ESPE Yearbook of Paediatric Endocrinology

To read the full abstract: JAMA Pediatr 2018;172:e180739.

This randomised controlled trial of 1303 exclusively breastfed 3-month-old UK infants was primarily performed to test the impact of early introduction of solid foods, from age 3 months, on the risk of food allergies (1). Sleep was measured as a secondary trial outcome: the trial showed that early introduction of solids increased infant sleep duration, reduced the frequency of waking at night, and reduced the risk of reported very serious sleep problems.

There is currently debate as to the optimal age to introduce solid foods into infant diets. The main disadvantage of early introduction is the higher risk of gastrointestinal and respiratory tract infections, primarily due to displacement of breast milk. At age 3 months most babies lack the coordination to move solid food from the front of the mouth to the back for swallowing and are at risk of choking. Early introduction of solids is also consistently associated with higher infant weight gain and childhood obesity risk, although some studies show this is association is due to reverse causality (i.e. parents give solids earlier to hungrier infants) (2). Recently, the UK restated its agreement with WHO guidance that solids should be introduced at around age 6 months (3). US and European guidance states ‘at 4–6 months’, but the European guidance is under review.

The current paper reminds us that when we set guidance for health reasons, we need to be aware of the issues that families are actually concerned about. Longer sleep duration and less frequent night wakening are consistent with the higher energy density contained in solids. Whenever we discuss lifestyle advice, e.g. in diabetes or obesity clinics, we should be aware of the obvious trade-offs between convenience and health outcomes, and acknowledge that these choices are difficult for many families.

References: 1. Perkin MR, Logan K, Tseng A, Raji B, Ayis S, Peacock J, Brough H, Marrs T, Radulovic S, Craven J, Flohr C, Lack G; EAT Study Team. Randomized Trial of Introduction of Allergenic Foods in Breast-Fed Infants. N Engl J Med. 2016 May 5;374(18):1733–43.

2. Vail B, Prentice P, Dunger DB, Hughes IA, Acerini CL, Ong KK. Age at Weaning and Infant Growth: Primary Analysis and Systematic Review. J Pediatr. 2015 Aug;167(2):317–24.e1.

3. The Scientific Advisory Committee on Nutrition (SACN). Feeding in the first year of life. www.gov.uk/government/publications/feeding-in-the-first-year-of-life-sacn-report (2018).