk, babies should be exposed to gluten between 4 and 7 months.
- Research on celiac disease also shows lowered risk to babies exposed to gluten while their mothers are still breastfeeding. Since more mothers are nursing at four months than at six, the guidelines may ensure that more babies will be exposed to gluten during the breastfeeding stage.
- Research on allergies has not shown a benefit to delaying solids for longer than four months, even in children with a family history of allergies. Relatively early exposure may actually reduce risk.
- Introduction of large quantities of solids at an early age can negatively affect breastfeeding and lead to lower weight gain, but small quantities (1 to 2 tablespoons after four months) do not harm babies developmentally nor do they impact long-term breastfeeding.
- This was not in the report, but there is concern that formula-fed babies could also benefit from earlier introduction of solid foods. Several years ago, three Israeli babies died and many were brain-damaged because of lack of Vitamin B1 in one type of Remedia brand soy formula. Since then the health ministry is concerned about the lack of variety in the diets of formula-fed babies. The babies on the Remedia formula that received even one dose of Vitamin B1 from another source, whether it was nursing or Bamba, survived.
It is not necessary or required to start solids before six months, but according to new research it may not be wise to delay much longer than six or seven months. I know many babies are not interested until long after that age, and if that is the case with your baby I would not be overly concerned. We are talking about statistical lowering of risk, and genetic components are more significant.
There is a risk that mothers will misunderstand, like the press did, and think that nursing after four months isn’t important. On the other hand, exclusive breastfeeding for four months instead of six may be easier for some mothers to “swallow,” especially since most mothers return to work at around four months. It may seem like a more attainable goal. Relaxing the restrictions on complementary foods reduces pressure on working and pumping mothers, who can relax knowing that the babysitter can give some solids if there isn’t enough pumped milk available. It also gives mothers less reason to supplement with bottles of formula, which is more likely to lead to early weaning.
At any rate, the ministry should be more concerned with the bottles given to 70% of the babies in the hospital (They do address this in the guidelines, but not strongly enough.) Most babies in Israel have been exposed to formula long before they reach four months of age.