When Medical Experts Disagree About Basic Pediatric Nutrition Issues: What Should The Public Do?

January 27, 2011


We are used to the idea that doctors and scientists will look at an issue, conduct studies and then guide us on what to do. Sometimes there are outlying opinions that need to be dealt with, but mostly a consensus occurs for ideas directly related to public action. So, when opinions collide, problems arise.

For example, there is the age-old question of when breastfed babies should begin solid foods.

For a long time, there was a consensus of 4 months of age. Then, about 9 years ago, the World Health Organization (WHO) said that babies shouldn't get solids until 6 months of age. Now, this issue has become unbelievably contentious, with groups including the Center for Disease Control (CDC) and the American Academy of Pediatrics (AAP) neither entirely supporting the WHO position nor clarifying their own stances.

In January of this year, a well-respected research group in the United Kingdom published a paper saying that the WHO was wrong and that it was actually best for breastfed infants to start iron-containing solid foods before 6 months of age. This of course added to the confusion.

What is a parent to do when medical experts can't agree on something so basic in child care?

Discussing all the facts and claims of this debate is beyond the scope of a mere blog post. In brief:

  • Those who support later introduction of solids believe this stance supports breastfeeding, decreases infections, and perhaps improves growth with a lower risk of overfeeding.
  • Those who support earlier introductions of solids (before 6 months of age) believe it provides an additional iron source, accommodates parents who wish to feed solids earlier, and potentially decreases the risk of allergies and celiac disease.

What do I recommend? Well, for now, the goal of waiting to introduce solids for breastfed infants until 6 months is still a good idea, as long as vitamin drops containing vitamin D and iron are provided (vitamin D from birth, iron from 4 months). However, I doubt that it is harmful to start a small amount of solid foods, especially those containing iron, at 4 or 5 months of age for most babies. Instead of focusing on the exact timing of the introduction of solid foods, it is more important to support continued breastfeeding, preferably for at least a year.

Ultimately, these debates remind us that even the most basic parenting decisions are never cut and dried. Take each recommendation with the knowledge that even the most authoritative institutions don't have the final word. Using good "parent judgment" and getting advice from a pediatrician who is familiar with the issues is the way to go.

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