Advancing New Foods Influences Baby’s Sleep

The World Health Organization (WHO) considers breast milk to be the ideal food for the baby during the first six months. After that, exclusive breastfeeding (maternal or artificial) is not enough, but it remains the main source of nutrition throughout the first year of life. Pediatricians are guided by these basic principles to address infant feeding and advise parents, who often bombard health professionals with questions about when to start introducing complementary feeding, which products should be given to the baby earlier and which later, the convenience of bringing forward or delaying the consumption of potentially allergenic nutrients such as eggs or certain nuts…

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Scientific studies on the subject often help to discern what is important and to dispel false myths, but not always. From time to time, one emerges that, instead of clarifying concepts, could further entangle things. This is the case with a clinical trial published last week in JAMA Pediatrics, whose authors, led by Professor Gideon Lack of King’s College London, found that babies who started complementary feeding before the age of six months slept better and woke up less frequently during the night.

The researchers comment in the introduction to their work that, despite WHO recommendations, 75 per cent of British parents introduce complementary feeding before five months and 26 per cent of them say that the baby’s sleep influences the decision.

The new work changes previous thinking, but is not enough to change the recommendations

In fact, the main purpose of the study, called EAT (Enquirig About Tolerance), was not to investigate how eating affects the way babies sleep, but to find out if introducing complementary feeding earlier could reduce allergies.

And to do so, they brought forward the supply of new nutrients to infants to three months. The findings, published in The New England Journal of Medicine (NEJM) in 2016, pointed to the achievement of the proposed goal, but the study faced a fundamental problem: Three- and even four-month-old infants are generally unprepared for foods other than milk and reject them. In fact, many mothers were unable to get their children – who were clinging to their breast milk – to try new foods.


16 minutes a day

The recently published article represents a sub-study of TAS, taking advantage of the extensive questionnaire that had to be completed by the mothers of the 1,300 babies that could be counted, who were randomly divided into two groups: those in the first group continued to be exclusively breastfed until they were six months old, while those in the second group started receiving other nutrients from three months of age.

The researchers found that infants in the second group slept more and woke up less often than those in the first group. The differences peaked at about six months, when those in the early introduction of complementary feeding group slept, on average, 16 minutes more per night than those in exclusive breastfeeding and their frequency of waking up decreased from two to 1.74 times. These differences, in turn, translated into improved quality of maternal life.

The first thing that is striking about these results is that, as the authors themselves acknowledge, the differences between the two groups are small. This is the understanding of José Manuel Moreno, coordinator of the Nutrition Committee of the Association of Pediatrics (AEP), who believes that this is “an interesting study carried out in accordance with scientific methodology”.

Most infants of a few months old refuse to ingest products other than milk

The expert warns, however, that sleep cannot be considered in isolation, but as part of a whole. “It is a single health variable and in the short term,” he says. We should find out what “this difference of 16 minutes – which is two hours a week – means in the long term”. Therefore, Moreno believes that this study, by itself, does not provide sufficient arguments to alter the recommendation to start complementary feeding around 6 months. Nevertheless, the pediatrician believes that the message can be drawn that there is a margin for “flexibilizing” the start of the nutrition that accompanies milk until the year.

A physiological issue

On the other hand, Teresa Cenarro, specialist in Nutrition of the Association of Primary Care Paediatrics (AEPap) and president of the Aragonese Association of Primary Care Paediatrics, is much more emphatic in her criticism of the study: “its results are not conclusive; further research is needed”. In addition to reiterating that the improvement in time and quality of sleep is very small, she believes that “what the study does not say is how many breast-milk feedings are lost by starting complementary feeding so early”.

On the other hand, he stresses that “in the first months of life there are, for physiological reasons, many nocturnal awakenings. There is nothing pathological about this.

With regard to the quality of life of the parents, she asks: “What is more important, the well-being of the parents for a few months or the future health of their child?

Recommendations on complementary feeding from paediatric associations

  • Up to 6 months, the baby only needs to drink breast milk (preferably) or infant formula.
  • New foods are introduced gradually. One at a time and in small amounts. They can be from the normal family food.
  • The new foods complement the breast milk (or infant formula).
  • It is good to encourage the baby to learn skills. Feed her with a spoon and cup. Let her handle the food. Encourage chewing.
  • When your baby indicates that he is full, do not insist that he take more.
  • Between 6 and 12 months, you can introduce almost all foods. Whole milk, honey and nuts are some of the exceptions.
  • There does not seem to be any scientific reason for a particular order in which the different foods are introduced

The sleep pattern considered normal is not reached until the age of 5-6

The Association of Primary Care Paediatrics (AEPap) reports in a document the main characteristics of infant sleep. Firstly, the experts clarify that children end up acquiring “the pattern of sleep considered normal in a natural and spontaneous way (such as wandering or sphincter control) but, as in other aspects of child development, there is great variability”.

Babies sleep most of the day, up to a total of 16-18 hours, but often wake up to eat, as their growth is very rapid in this first phase.

At around 2.5 months, they spend some time awake and not eating, and from the second half of their lives, the sleep phases of adulthood begin to appear, although “each baby will evolve in a particular way”. In any case, waking up is still frequent. The adult sleep pattern is acquired around the age of 5-6 years.

According to data collected by the AEPap, “3 out of 10 children may have some difficulty in acquiring a regular sleep pattern”. In many cases “this may be unrealistic expectations on the part of the family”, while in others “it is related to the child’s temperament or inadequate sleep routines”.