Hi Karen
There is very little evidence (that I am aware of) addressing the question
of whether premmies should begin solids at their adjusted age of six months
or their birth age.  What we do know is that premmies are at increased risk
of infection.  Introducing foods other than human milk before six months
increases the risk of infection.  Four and a half months is not 'around six
months'.  Feeding solids before breastfeeding is not recommended until the
second year because it results in a faster decline in frequency and duration
of breastfeeding.
Karen said, " However, the pedi suggested introducing some solid food and
per mom  more for her/mom's sake than babies."  Don't you love the health
professionals who are so keen to 'look after' their mothers that they forget
to involve the mothers in making informed decisions for themselves and their
babies? This sort of behaviour runs contrary to one of the pillars of
biomedical ethics, Autonomy.  There is another principle called
'beneficence' (doing good for your patient) that is much better understood -
and is clearly the principle guiding the paed in this case -  but the use of
beneficence here threatens the mother's autonomy.  Autonomy trumps
beneficence almost every time.  (If it doesn't, there is usually a very very
good reason, like the patient is incapable of autonomy usually due to mental
deficit or defect - but intellectual disability/mental illness/immaturity do
not necessarily exclude autonomy.)  
The mother needs to know that there is no evidence to support the
paediatrician's recommendation.  Perhaps she could call back and ask him for
the evidence upon which he has based his recommendation. (And so retain her
autonomy and illustrate to her adviser that she is in charge of her body and
her babies.)
Cheers
Nina Berry
Australia

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