Q. My health visitor advises breastfeeding my baby, my first, for a full six months. He was fine for four months, but for the past five weeks he has been demanding milk about every 90 minutes, including at night. He’s interested in our meals and even grabs things off my plate. Is it safe to introduce solids even though the health visitor recommends against it?

A. Experts are unanimous that breast is best for babies, but the stage at which solid foods can be introduced alongside breastfeeding (known as complementary feeding) is vigorously debated. In the last century, the official line was three to four months. Then, in 2001, the World Health Organisation (WHO) said all babies should be exclusively breastfed for the first six months. In 2003, the Department of Health and bodies including the Institute of Health Visiting (ihv.org.uk) followed suit and have stuck to that line despite ongoing research suggesting it may not be best for all babies.

The WHO recommendation was based on a review that concluded exclusively breastfed babies have fewer infections and experience no growth problems. But a 2011 review by researchers at the UCL Great Ormond Street Institute of Child Health (ICH) challenged this, largely because no distinction was made between Western countries and developing countries with limited access to clean water and safe weaning foods.

In 2017, a position paper on complementary feeding (CF) by the European Society for Paediatric Gastroenterology, Hepatology and Nutrition focused on healthy-term infants in Europe. The committee recommended that exclusive breastfeeding should be promoted for at least 17 weeks, with six months considered ‘a desirable goal’ if it suits mother and baby. Complementary foods (solids and liquids other than breast milk or infant formula) should not be introduced before four months or delayed beyond six. Mothers should also continue breastfeeding alongside CF .

Professor Mary Fewtrell from the ICH , one of the authors, says: ‘Mums should be supported to breastfeed exclusively for at least four months and we still have a long way to go in the UK . But each baby must be treated as an individual. It is very unlikely that all babies will need solid foods at exactly the same age, just as they don’t all crawl,
walk or talk at the same time.’

Independent breastfeeding consultant Clare Byam-Cook (clarebyam-cook.com) agrees. ‘This baby is waking at night when he didn’t before, is less content and is noticing food. These are all signs he wants to start on solids so his mum could try adding in suitable baby food, such as puréed rice and vegetables.’ For more details, see Clare's book What to Expect When You’re Breastfeeding…and What If You Can’t? (Vermilion, £12.99*).

A week before I wrote this, I passed on Clare’s advice to Emma, the young mother who wrote to me. She says, ‘Arthur has embraced food with excitement and is more content between breastfeeds. He is feeding less frequently for longer periods, which is much easier for me. His sleep is improving too – two nights with only two wakes for a quick feed, which is amazing.’ Introducing CF ‘has made breastfeeding easier, so I’m hoping to carry on for a few more months,’ she says. And that’s the result experts want.

BABY FOOD DOS AND DON’TS

• Don’t add salt or sugar to foods; avoid processed products with added sugar, also fruit juices, sweetened drinks and syrups.

• Before 12 months, avoid honey and do not use whole cow’s milk as the main drink.

• Gluten in small quantities may be introduced between four and 11 months.

• Iron-rich foods are important in small quantities, eg, meat products and/or iron-fortified foods.

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Photo by Colin Maynard on Unsplash

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