Introducing Solid Foods to Preterm Infants in Developed Countries

Abstract

The addition of solid foods to an infant’s diet is required to provide adequate nutrition, as eventually an infant will be unable to consume a sufficient volume of breast milk to meet their nutritional needs. The timing of this important dietary change for infants born preterm (<37 weeks of gestation) should take into consideration their delayed early gross motor developmental progress, increased nutritional requirements, organ immaturity, increased gut permeability and increased risk of hospitalization from infections. Good head control is important for safe eating of solid foods: this developmental milestone may be delayed in preterm infants up to 3 months of corrected age. One randomized controlled trial has demonstrated improved nutritional intakes with the introduction of nutrient-dense solid foods from 13 weeks of uncorrected age, resulting in improved nutritional iron status and greater rate of growth during infancy. There is neither current evidence for an increased infection rate with an early introduction of solid foods in developed countries, nor is there evidence that in preterm infants maturation of renal function is reduced. However, one observational study has determined that preterm infants who had 4 or more solid foods introduced prior to 17 weeks of corrected age, or who had any solid foods introduced prior to 10 weeks of corrected age, had an increased risk of eczema development. A compromise is needed to balance the nutritional benefits of commencing solid foods from 13 weeks of uncorrected age with the risks of increased eczema development, along with ensuring developmental readiness. Based on the current evidence, 3 months (13 weeks) of corrected age seems to be an appropriate age to commence nutrient-dense solid foods for most preterm infants. Further research, with an emphasis on immediate as well as longer-term consequences, would be valuable to provide more specific evidence-based guidelines regarding the introduction of solid food for preterm infants.

The Timing of Initiating Complementary Feeding in Preterm Infants and Its Effect on Overweight: A Systematic Review

“…Previous reviews of Palmer et al [14] and King suggest that the corrected age of 3 months (i.e., 13 weeks post-term) may be an appropriate age to commence the introduction of solid foods for the most preterm infants [15]. The AAP recommended in 2007 that solid foods should be introduced based on oral-motor readiness, which is usually achieved at a corrected age of 4–6 months [16].…”

“…Furthermore, preterm infants are a vulnerable group who have increased nutritional requirements, are at risk of developing gastro-esophageal reflux, respiratory problems, and have delayed early gross motor development. Therefore, delayed introduction of complementary feeding may result in insufficient nutritional needs [14, 15]. In addition, the introduction of solid foods assists speech development, as well as the acceptance of a variety of foods and structures [14, 15].…”

“…Therefore, delayed introduction of complementary feeding may result in insufficient nutritional needs [14, 15]. In addition, the introduction of solid foods assists speech development, as well as the acceptance of a variety of foods and structures [14, 15]. On the other hand, since some suggest that very early introduction of solids in term infants is associated with rapid weight gain and childhood obesity, it raises the question about the optimal timing of solids in preterm infants and the effect on overweight [2, 3, 14-17].…”

Length and weight of very low birth weight infants in Germany at 2 years of age: does it matter at what age they start complementary food?

“…Palmer and Makrides. 19 recommended that gestational age, current nutritional status and developmental aspects should be considered when advising the introduction of complementary food. They suggested a corrected age of 3 months to introduce complementary food that is protein rich as well as energy-and nutrient-dense.…”

Weaning and complementary feeding in preterm infants: management, timing and health outcome

“…However, there has been limited research regard the optimal age and type of food to be introduced and whether this period of important dietary change influences later health and development. 9 The development of good head control is important for the safe eating of solid food. Preterm infants have been observed to have delayed early gross motor development when compared with infants born at term, even after correction for prematurity.…”