Does early introduction of solid feeding lead to early cessation of breastfeeding?

Abstract

Mixed milk feeding increases the likelihood of breastfeeding cessation, but it is not known if solid feeding (SF) has the same effect. We have identified 10,407 infants breastfed for at least 8–10 weeks from three large U.K. studies (Avon Longitudinal Study of Parents and Children [ALSPAC; born 1990–1991], Southampton Woman's Survey [SWS; 1998–2008], and Infant Feeding Survey 2010 [IFS 2010]) to investigate the associations between early SF and breastfeeding cessation. In the earliest study (ALSPAC), 67% had started SF before the age of 4 months, but in the latest (IFS), only 23% had started before 4 months. Solid food introduction before 4 months was associated with stopping breastfeeding before 6 months in all three cohorts, with little effect of adjustment for maternal sociodemographic characteristics (Poisson regression, adjusted prevalence ratios: ALSPAC 1.55, [95% confidence interval 1.4, 1.8], SWS 1.13 [1.0, 1.3], IFS 1.10 [1.1, 1.3]). Using Cox regression, adjusted hazard ratios for breastfeeding cessation compared with SF after 5 months were 2.07 (1.8, 2.4) for SF before 4 and 1.51 (1.3, 1.8) at 4–5 months for ALSPAC and 1.25 (1.1, 1.5) and 1.15 (1.0, 1.3) for SWS. Earlier introduction of solids was associated with a shorter duration of breastfeeding, particularly in cohorts where earlier introduction of solids was the norm, with a dose–response relationship, which was not explained by background social characteristics. As mothers most commonly introduced solids in the month prior to the then recommended age, continuing to recommend deferring solids to the age of 6 months is important to support sustained breastfeeding.

Global prevalence of WHO infant feeding practices in 57 LMICs in 2010–2018 and time trends since 2000 for 44 LMICs

“…The mid-term review foresight of the United Nations Decade of Action on Nutrition 2016–2025 underlined that counselling on breastfeeding and complementary feeding should be continuously delivered through health systems [31] . Earlier introduction of solid, semi-solid or soft foods may not only lead to exclusive breastfeeding cessation but also a shorter duration of breastfeeding [32] . Although some guidelines recommended introduction of complementary foods between 4 and 5 months for those infants with possible food allergy [ [33] , [34] , [35] , [36] ], there is no evidence to support the benefits of introduction of complementary foods during this period [37] .…”

Breastfeeding rates are high in a prenatal community support program targeting vulnerable women and offering enhanced postnatal lactation support: a prospective cohort study

“…Solid foods were introduced before 6 months by 52% of study participants, as is common in Canada [59,60]. Early introduction of solids has been shown to undermine breastfeeding [61]. We did not collect data on the reason for the timing of solids introduction.…”

High levels of breastmilk feeding despite a low rate of exclusive breastfeeding for 6 months in a cohort of vulnerable women in Toronto, Canada

“…All supplements displace breastmilk and are therefore not recommended during the first 6 months post‐partum, but relative harms vary depending on the nature, timing and context of supplement use. Introduction of solids before 4 months is associated with early cessation of breastfeeding (Lessa et al, 2020 ). Between 4 and 6 months post‐partum, introduction of solids does not confer health benefits, but in hygienic settings where nutrient‐rich complementary foods are available it has not been associated with health risks beyond displacement of breastmilk (Azad et al, 2018 ; Fewtrell et al, 2017 ).…”

“…All supplements displace breastmilk and are therefore not recommended during the first 6 months post-partum, but relative harms vary depending on the nature, timing and context of supplement use. Introduction of solids before 4 months is associated with early cessation of breastfeeding (Lessa et al, 2020).…”