Book Excerpt: An Appetite for Life

An Appetite for Life Excerpt

Hello! I want to tell you about a new book that I am reading. I am midway through An Appetite for Life by Clare Llewellyn, PhD, and Hayley Syrad, PhD. I am enjoying learning about the science and research behind feeding children. I am particularly interested in appetite, what is normal/ abnormal, and  how the lack of it contributes to feeding disorders in the kids we treat. This is a meaty book full of information and advice. I am happy to share an excerpt here of this new and very interesting read. I will share an interview with the authors in the next post. Krisi

Excerpt from 

An Appetite for Life 

How to Feed Your Child from the Start 

by Clare Llewellyn, PhD, and Hayley Syrad, PhD 

Introducing solid foods (known as complementary feeding) after you have been feeding your baby only milk can seem like a daunting task. There is a lot of information out there—when to start, which foods to start with and how to do it—and this can be confusing. We want to help you navigate what can be a tricky topic, bringing to bear the research we have done ourselves and the studies we have read. 

Being introduced to solid foods can be an exciting time for a baby—his diet finally deviates from the monotony of milk, and he begins to experience a whole range of new textures and flavors. But it can be stressful for some parents, especially when things don’t go as planned—for example, when your baby refuses to try certain foods or doesn’t seem to be eating anything at all. 

When to Introduce Solid Foods

Complementary feeding is the term used to describe the introduction of solid foods and other drinks alongside breast milk or formula. The optimal age at which to introduce solid foods is one of the most debated topics in infant nutrition. Countries (and even organizations within the same country) often have different views, which can make it confusing for parents. It is generally agreed that introducing solid food before seventeen weeks of age (less than four months) can be harmful to your baby: He doesn’t yet have the ability to swallow food safely (even if puréed); his digestive system and kidneys are not mature enough to be able to handle anything other than breast milk or formula; and there may also be an increased risk of infection, some allergies and later obesity. But what is less clear is whether it is best to wait until six months for all babies, or to introduce solid food between four months (seventeen weeks) and six months, depending on a baby’s particular needs or readiness. 

In line with the World Health Organization (WHO), the American Academy of Pediatrics (AAP) recommends exclusive breastfeeding for approximately six months, followed by continued breastfeeding for at least one year as complementary foods are introduced (the WHO recommends continuing to breastfeed for two years or beyond). The AAP also provides a general recommendation to introduce solid foods at about six months for all infants, which includes those who are formula-fed. Other countries such as the UK also recommend waiting until your baby is about six months old. But several organizations consider any time between seventeen weeks (four months) and six months to be safe and acceptable, including the European Society for Paediatric Gastroenterology, Hepatology and Nutrition (ESPGHAN), the European Food Safety Authority, the British Dietetic Association, the European Academy of Allergy and Clinical Immunology, and the American Academy of Allergy, Asthma and Immunology. So why do organizations take a different view, and what is the best age to introduce your baby to solid foods?

There is general agreement that babies’ iron stores start to deplete at around four to six months of age, which introduces concerns about iron deficiency (anemia), especially for exclusively breastfed infants, because breast milk is low in iron (although iron is absorbed more easily from breast milk than from formula), and this is around the time that a baby needs to start sourcing his iron from food. Iron is crucial for healthy growth and development in infancy, and deficiency can result in cognitive and psychomotor problems, suggesting that some infants may need iron from other food sources earlier than six months. On the other hand, introducing solid foods before six months displaces breast milk, which provides some protection against infection, and introducing solid food earlier than six months may increase the risk of infection. The crux of the timing issue is sometimes referred to as the “weanling’s dilemma”—timing of introduction to solids must weigh the benefits of breast milk against the possibility that milk alone is insufficient to satisfy a baby’s energy and nutrient requirements beyond four months of age. 

These issues are unlikely to be relevant for babies who are predominantly fed formula, because formula doesn’t protect against infection and is nutritionally complete with iron and other necessary nutrients to support a baby up to six months. But, although there is very little evidence about the optimal age at which to introduce solid food to formula-fed babies, they are treated like breastfed babies for the purpose of the guidelines. So, if your baby is on formula, do you still need to wait until six months to move him on to solid food? This applies to a large number of babies in the US: 29 percent have received formula before three months and 35 percent before six months; in fact, only 25 percent of babies are exclusively breastfed to six months. And what about parents of exclusively breastfed babies who think their baby is ready for food earlier than six months? A national survey in the US found that 55 percent of parents had offered solid foods before their baby was six months old. The US Department of Agriculture’s Special Supplemental Nutrition Program for Women, Infants, and Children (WIC) began its Infant and Toddler Feeding and Practices Study in 2013 and found that 20 percent of low-income infants were introduced to infant cereals, fruits, vegetables or meats before four months of age.

What Age Should You Go With?

The evidence suggests that babies who are breastfed exclusively for six months compared to three to four may experience slightly fewer gastrointestinal infections, without any real detriment in growth or other outcomes, although it’s not entirely clear if babies in all high-income countries necessarily benefit to the same extent. The downside of waiting until six months to introduce solids is that iron levels are compromised slightly. However, the AAP recommends that babies be given iron supplementation from four months of age, making this less of a concern for US babies who follow this guidance. So, weighing the pros and cons, it makes sense to wait until six months to introduce solid foods if you are exclusively breastfeeding your baby, he is growing and developing well and it is working well for you. But babies can differ in their needs, so the best way to make sure that waiting until six months is best for your baby is to take him for his regular well-child care visits during the first six months and discuss this with your pediatrician.

Although there is virtually no research to draw on to provide any helpful guidance for the best time to introduce solid foods to babies who are mainly formula-fed, they don’t seem to need to be introduced to solid foods before six months. This is because they receive adequate nutrition from formula until then. But again, babies may differ in their needs, and when to start your baby on solid foods if he is formula-fed will depend on his health and development, which your pediatrician will be able to advise you on.

Key Signs Your Baby Is Ready for Solids

Generally there are three key signs that you can look out for to help you decide whether your baby might be ready to move on from milk to solid food:

1. He can sit upright and hold his head up. This is important to ensure he can swallow food.
2. He has good hand-eye coordination so he can look at food, pick it up and put it in his own mouth.
3. He can swallow food. If your baby is not ready, he will use his tongue to push the food back out of his mouth (this is known as the tongue thrust reflex).

If your baby is showing all of the above signs and is six months old, then you can feel confident that he is ready to start solids. 

Credit line: Excerpted from An Appetite for Life: How to Feed Your Child from the Start © Clare Llewellyn and Hayley Syrad, 2018, 2019. Reprinted by permission of the publisher, The Experiment. Available wherever books are sold. theexperimentpublishing.com