Babies given solid food plus breast milk from three months sleep better than those who are solely breastfed, a large UK study has found, challenging the official recommendation, which is currently under review.
BBC News reports that official advice is to breastfeed exclusively for the first six months of life and experts say women should still heed this recommendation, although it is under review.
The study, by King’s College London, and St George’s University of London, surveyed 1,303 three-month-olds, and divided them into two groups. One group was solely breastfed for six months, the other group was given solid foods in addition to breast milk from the age of three months. Parents then filled in online questionnaires every month until their baby was 12 months old, and then every three months until they were three years old.
The study showed that infants in the group who ate solids as well as breast milk: slept longer; woke less frequently; and had fewer sleep problems than those who were exclusively breastfed until about six months
The report says although the findings were significant, the differences between the solids group and the control group were not huge. Babies on earlier solids slept for up to 16 minutes longer per night, potentially giving parents about two extra hours of sleep per week.
Co-author of the study Dr Michael Perkin, from St George’s, University of London, says small differences generated large benefits for parents. “Given that infant sleep directly affects parental quality of life, even a small improvement can have important benefits.” More significantly, the group of babies on early solids reported half the rate of the type of sleep problems, such as crying and irritability, which make it less likely that parents are going to get back to sleep.
The report says the UK’s National Health Service and the World Health Organisation currently advise to wait until around six months before introducing solid foods, but these guidelines are currently under review. Experts say babies should not have solid foods, at the earliest, before the end of four months.
But despite the official advice, 75% of British mothers introduced solid food before five months, with a quarter (26%) citing infant night-time waking as the reason for their decision, according to the Infant Feeding Survey of 2010.
Professor Gideon Lack from King’s College, London, said: “The results of this research support the widely held parental view that early introduction of solids improves sleep.
“While the official guidance is that starting solid foods won’t make babies more likely to sleep through the night, this study suggests that this advice needs to be re-examined in light of the evidence we have gathered.”
The report says responding to the study, Professor Mary Fewtrell, nutrition lead at the Royal College of Paediatrics and Child Health, pointed out that guidelines for infant feeding are currently being reviewed. She said: “These are interesting findings from a large randomised controlled trial.
“At the RCPCH, we recommend that mothers should be supported to breastfeed their healthy-term infant exclusively for up to six months, with solid foods not introduced before four months. However, the evidence base for the existing advice on exclusive breastfeeding is over 10 years old and is currently being reviewed in the UK by the Scientific Advisory Committee on Nutrition. We expect to see updated recommendations on infant feeding in the not too distant future.”
The report says what to feed babies in the first six months of life can be controversial, with many mothers feeling judged if they are unable to breastfeed successfully, and guilty if they introduce bottles or solids.
Last month, the Royal College of Midwives responded to the pressure felt by new mothers by publicly stating new guidelines for midwives to respect a woman’s choice not to breastfeed.
The study on solids was part-funded by the Food Standards Agency, which was also looking at how allergies develop in babies. An FSA spokesperson said: “We are encouraging all women to stick to existing advice to exclusively breastfeed for around the first six months of age.
“If there is any doubt about what’s best for your baby, please seek advice from your doctor or health professional.”
Importance: The World Health Organization recommends exclusive breastfeeding for 6 months. However, 75% of British mothers introduce solids before 5 months and 26% report infant waking at night as influencing this decision.
Objective: To determine whether early introduction of solids influences infant sleep.
Design, Setting, and Participants: The Enquiring About Tolerance study was a population-based randomized clinical trial conducted from January 15, 2008, to August 31, 2015, that included 1303 exclusively breastfed 3-month-old infants from England and Wales. Clinical visits took place at St Thomas’ Hospital, London, England, and the trial studied the early introduction of solids into the infant diet from age 3 months.
Interventions: The early introduction group (EIG) continued to breastfeed while nonallergenic and then 6 allergenic foods were introduced. The standard introduction group (SIG) followed British infant feeding guidelines (ie, exclusive breastfeeding to around age 6 months and to avoid any food consumption during this period).
Main Outcomes and Measures: Secondary analysis of an a priori secondary outcome of the effect of early food introduction on infant sleep using the standardized Brief Infant Sleep Questionnaire.
Results: Of the 1303 infants who were enrolled in the Enquiring About Tolerance study, 1225 participants (94%) completed the final 3-year questionnaire (618 SIG [95%] and 607 EIG [93%]). Randomization was effective and there were no significant baseline differences between the 2 groups. Following the early introduction of solids, infants in the EIG slept significantly longer and woke significantly less frequently than infants in the SIG. Differences between the 2 groups peaked at age 6 months. At this point, in the intention-to-treat analysis infants in the EIG slept for 16.6 (95% CI, 7.8-25.4) minutes longer per night and their night waking frequency had decreased from 2.01 to 1.74 wakings per night. Most clinically important, very serious sleep problems, which were significantly associated with maternal quality of life, were reported significantly more frequently in the SIG than in the EIG (odds ratio, 1.8; 95% CI, 1.22-2.61).
Conclusions and Relevance: In a randomized clinical trial, the early introduction of solids into the infant’s diet was associated with longer sleep duration, less frequent waking at night, and a reduction in reported very serious sleep problems.
Michael R Perkin; Henry T Bahnson; Kirsty Logan; Tom Marrs; Suzana Radulovic; Joanna Craven; Carsten Flohr; Gideon Lack