Extract from the revised edition of 
‘The Contented Little Baby Book of Weaning’
Published 6th April 2006

Introduction

In 2003, the Department of Health, prompted by a recommendation from the World Health Organisation, changed the recommendations as to when solid food should be introduced to babies. The Department of Health now advise exclusive breast-feeding for the first six months of a baby’s life, i.e. no solids or infant formula.  The previous DoH advice was to wean between four and six months and not to give solids to any baby before four months (17 weeks). This is because it takes up to four months for the lining of a baby’s gut to develop and for the kidneys to mature sufficiently. Introducing solids too early can put a strain on the immature gut and kidneys, and many experts now believe that introducing solids before a baby’s digestive system is ready to cope is the cause of the rapid increase in allergies over the last twenty years.

Up until 2003, when parents followed the previous DoH advice to wean between four and six months, I found that the decision to start weaning depended on the needs of each individual baby.  Because all babies are different, and grow and develop at different rates, some needed weaning at four months, others would be nearer five months and some would manage to get to six months.

While writing the latest edition of my weaning book, I have spoken to many health professionals, as well as to hundreds of mothers.  It is clear that there is some controversy and confusion surrounding the latest government recommendations.  Certainly, there are health professionals who believe that it is not weaning before four and six months which threatens a baby’s health, but the kind of food the baby is given. It is also clear that there are some babies who seem not to be satisfied on milk alone for the full six months, and parents are struggling to cope with a miserable, fretful baby as they try to push them to six months on milk alone.

In my latest book I give very detailed advice, which I hope will help you to get your baby happily to six months without the introduction of solid foods.However, because I do not know your baby personally, it is vital that you discuss with your health visitor or GP any concerns that you have about your baby showing signs that he is not being satisfied on milk alone, despite reintroducing the extra feeds that I recommend. It is important to seek advice, because increasing the amount of food too quickly or introducing the wrong types of food could result in some, if not all of the following:

• Possible damage to the baby’s digestive system.  It takes up to four months for the lining of a baby’s gut to develop and for the kidneys to mature enough to cope with the waste products from solid food. Introducing solids before your baby has a complete set of enzymes required to digest food properly could put pressure on his liver and kidneys and impair his digestive system.
• Physical problems when feeding.  It is important not to start weaning before your baby’s neuromuscular co-ordination has developed enough for him to control his head and neck while sitting upright supported in a chair to be fed.  He should also be able to swallow food easily by moving it from the front of his mouth to the back.  He will only be able to do this if he is supported upright.
• Introducing solids too early can put your baby at a higher risk of developing allergic conditions, such asthma, eczema, and hay fever.
• Scientific studies in Scotland found that a persistent cough was more common in babies who had been given solids before 12 weeks.
• A baby who is given solids too soon or increases them too rapidly may cut back too much on his milk and be denied the essential nutrients that milk provides.
• Early weaning can sometimes lead to overfeeding, making the baby overweightwhich, research suggests, can lead to obesity in later life and increase the risk of cancer, diabetes or heart disease.

The following guidelines should help you identify possible signs of your baby being ready to wean.  Your baby could be ready if:

• He is at least four months (17 weeks) old, has doubled his birth weight and weighs over fifteen pounds in weight, and your health visitor is happy with his weight gain each week.
• He has been taking a full feed four to five times a day from both breasts or a 240ml (8oz) formula feed and has been happily going four hours from the beginning of one feed to the beginning of the next feed, but now gets irritable and chews his hands long before his next feed is due.
• He has been taking a full feed from both breasts, or a 240ml (8oz) formula feed, and screams for more when the feed finishes.
• He usually sleeps well at night, but starts to wake up earlier or in the middle of the night despite taking a full feed at 10/10.30pm.  Daytime sleep becomes more erratic, waking up midway through a nap and not settling back, or waking up earlier from naps.

If your baby is at least four months and showing most of these signs, despite having four to five full feeds a day, it could be that he is ready for weaning.  If your baby is under six months you should tell your health visitor or GP so they can help you decide whether to proceed with the introduction of solids.

If you agree that your baby should wait until six months before having solids introduced, it is important that his increased hunger is met by introducing further milk feeds. Babies who have been sleeping through the night with only a small feed, and are waking earlier should have the 10/10.30pm feed increased.  Babies who are taking a full feed at 10/10.30pm and waking in the middle of the night may need to have a small milk feed in the middle of the night to get them through until 7am.

It is very important to remember that, as your baby grows, so will his appetite. It is unreasonable to expect him to manage on only four milk feeds a day, when he is showing signs of increased hunger. Therefore, even if you have dropped the fifth feed, you will probably need to reintroduce it until he starts weaning at six months.

Early weaning

If your baby is over 17 weeks and having five to six full milk feeds, and still not managing to go happily between feeds, it is possible that he may need to be weaned early. Check the signs above, which may indicate that your baby is no longer satisfied by milk alone. I would then suggest that you keep a feeding and sleeping diary for three to four days so that you can show this to your health visitor or doctor when discussing whether your baby should be weaned early.  If they advise that you should introduce solids before the recommended age of six months, it is important to remember that milk is still the most important food, as it provides your baby with the right balance of vitamins and minerals.  Solids given during early weaning should be classed as fillers, which should be increased very slowly over several weeks, gradually preparing your baby for three meals a day between six and seven months.  By always offering the milk first, you will ensure that his daily milk intake does not decrease too rapidly if you have been advised to wean early.

It is also very important if you are weaning early to ensure that the foods you offer your baby are all from the first stage baby foods, and that you do not start to introduce foods too early which could put your baby at risk of allergies. Depending on how old your baby is when you first introduce solids, he probably still needs a late feed at 10pm until solids are well established.  However, as he increases his solids, he should automatically cut down on his 10pm feed and, provided he has been sleeping through for at least two weeks, you should be able to eliminate the last couple of ounces at that feed by the time he reaches six months and is established on three meals a day.

Weaning at six to seven months

The previous DoH advice was to wean between four and six months. It advised that new foods were introduced every three to four days. This was to reduce the risk of allergies, and avoid solids being increased too quickly, resulting in too rapid a decrease in the milk intake. Starting weaning at six months coincides with the age that a baby’s natural store of iron, with which he is born, depletes. It is, therefore, important that you progress through the first stage weaning foods much quicker than previously recommended to ensure that your baby is introduced to iron-containing foods.

When starting weaning at six months you should also immediately go on to the tier system of feeding at lunchtime, as this will encourage your baby to increase his solids more rapidly.  If you do not reduce your baby’s milk intake at this feed, you may find that he becomes very fussy about weaning, and rejects many of the foods you are introducing.

By seven months you should aim to have reduced your baby’s milk intake to three milk feeds a day, and to have established him on a proper lunch and tea with a small breakfast.  If your baby is fussy about solids, but still taking four to six milk feeds a day, it is important that you reduce the milk that he is taking so as to improve his appetite for the solids.

Many babies continue to need a feed at 10pm to get them through the night until solids are well established.  If your baby is following the CLB routines during the day and sleeping through from 11pm to 7am, with only a small feed at 10/10.30pm, then introducing solids and weaning him off this feed should be fairly simple.  As the amount of solids he takes at teatimeincreases, then the amount he wants at the late feed should decrease.  If he does not cut back automatically, as long as he sleeping through to 7am I would suggest that you gradually reduce the amount he is taking.  For breast-fed babies you can reduce the feed by a few minutes, and for formula-fed babies you should reduce the amount he takes by an ounce.  Provided he sleeps through, you can continue to reduce this feed by those amounts every three nights.  Once you reach a stage where he has slept through for several nights on a very short breast feed of around five minutes, or a formula feed of a couple ounces, you should safely be able to cut the feed out altogether, without worrying about him waking up hungry earlier.

With babies who are taking a full breast-feed or formula feed it could take at least three to four weeks to eliminate the late feed.  There is no benefit to reducing it too quickly and having your baby waking up earlier. Many babies will take a full feed at 10pm, then wake up and only take a small milk feed at breakfast time - they then demand a big milk feed at 11am and refuse solids at this time. They then proceed to demand a further big feed at 2.30pm.  When this situation occurs it can be very tempting to just cut out the 10pm feed altogether so that the baby wakes up and takes a full feed at 7am.  However, this can lead to the problem of the baby waking up earlier, which in turn throws the whole day out.  If you find your baby still needs a full feed at 10/10.30pm to get through the night, I would suggest that you continue with this, but look at his overall daily milk intake, to see where else in the day you can reduce his milk intake to make the introduction of solids easier - and to get him on to three full milk feeds between 7am and 7pm.

In my experience the simplest way to do this is to accept that, for a couple of weeks, your baby needs more at 10pm, but look to cut down the amount of milk he has at 11am and 2.30pm quite severely.  This will encourage him to eat more solids after the 11am milk feed, and be more ready for solids in the evening.  Once he starts to take a reasonable amount of solids at this time, you can then start to decrease the amount of milk he is taking at 10pm using the method already described above.  As this feed decreases, you should see an increase in the 7am milk feed.  You should continue to decrease the 11am milk feed as suggested in the feeding plan, but once he is only taking a very small amount at this time, you would need to increase the 2/2.30pm milk feed, so that he is starting to take most of his daily intake between the 7am, 2/2.30pm and the 6.30pm feed.

While doing it this way may take longer to eliminate the 10/10.30pm feed, it will ensure that you do not end up with your baby waking at 5am and genuinely needing to feed. Once he is increasing the amount of solids he is taking during the day, and taking near enough the amounts of milk at the recommended times in the feeding plan, you can then gradually start to reduce the amount of milk he is taking at 10pm using the method already described, without worrying about the risk of him waking earlier.

A plan on how to introduce solids during the first week of weaning

The following plan gives an example of how to introduce solids during the first week of weaning at six months. Please remember, this is only an example; all babies are different, so be guided by your baby’s needs:

• If you are weaning at six months, your baby will probably still be on four to five milk feeds a day. Because you will be establishing solids much quicker, you would need to cut back very rapidly on the milk feed at 11am to ensure that your baby is interested in solids.  Once solids are introduced at 11am and in the evening, he should start to cut down and eventually cut out his late feed.  If he does not cut down on this feed, he could become very resistant to the introduction of solids. 
• Although all babies’ appetites are different, how quickly your baby increases his solids will depend on his age when you first introduced solids.  Babies weaned early will increase their solids at a slower pace than babies who started weaning at six months.  However, between six and seven months most babies will have reached a stage where they are taking between 6-8 cubes of vegetables and protein at lunch time, and 6-8 teaspoonfuls of baby rice mixed with two cubes of vegetable or fruit puree in the evening.
• Most will also be taking a small amount of cereal and fruit at breakfast time. Very small babies may be taking less than this and very large babies may need slightly more. Be guided by your baby.
• If you are weaning your baby before six months, the most important thing to remember during this first month of weaning is that any solid food you give your baby should be in addition to the milk, not as a replacement for it.  A baby who is taking a lot more than the quantities I have recommended and cuts right back on his milk, will be losing the valuable nutrients that he gets from his milk. Remember, solids at this stage are really first tastes and fillers, not meals.
• Until your baby is weaned, he will need between four to five full feeds a day, which could mean anything between 600ml and 900ml a day. Once solids are introduced he will still need a minimum of 600ml a day.
• When solids are introduced at six months, you should go straight into the tier method of feeding, giving him half the milk feed first, then some solids, followed by more milk.  This will encourage your baby to cut back slightly on his milk feed and increase his solids, preparing him for a feeding pattern of three meals a day between six and seven months.
• Once solids are established in the evening, your baby should automatically cut back on the 10pm feed if he is still having one. If he is not, I would suggest that you increase his solids and gradually decrease this feed using the method described in the CLB Book of Weaning.    
• For breast-fed babies, a feed from one breast can be classed as half a milk feed.

Introducing solids at 11am

Follow the suggested times for feeds, but instead of giving all of the milk first at the 11am feed, it is important that you only give half of the milk, so that your baby is hungry enough to accept the solids. Continue to reduce the time he is on the breast before he has his solids by 2 to 3 minutes every couple of days.  If your baby is formula-fed, then reduce his feed by an ounce every couple of days.  Within seven to ten days you should have reached a stage where he is taking a very short breast feed, or around 90ml (3oz) of formula, before his solids. You should still offer him a short breast-feed or a couple of ounces of milk after his solids.  However, if he is looking for more milk, this is an indication that you need to increase the amount of solids you are giving him more rapidly.

Continue to decrease the milk he is taking at the 11am feed, until he is happy to start with his solids at lunchtime. Once he is taking between 4-6 cubes, he should have cut the amount of milk he is taking after the solids until he is only taking a few minutes on the breast or a couple of ounces of formula.  Once he reaches this stage, you should then start to introduce small amounts of protein at lunchtime.  Begin by replacing two of the vegetable cubes with two cubes of one of the simpler protein meals, such as chicken or lentil casserole. Continue to replace a cube of vegetables each day with a cube of the protein meal, until his lunch consists of a complete meal from one of the protein recipes. Once you reach this stage any top-up milk should be replaced with a drink of well-diluted juice or cool boiled water from a beaker.

Introducing solids in the evening

Within a couple of days of introducing baby rice at 11am, you should progress to introducing solids in the evening as well.  For the first week I would advise that you give him the solids after he has taken most of his 6.15pm feed.  This will encourage him to cut back on his 10pm feed, which will have the knock-on effect of him being hungrier for his first milk feed of the day. You should increase the amounts you give him, but do so on alternate days to the days on which you are increasing the lunchtime solids.  Remember that the baby rice is far more filling than fruit, so increase that more rapidly than the fruit.  Once your baby is taking nearer the quantities that I have mentioned in the feeding plan below, you should automatically see a decrease in his 10pm feed.  If he does not cut back of his own accord, I would suggest that you reduce his 10pm feed gradually by half an ounce every couple of nights providing, of course, that he continues to sleep through to 6/7am.

Introducing Protein

If your baby was introduced to solids before six months, by the time he reaches six months he should have tasted a wide variety of vegetables and fruit, and be used to digesting reasonable amounts of carbohydrate in the form of potato and baby rice. He   will be ready for the introduction of protein, between six and seven months.

When your baby reaches six months you can introduce chicken, fish, meat, pulses and dairy products.  I would advise that you introduce these foods slowly during the early stages, introducing a new food every three days to ensure that your baby does not have a bad response to a particular food.  Start by replacing two of his vegetable cubes with two cubes of the more simple chicken, fish, meat or pulse recipes.  Increase the amount by one or two cubes a day until your baby’s meal consists totally of one of the protein recipes.

It is very easy to get into the habit of serving the same favourite foods to your baby, but this could lead to him becoming very fussy about the foods he eats. I therefore advise that, once your baby is established on the different protein meals, you should try to ensure that your baby receives a variety of different foods and meals each week.

Once a protein is established at lunchtime, the rice and fruit in the evening can gradually be replaced with other savoury foods.