>After talking to my pediatrician friend, it seems to us that there is a
>window of opportunity to begin the introduction of solids - a period of time
>where the baby is openly displaying cues that he or she is ready, and the
>parent ignores those cues for whatever reason - other kids, too busy,
>emotional disturbance, misinformation, etc. It also seemed to us that if
>this window is missed, a child could become a really picky eater.

I do not believe there is any research to support your 'feelings' on this
topic.  Around the world, there is a wide variety of cultural beliefs about
when babies should start non-breast milk foods.  Many start well before the
4-6 months recommended by the World Health Organization.  Many start well
after this time frame, and yet, the vast majority of those children eat
perfectly well as toddlers.  In Mali, the average age for starting solids
was over 8 months.

There is a SINGLE study suggesting that failure to start solids in a timely
manner in *MENTALLY RETARDED CHILDREN* might lead to problems with accepting
solids later on.  This was a single article based on a series of anecdotal
case reports, with a very small sample size (nine, I think).  This study is
sometimes cited when people are talking about "normal" children and a
"window of opportunity for starting solids," but it only is applicable to
mentally retarded children, and even for them, it has never been replicated,
and the sample size was miniscule.

I would look for something else as a cause of a spate of "failure to thrive"
diagnoses in older breastfed children, before I would assume that it was
just that the parents didn't offer foods in a timely or appropriate manner.

And someone else wrote on this topic:

>It is also very common for babies not to eat any
>substantial amount of other foods for 9 months to a year rather than 6
>months, and my personal guess is that the healthy age to start solids may
>be older than we currently think - I'm not sure what the six month
>guideline is based upon.

The 4-6 month (NOT 6 months) World Health Organization Infant Feeding
Recommendations are based on solid scientific evidence that the average
growth of groups of children will fall away from the current standards if
they are exclusively breastfed beyond the 4-6 month window.  The 4 month end
of the range comes from studies of children in "adverse environmental
conditions" such as Third World countries, with malnourished and sickly
mothers, poor sanitation, and lots and lots of diseases to cope with.  The 6
month end of the range comes from studies of children in "adequate
environmental conditions" such as First World countries, will well-nourished
and healthy mothers, good sanitation, and few diseases to cope with (due to
better sanitation, immunizations, and antibiotics).  The World Health
Organization recommendations are written to cover all children, everywhere,
and therefore MUST include a range of appropriate ages, not "one age fits
all."  We do not have good evidence yet (and I suspect we won't ever have
it) that children who are breasfed on demand and who co-sleep and nurse at
night have growth patterns that are different from the current standards.
What we have are growth data from breastfed babies who (mostly) were nursed
according to a 3-4 hour schedule and who (mostly) slept in a crib in a
separate room and were encouraged to sleep through the night at an early
age.  I strongly suspect that if we did have growth data on children who
were breastfed on demand and who co-slept and breastfed at night, we would
have children whose growth rates are ABOVE the current standards.  Remember
that the current standards are based on a mixture of breastfed and
bottle-fed children, and most of the bottle-fed children got homemade or
early commercial formula, not the formulas available today.

You also need to remember that the growth standards currently available
(WHO/CDC/NCHS/Ross Labs -- they're all the same charts) were developed to
asses the growth of GROUPS of children.  They were never intended to be used
to monitor individual children's growth.

INDIVIDUAL children will display different characteristics.  Some will need
supplementing with something well before 4 months, if the mother isn't
producing enough milk, or isn't nursing often enough, the baby is not an
effective nurser, or the baby has extraordinary needs.

Some children will do fine with exclusive breastfeeding until 9 months, 1
year, or even longer.  That is not the point.  The vast majority of children
will both
(a) need and (b) be interested in solid foods between 4 and 6 months of age.
A healthy, 'normal' alert and active infant will be showing interest in
foods by about 6 months.  If offered foods, most will eat.  Those who refuse
solids may be those with allergies, those with problem of sensory
integration who find the smell/taste/texture of solid foods problematic,
those with swallowing problems (overactive gag reflex, difficulty
coordinating tongue and cheek muscles to move food around for chewing and
swallowing, etc.), those with global developmental delays, and those who are
faced with inappropriate mealtime conditions -- mother force-feeding, mother
browbeating, etc.


Katherine A. Dettwyler, Ph.D.
Associate Professor of Anthropology and Nutrition
Specialist in infant/child nutrition, growth, and development

             ***********************************************
The LACTNET mailing list is powered by L-Soft's renowned
LISTSERV(R) list management software together with L-Soft's LSMTP(TM)
mailer for lightning fast mail delivery. For more information, go to:
http://www.lsoft.com/LISTSERV-powered.html