Breastfeeding and Introduction of Solid Foods: New Guidelines from Israel Health Ministry

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:

1. 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.
2. 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.
3. 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.
4. 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.
5. 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.

Click to read more posts on breastfeeding at A Mother in Israel.

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8 Responses to “Breastfeeding and Introduction of Solid Foods: New Guidelines from Israel Health Ministry”

1. Ariela says:

   May 14, 2009 at 12:54 PM

   thank you.

   Reply
2. Ariela says:

   May 14, 2009 at 12:57 PM

   My child’s babysitter at the daycare center heard a report about this on the Channel 2 news. When I came to pick up my baby she said to me “did you see the report on breastfeeding on channel 2?” I had not. “Well,” she said, “new research shows that there is no benefit to breastfeeding after the first 4 months!” It seems that this report was misinterpreted by the media.

   Reply
3. triLcat says:

   May 14, 2009 at 1:50 PM

   interesting. Since my little guy is into eating constantly, I’ve been looking forward to some solids. (He nurses 8-10 times a day for 30-40 minutes at a time and takes 3-4 bottles a day as well – his weight gain is right on target, so obviously this is what he needs)

   Reply
4. Katherine says:

   May 14, 2009 at 3:56 PM

   yup a friend already told me, did I read that you can start them on food at 4 months, exclusive breastfeeding is only needed til then. I think the ministry of health people should be lined up and shot – it is so obvious what people would take away from this as the bottom line.

   Reply
5. Keren says:

   May 14, 2009 at 4:06 PM

   Yesterday morning there was a report on this on Reshet Bet on the program called Seder Yom.

   This was 20 minutes spent correcting the misconceptions created by the press headlines.

   She brought a Nursing Councellor IBLC and a doctor.
   the interesting part to me was bringing this lady and explaining what she did and letting her speak for 10 minutes about the advantages of nursing.
   they clarified the issue, as well as emphasized that these tastes of solids should be baby-led

   Reply
6. mominisrael says:

   May 14, 2009 at 4:56 PM

   Ariela, thanks for sharing that story and encouraging me to put up the post.
   Katherine, I hear what you are saying, but I blame the press here.
   TC, hope it will help.
   Keren, I heard that Shelley Gat (the IBCLC) was excellent.

   Reply
7. Jessika says:

   October 16, 2009 at 6:22 AM

   Interesting about waiting to breastfeed babies exposing them to gluten between 4 and 7 months. I had never heard of that before. I personally do not plan on kids but I always wondered since its hereditary and I have Celiac if they would also.

   - Jessika : Celiac Speaks – My Personal Notes

   Reply
   • mominisrael says:

     October 16, 2009 at 8:23 AM

     Thanks Jessica. I would definitely do more research before coming to conclusions. I think it is mainly based on something called the Swedish Reconstructive study that looked at celiac rates in Sweden.

     Reply