solid foods, introduction of

Every doctor has different prejudices about when to introduce solids to babies. Parents seem to demand direction about this, at least for the first baby (before the mothers figure out that they can judge their baby's nutritional demand about as well as any doctor). Let me tell you a little story.

I bought my first practice in Corpus Christi, Texas some years ago from the man who was Farah Fawcett's pediatrician, C. L. Concklin, M.D. Dr. Concklin ("Lewie") practiced for 38 years in Corpus Christi, as respected and beloved a physician as you will ever find. I noticed when I went down there to take over his practice that he started solids like this: meats, then vegetables, then fruits, and last, cereals. I asked him why he did it that way - the rest of the world (all the younger doctors) had the order exactly the opposite of his. His reply: "Well, Jeff, they all grew up, didn't they?"

I usually start rice cereal first, at "around four months." "Around four months" gets various interpretations, but the underlying theme is "when Mother's breasts can't keep up with Baby's demand," which seems to be around four months. With some big babies it's more like three months, or it might be later than five months. It depends. With bottle fed infants, the rule is easier - when Baby needs more than 32 ounces a day on a regular basis to be happy and sleep well, that's time for solids. Again, the exact time is variable.

And of course, I do introduce cereal at bedtime earlier if the baby gets to three months old and isn't sleeping through the night despite being on a good feeding interval during the day. Interestingly, it has been shown that giving cereal to babies at bedtime in randomized studies does not improve their odds of sleeping through the night. But in my clinical experience, if the baby has been properly trained during the day (i.e., is on a good feeding interval), he will promptly start sleeping through in almost all cases with the introduction of cereal.

After cereal comes fruits, then veggies, then meats. I give chicken at five months or later, and beef after six months (because I read a study that associated earlier beef introduction with allergy troubles later - that's not really carved in stone in the pediatric literature). There is a certain mythology about how to introduce things - one new food a week, or whatever. This is supposed to allow us to identify foods baby is allergic to. However, since it is a recognized fact of immunology that it takes a couple of weeks to develop the triggering antibodies required for an allergic reaction, it is unlikely that this is really necessary. I won't argue with anybody about it - whatever. At any rate, all the studies I've ever seen on early solids and associated allergies have been pretty unconvincing, so I think if you use the guidelines above, you're pretty safe.

By the way, a recent study showed that the timing of introducton of sold foods had no influence on ultimate bodhy composition or growth at one year of age. Specifically, early solids did not predispose to excessive weight gain.1

1 Pediatrics 102:569-573, Sept 1998

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