As of Thursday, June 20, 2013
DEAR DOCTOR K: I’ve started giving pureed solid foods to my 2-month-old daughter. My sister doesn’t think this is safe. What’s your opinion?
DEAR READER: I agree that it’s too soon. Pediatricians advise waiting until a baby is 4 months old to introduce solid foods. You can even wait a bit longer. Breast milk or iron-fortified infant formula provides all the nutrients your baby needs for the first 6 months. There is no proven benefit from introducing solid foods before 4 months, and there are risks.
Babies younger than 4 months are not physically ready for solid foods. They usually cannot sit up by themselves or hold their heads up well. Also, the muscles in the mouth that help guide solid food into the back of the throat and then down into the stomach are not fully developed. This means that when they try to swallow solid foods into the stomach, the food can drop down into the lungs, not the stomach. That’s called aspiration, and it can cause pneumonia.
Giving solids before 4 months may increase the risk of obesity, Type 1 diabetes and celiac disease, although these disease links are not solidly established. It may also increase the risk of eczema and of food allergies. Breast-fed babies who start solids early tend to stop breast-feeding sooner. Given all we know about the health benefits of breast-feeding, that’s not a good thing.
Most babies develop the ability to eat solid foods at 4 to 6 months. But even when your baby is ready, learning to eat solids takes time and practice.
Before you begin, talk with your pediatrician. Most recommend one of the iron-fortified infant cereals, such as rice, oatmeal or barley, for the first food. These types of cereals are least likely to cause allergies. Foods rich in vitamin C, such as orange juice, can help the absorption of iron.
There is no value, and there is potential harm, from adding either salt or table sugar to the food. You will still be giving the baby milk or formula as you gradually introduce solid foods. Be careful not to feed the baby too many calories. Your pediatrician or a nutritionist can help you plan.
Watch for symptoms of allergy, such as rash, wheezing, stomachache, diarrhea, gas, fussiness or vomiting. If you notice any of these things, stop giving the food in question and consult your pediatrician.
Also keep the following in mind as you start your baby on solids:
— Add only one new food at a time. Wait five to seven days between new foods so that you have time to watch for a possible allergy.
— Do not give honey to your infant before 1 year. Honey can cause life-threatening food poisoning (botulism).
— Wait until your child is at least 3 years old to give small, round or hard foods that can cause choking. Examples include grapes, raw carrots, popcorn, hot dogs, raisins, nuts, seeds, jelly beans and other hard candies.
Dr. Anthony L. Komaroff is a physician and professor at Harvard Medical School. To send questions, go to AskDoctorK.com, or write: Ask Doctor K, 10 Shattuck St., Second Floor, Boston, MA 02115.