Introducing solids schedules - outdated advice?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 & butternut squash
• Savoury vegetables like cabbage
• Fruits
• White meat/fish/green veg
• Red meat

These recommendations have been around since the norm was to introduce solids from as early as 10 weeks (more on this in a moment).  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.

They were wrong

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Science has since highlighted 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 covered in detail here.

From six months ish some babies may also begin to need more nutritionally, zinc, 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 practises such as early cord cutting or cesarean sections have also been linked with reduced iron levels due to baby not receiving their cord blood.

So potentially we have parents waiting until six months (as per the guidelines) and then introducing baby rice which is pretty nutritionally pants.

This is then followed by veg and fruit, which as Dr Carlos Gonzalez highlights in his book "My child won't eat" offers little nutritionally to someone with a small stomach.  He says:

"In the early 1900s, vegetables as well as fruits were introduced very late in children's diets; perhaps at two or three years of age and with great caution.  Since they were breastfed, children were fine without them because human milk provided all the necessary vitamins.  When artificial feeding started becoming more widespread, babies started becoming deficient in some vitamins (due to the fact that it took manufacturers decades to add all the necessary vitamins to artificial baby milk).  This made it necessary to introduce fruits and vegetables much earlier. But there was a problem: their low calorific density.  Children have smaller stomachs.  They need concentrated foods, high in calories but low in volume. 

He then goes on to explain that mother's milk has 70 Kcal per 100g, chicken has 186, chickpeas have 150. Yet apples have only 52, carrots 27 and cabbage 15 (assuming they're drained well or nutritional content further reduces).

He continues:

"If left alone small children seldom refuse vegetables.  It is not a matter of taste.  Usually they will gladly accept a few bites of vegetables rich in vitamin and minerals.  But only a few bites. Some mothers try to give them a plateful of these "healthy" foods."

Furthermore, nothing biologically tallies with this man made 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 amounts 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."

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 paediatric 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.

Yet how often do we see toast, sandwiches, pasta, wraps, crumpets etc featuring as ideal first foods? Some diets are so grain heavy they include cereal for breakfast, sandwich for lunch and pasta for dinner.

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.

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 11.9g total sugar per 100g.  A tiny proportion of this is lactose (the naturally occurring milk sugar) - however they add to that 6.9% sugar, 5%  fruit puree AND 3.9% fructose.  Why?

If we consider the maximum daily intake for a toddler is around this mark, a 50g pot is supplying half. Babies have a smaller allowance, and are also getting sugars via their breastmilk and formula.  All it's doing is giving baby a taste for excessively sweet products, and both sugar and fructose are heavily implicated in the obesity epidemic.

The healthiest option is to simply buy natural live yoghurt.  Whilst adults are often used to sugar laden products, infants weaned onto plain natural yogurt like it just as much and may actually wince when they receive a sugar hit version! We seem to think things need sweetening and fruit adding for babies and children, some say their baby doesn't like plain yoghurt because they don't consume lots immediately (like they may be tempted to do with sugar filled Filous), but it can take over ten tastes for a baby to like many foods and ultimately we don't sprinkle broccoli in sugar to increase its appeal?  If you really need to sweeten it fruit should be sweet enough alone, without added fructose?

If we want our child to develop healthy eating habits, which ultimately I'm sure many do - the relationship we develop with food during infancy surely matters?

Updated Jan 2015

Related Post: 

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