When is the right time to start infants on solid foods?

The first study of a nationally-representative group of U.S. infants reports that more than half of babies are currently introduced to complementary foods, that is, foods or drinks other than breast milk or formula, sooner than they should be. Babies who were never breastfed or breastfed for less than four months were most likely to be introduced to foods too early. These findings are reported in the Journal of the Academy of Nutrition and Dietetics and emphasize the need to introduce foods at the proper time to get the most benefit from breast milk or formula.

"Introducing babies to complementary foods too early can cause them to miss out on important nutrients that come from breast milk and infant formula. Conversely, introducing them to complementary foods too late has been associated with micronutrient deficiencies, allergies, and poorer diets later in life," explained lead investigator Chloe M. Barrera, MPH, Division of Nutrition, Physical Activity, and Obesity, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, GA.

Current recommendations stipulate that infants should be introduced to complementary foods at around six months of age. Analyzing data from the 2009-2014 National Health and Nutrition Examination Survey (NHANES), investigators assessed the food intake of 1482 children aged six to 36 months, gathered during household interviews with the child's proxy, typically a parent. The survey asked how old infants were when they were first fed anything other than breast milk or formula. This includes juice, cow's milk, sugar water, baby food, or anything else that the infant might have been given, even water.

This analysis shows that only one-third (32.5%) of babies in the U.S. were introduced to complementary foods at the recommended time of about six months; 16.3% were introduced to complementary foods before four months, 38.3% at four-five months, and 12.9% at seven or more months of age. These data help understand the current state of infant feeding practices in the U.S.

Over the last 60 years, recommendations for when to introduce complementary foods have changed dramatically. The 1958 guidelines suggested solid foods in the third month, the 1970s brought a delay until after four months, and the 1990s pushed the introduction of solid food out to six months. These changing recommendations have influenced many past studies of infant nutrition, most of which show a general lack of adherence to current professional guidelines, whatever they may be. The U.S. Department of Agriculture (USDA) and Department of Health and Human Services (HHS) are currently developing the first federal dietary guidelines for children under two years, to be released in 2020.

"Efforts to support caregivers, families, and healthcare providers may be needed to ensure that U.S. children are achieving recommendations on the timing of food introduction," commented Chloe Barrera and her co-investigators from CDC. "Inclusion of children under two in the 2020-2025 Dietary Guidelines for Americans may promote consistent messaging of when children should be introduced to complementary foods."