Introducing solids schedules - outdated advice?

Many starting solids books recommend introducing foods in a particular order - usually something along the lines of:

• Baby rice with your baby's usual milk
• Sweet vegetables like carrot, carrots, swede, parsnips, sweet potato & amp; butternut squash
• Fruits
• White meat/fish/green veg
• Red meat

These recommendations have been around since the norm was early weaning at 3/4 months.  Initially parents were advised to give baby rice due to its low allergenic properties, moving onto fruit and veg months 4-5, fish and white meats from 6 months and finally red meat around 7 months.  It was believed the immature gut needed time to get used to digesting foods and anything rich like meat could pose a strain.


But how relevant are they to today's weaning guidelines?

In my opinion not very and in fact potentially harmful.

Image Kellymom.com

Science has since shown us that it's around the middle of the first year before infants are capable of effectively digesting food.  Whilst young babies have an "open gut" which can allow harmful microbes and allergens to pass into baby's blood stream - around six months the gut closes in preparation for consuming food.  This also ties in with when infants can take food to their mouths, but that's one for another post.

From six months ish the infant may also begin to need more nutritionally, such as iron or B vitamins - but a lot depends on the individual circumstances surrounding birth.  Lower birth weight infants may need iron earlier as studies show infants born below 6 1/2 lb have smaller stores; similarly modern practices such as early cord cutting or cesarean sections have also been linked with reduced iron levels.

So potentially we have a mum waiting until six months (as per the guidelines) and then introducing baby rice.  Now for a start, have you tasted it?  Breastfed babies are exposed to tastes and flavours via breastmilk and so even to them I suspect it tastes like wallpaper paste.  It's white and highly refined - in effect stripped of all goodness, before being fortified with synthetic vitamins and minerals (which are a lot harder for the body to utilise). In addition there's the interesting issue of arsenic contamination!

This is then followed by veg and fruit, which offer little from a calorific perspective and often not much more vitamin/mineral wise when you examine the tiny amounts consumed.  Studies show that infants actively reduce their milk intake in response to solids, milk is displaced rather than solids being "in addition to".  Therefore the rationale of early weaning for slow gaining infants - and swapping calorific milk for baby rice and carrots, makes little sense.

Furthermore, nothing biologically tallies with this made up introduction plan. 

Babies produce enzymes and digestive juices that work effectively on proteins and fats, however the pancreatic enzyme amylase necessary for the digestion of starches - whilst  produced in larger quantities from around 6 months, can take up to 2 years to reach mature levels.  Furthermore carbohydrate enzymes maltase, isomaltase and sucrase, do not reach adequate levels until around 7 months.  Breastmilk does contain amylase to assist digestion, but it rather makes a mockery of the traditional "weaning plan".

Judy Hopkinson, Ph.D., Associate Professor of Pediatrics at Baylor College of Medicine and member of LLLI's Health Advisory Council states:

It is important to remember, that when solid foods are introduced, the amount of breast milk a baby consumes decreases. If protein, zinc, or other nutrients are not provided in solid foods, the amount a baby receives from breast milk could be insufficient for optimal growth during the weaning period. Therefore, adding meat to the diet early in the weaning period may be beneficial.

There is also a small study from Sweden which indicates that infants given substantial amounts of cereal, may have lower concentrations of zinc and reduced calcium absorption (Persson 1998).

A study by Dr. Nancy Krebs found both protein and zinc levels were higher in the diets of the infants who received meat, and they grew at a slightly faster rate. Dr. Krebs' suggests that inadequate protein or zinc from complementary foods may limit the growth of some breastfed infants during the weaning period.  (Krebs 1998).

Meat is also an excellent source of heme iron, which is better absorbed than iron from plant sources. The protein in meat also helps the baby more easily absorb the iron from other foods.  A couple of studies looking at iron status of breastfed infants receiving meat as a first food, found higher levels of hemoglobin circulating in the blood stream. (Makrides 1998; Engelmann 1998)

Many people think the "order of introduction charts" are evidence based.  Not so!

Rachel Brandeis, a spokeswoman for the American Dietetic Association said:

Most parents are told to start rice cereal at 6 months, then slowly progress to simple vegetables, mild fruits and finally pasta and meat. Ethnic foods and spices are mostly ignored by the guidelines; cinnamon and avocados are about as exotic as it gets, and parents are warned off potential allergens such as nuts and seafood for at least a year.

Yet experts say children over 6 months can handle most anything, with a few caveats: Be cautious if you have a family history of allergies; introduce one food at a time, watch for any problems; and make sure the food isn't a choking hazard.

Dr. Jatinder Bhatia, a member of the American Academy of Pediatrics' nutrition committee says:

The difference is cultural, not scientific, the American approach suffers from a Western bias that fails to reflect the nation's ethnic diversity.

In a review of the research, Nancy Butte, a pediatrics professor at Baylor College of Medicine, found that many strongly held assumptions such as the need to offer foods in a particular order or to delay allergenic foods have little scientific basis:

Take rice cereal, for example. Under conventional American wisdom, it's the best first food. But iron-rich meat, often one of the last foods American parents introduce would be a better choice.

Dr. David Ludwig of Children's Hospital Boston, a specialist in pediatric nutrition says:

Some studies suggest rice and other highly processed grain cereals actually could be among the worst foods for infants.  These foods are in a certain sense no different from adding sugar to formula. They digest very rapidly in the body into sugar, raising blood sugar and insulin levels and could contribute to later health problems, including obesity.

What about if I'm vegetarian?
From LLL:

Vegetarian mothers are almost always aware of their need for protein, iron, zinc, calcium and vitamin B₁₂ as well as adequate calories. Those who occasionally add poultry or fish to their diets and those who are lacto-ovo vegetarians, using milk and eggs in their diets, usually have no problems meeting their needs for these nutrients. For vegans, who do not use any dairy products, attention needs to be given to adequate sources of calcium. There are also many non-animal foods that provide iron, calcium, and zinc. Vegetarians may need supplements to get enough B₁₂. Vegetarians who want their children to eat as they do will need to be aware of the same nutrient needs for their children. When starting solids, single foods are given so that any sensitivities or allergies can be noted.

Ultimately regardless of whether you are omnivore, vegetarian or vegan, it seems to make most sense to offer more than baby rice or squished carrot if weaning around the middle of the first year.

Chuck out the baby rice?

There are far healthier cereals available than baby rice, so why not try something different?

Some parents like to give a porridge type breakfast: millet flakes are readily available at most Supermarkets or Health Food Stores and quickly and easily make a delicious porridge.  You can mash in banana or stewed apples for flavour if you wish, or even stir in a real fruit puree pot!  Millet is considered one of the least allergenic and most digestible grains available; it is non acid forming so is easier to digest and contains a myriad of beneficial nutrients. It is nearly 15% protein, contains high amounts of fibre, B-complex vitamins including niacin, thiamin, and riboflavin, the essential amino acid methionine, lecithin, and some vitamin E. It is also particularly high in the minerals iron, magnesium, phosphorous, and potassium.   Quinoa and Buckwheat are also highly nutritious and easy to digest.

Whilst we are on the subject - one of my pet hates, Baby yoghurts!

Teeny pots of sugar laden junk.  The leading UK brand Petits Filous has a staggering 12.4g total sugar per 100g pot and (6.2g per 50g pot).  A tiny proportion of this is lactose (the naturally occurring milk sugar)  Their website states they add approximately 4.6g of sugar per 50g pot and 9.6g per 100g pot!
In addition there are no less than 16 ingredients

Strawberry:
Fromage Frais, Sugar, Water, Strawberry Purée From Concentrate (5%), Fructose, Colour: Concentrated Aronia Juice; Stabilisers: Pectin, Guar Gum, Xanthan Gum; Calcium Phosphate, Modified Maize Starch, Flavourings, Acidity Regulator: Lactic Acid; Vitamin D. While adult tastes are often used to sugar rich products, infants weaned onto plain natural  yogurt like it just as much and actually wince when they receive a sugar hit version!

Why not try Rachel's Dairy "natural wholemilk bio-live yogurt"; it is made with yogurt cultures and nothing else added, and so contains probiotic cultures Lactobacillus acidophilus and Bifidobacterium.  If you feel fruit is a must, Rachel's dairy baby range are the only baby yogurts I can find that are flavoured with fruit juice. 

Strawberry: organic yogurt, organic strawberry purée (12%), organic apple juice concentrate, organic rice starch, organic lemon juice

• No artificial additives – colours, flavours or preservatives
• No added refined sugar - sweetened only with organic fruit juice concentrate
• Natural Source of Calcium
• Probiotic cultures to help your child maintain a healthy digestive system
• Non-GM
• Gluten-Free
• Vegetarian

 (NB I have no affiliation with Rachel's Dairy or financial initiative for recommending them - it is purely as an alternative ready to eat fruit yoghurt)

Updated to add:

One reader has mentioned Yeo Valley now also do a sugar free pot.  Quick google and indeed they do:
They are called "Little Yeo's":

Strawberry
Organic Whole Milk Yogurt (85%), Organic Concentrated Apple Juice, Organic Strawberry Puree (5%), Organic Maize Starch, Natural Flavouring, Organic Concentrated Lemon Juice

• Boasting just six natural ingredients and no artificial sweeteners, colourings or preservatives, our Little Yeo's contain just simple organic goodness that will put a big smile on everyone's face!

I also spotted some own brand ones the other day - so the key is CHECK THE LABEL :D

Related Post: 

Starting Solids - Can Babies Be Ready Before 6 Months & How Will I Know?/ Baby led introduction of solids