Houston, Texas, USA: Introducing solid food to babies early might offer a small improvement to their sleep, new research suggests. A study published on Monday in the journal JAMA Pediatrics found that babies who were introduced to solid foods before they reach six months slept longer, woke less frequently at night than those exclusively breastfed for around the first six months of life.
Most official sources of advice for new parents recommend that parents should wait until six months before introducing solids.
Researchers from the UK and U.S. looked at data collected as part of a clinical trial exploring whether early introduction of certain foods could reduce the chance of an infant developing an allergy to them. As part of the study the team also looked the impact on other measures, including growth and sleep.
“An added benefit (of early introduction of solids) is that it seems to confer better sleep for the children,” said Gideon Lack, professor of paediatric allergy at King’s College London, and a co-author of the research.
“We believe the most likely explanation for our findings of improved sleep is that that these babies are less hungry” said Lack, adding that solid foods might mean less regurgitation or greater feelings of being full.
The studied 1,303 exclusively breastfed three-month-olds from England and Wales and divided them into two groups.
One group were encouraged to exclusively breastfeed for around six months. Children in the second group were breastfed and given solid foods, including peanuts, eggs and wheat, from the age of three months, in addition to breastfeeding.
Parents completed online questionnaires every month until their baby was 12 months, and then every three months up to three years of age. The questionnaires recorded the frequency of food consumption and included questions about breastfeeding frequency and duration, as well as questions about sleep duration.
While not all babies were kept to their allotted regime, on average, babies who were in the breastfeeding only group were first introduced to solids at around 23 weeks, while those in the other group encountered the foods at around 16 weeks
The results, based on data from 1,162 infants and taking into account factors such birth weight and whether children had eczema, reveal babies introduced to solids from three months slept, on average, two hours more a week at the age of six months, than the babies who were only breastfed. They also woke around two fewer times at night per week at six months and had just over 9% fewer incidents of waking up during the night over the course of the study.
A total of 94 percent (1,225) of them completed the three-year questionnaire, among which 608 from the exclusive breastfeeding group, and 607 from the early introduction of food group.
The team found that the more closely parents stuck to the early introduction programme, the stronger the effect. Infants in the group which had solids introduced early slept longer and woke less frequently than those infants that exclusively breastfeed to around six months of age.
Differences between the two groups peaked at six months, with the early introduction group sleeping for a quarter of an hour (16.6 minutes) longer per night and their night waking frequency decreased from just over twice per night to 1.74.
Feedback about maternal wellbeing showed that sleep problems were reported less frequently in the group introducing solids before six months.
Lack said a crucial finding is that parents who were asked to exclusively breastfeed had almost twice the odds of reporting a serious problem with their child’s sleep than those who were asked to introduce their babies to solid food early.
The team did note that the study did not use sensors to monitor infants’ sleep and that parents might have misreported sleeping behaviour because they had previously encountered the idea that babies fed solid foods earlier sleep better.
The results of this research support the widely held parental view that early introduction of solids improves sleep, said the paper’s lead author Gideon Lack with King’s College London.
However Professor Amy Brown of Swansea University, whose research includes weaning of babies, said the benefits revealed by the study were “minimal” in real-world terms, and that other research showed no rewards for early introduction of solids.
“There is no clear physiological reason why introducing solids foods early would help a baby sleep, especially not for the very small amounts parents were instructed to give in this trial,” she said.
Brown urged caution, noting that no difference in waking was seen until after five months, despite one group being introduced to solids from three months, and that self-report of infant sleep by tired parents was unlikely to be precise.
Erin Leichman, a senior research psychologist at St Joseph’s University, Philadelphia, and executive director of the Pediatric Sleep Council said while the impact of early introduction of solid foods likely varied across babies, the findings are important. “Results of this study certainly warrant further research on the topic, particularly addressing how long babies continue to breastfeed despite introduction of solids and how parents interact with their babies at bedtime and during the night after a night waking, which can be related to sleep and night wakings,” she said. “At this point, results of this study do not indicate that solids should be introduced early for all babies.” Making the decision about when to introduce solid foods should be one that is family-based, and made with a trusted health-care provider.”
The World Health Organization, WHO, recommends exclusive breastfeeding for the first six months of life and a spokesperson for the organization, Tarik Jašarević, says that globally, only about 40% of babies under 6 months old are exclusively breastfed. “If all infants under the age of 6 months were exclusively breastfed, we estimate that about 820,000 child lives would be saved every year,” Jašarević said.
“Breastfeeding is the normal way of providing young infants with the nutrients they need for healthy growth and development. Virtually all mothers can breastfeed, provided they have accurate information, and the support of their family, the health care system and society at large.
Colostrum, the yellowish, sticky breast milk produced at the end of pregnancy, is recommended by WHO as the perfect food for the newborn, and feeding should be initiated within the first hour after birth.
Exclusive breastfeeding is recommended up to 6 months of age, with continued breastfeeding along with appropriate complementary foods up to two years of age or beyond.” WHO says.
Infants should be exclusively breastfed – i.e. receive only breast milk – for the first six months of life to achieve optimal growth, development and health. “Exclusive breastfeeding” is defined as giving no other food or drink – not even water – except breast milk. It does, however, allow the infant to receive oral rehydration salts (ORS), drops and syrups (vitamins, minerals and medicines). Breast milk is the ideal food for the healthy growth and development of infants; breastfeeding is also an integral part of the reproductive process with important implications for the health of mothers.
WHO recommends that infants start receiving complementary foods at six months (180 days) of age in addition to breast milk. Foods should be adequate, meaning that they provide sufficient energy, protein and micronutrients to meet a growing child’s nutritional needs. Foods should be prepared and given in a safe manner to minimize the risk of contamination. Feeding young infants requires active care and stimulation to encourage the child to eat.
The transition from exclusive breastfeeding to full use of family foods is a very vulnerable period. It is the time when many infants become malnourished, contributing significantly to the high prevalence of malnutrition in children under five years of age worldwide. It is essential therefore that infants receive appropriate, adequate and safe complementary foods to ensure the right transition from the breastfeeding period to the full use of family foods, WHO says.