Food Introduction While Breastfeeding

Living Well in Myanmar

Early intoduction of table food may help breast-feeding babies  

New parents are typically interested in understanding how and when to introduce new foods when babies start eating. Most people with access to good medical care receive guidance on the importance of breast-feeding at the beginning of life. But advice on the timing of table food seems to be variable.

Historically doctors have tended to tell parents to introduce slowly foods that are known to cause allergies. Dairy products, eggs, nuts and fish were felt to be most safe when given to kids between 1 and 3 years old. The biological argument was that an infant’s immune system is fragile and therefore more likely to generate the type of antibodies (IgE) that can result in an allergy. However, the research that these recommendations were based on is not very strong and the purported biologic mechanism is only theoretical.

Meanwhile we have seen more recently the rise of advocates for the germ exposure theory. The hypothesis is that exposure to potential allergens while the immune system is developing will keep it from overreacting to those same allergens in later life. This school of thought advocates an approach to early childhood that minimises excessive hygiene and overprotection from the environment.

In this context, new research from Finland might prove important in helping primary care doctors counsel their patients. Investigators followed 3781 children from birth to age 5 and used questionnaires to compare their diets with both the frequency of  receiving asthma and allergies diagnoses, and the level of antibodies in their blood. They found that the earlier parents introduced grains (wheat, rye, oats, barley), fish and eggs, the less likely the children were to have asthma, nasal allergies and allergic reactions to the specific foods. They additionally found that mothers who continued to breast-feed while food was introduced had children with a lower chance of developing asthma.

While this type of observational study can show only an association between early food and reduced allergy – ie, it cannot prove that fewer allergies is directly caused by early introduction of food – it nevertheless echoes other, newer research that shows similar results. The implication is that doctors may have done a disservice to our youngest patients over the years by recommending parents wait to give cereals, fish and eggs.

Also, the study is interesting because it suggests breast-feeding is protective against allergies based on the total number of months that it occurs, rather than on the amount of time that breast milk is the infant’s only source of nutrition. Exclusive breast-feeding up to at least 4 months is well established as way to reduce infections and disease. The American Academy of Pediatrics continues to recommend exclusive breast-feeding up to 6 months, but it may well turn out that we can achieve the benefits of both illness and allergy protection by introducing food earlier while continuing to breast-feed.

In my clinics in Yangon and California I’ve adjusted my conversation with parents to reflect this general trend in the medical evidence. I suggest breast-feeding for a total of 12 months, while adding grains at 4-5 months, fish around 9 months and eggs before 1 year. The most important tasks for the doctor remain supporting mom and dad during the often challenging process of establishing breast-feeding and continuing to emphasise the strong advantages of breast milk over formula.  © Christoph Gelsdorf 2013