Summary: According to researchers, babies introduced to solid foods at 6 months of age slept longer, woke less frequently and experienced fewer sleep problems than babies who were exclusively breast fed at the same age.
Source: King’s College London.
A study by King’s College London and St George’s University of London has found that babies introduced to solid foods early, slept longer, woke less frequently at night and suffered fewer serious sleep problems, than those exclusively breastfed for around the first six months of life. The research is published today in JAMA Pediatrics.
Current government advice is that mothers should try to exclusively breastfeed until around six months of age. However, 75% of British mothers introduce solids before five months, with a quarter (26%), citing infant night time waking as influencing their decision.
The current guidance on the NHS choices website state that starting solid foods won’t make babies more likely to sleep through the night. The UK Department of Health and Social Care advises that infants be introduced to solids when they are ready.
The Enquiring About Tolerance (EAT) study, which was funded by the Food Standards Agency and the Medical Research Council, took place at St Thomas’ Hospital, London, between January 2008 and August 2015.
The population based randomised clinical trial involved 1303 exclusively breastfed three-month-olds from England and Wales who were divided into two groups. One group followed standard infant feeding advice and were encouraged to exclusively breastfeed for around six months. The second group, while continuing to breastfeed, were asked to introduce solid foods to their infants’ diet from the age of three months.
Parents completed online questionnaires every month until their baby was 12 months, and then every three months up to three years of age. The questionnaires recorded the frequency of food consumption and included questions about breastfeeding frequency and duration, as well as questions about sleep duration.
Maternal quality of life was also assessed using World Health Organisation measures of physical and psychological health, social relationships and environment.
Of the 1303 infants who took part in the study, 94 per cent (1225), completed the three-year questionnaire – 608 from the exclusive breastfeeding group, and 607 from the early introduction of food group.
The study found that infants in the group which had solids introduced early slept longer and woke less frequently than those infants that followed standard advice to exclusively breastfeed to around six months of age.
Differences between the two groups peaked at six months, with the early introduction group sleeping for a quarter of an hour (16.6 minutes) longer per night (almost 2 hours longer per week), and their night waking frequency decreased from just over twice per night to 1.74.
Feedback about maternal wellbeing showed that sleep problems (as defined by the parents), which were significantly associated with maternal quality of life, were reported less frequently in the group introducing solids before six months.
Speaking about the results lead author 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.’
Co-lead author Dr Michael Perkin, from St George’s, University of London, said: ‘It is a commonly-held belief among mothers that introducing solids early will help babies sleep better, and our study supports this. We found a small but significant increase in sleep duration and less frequent waking at night. Given that infant sleep directly affects parental quality of life, even a small improvement can have important benefits.’
An FSA spokesperson said: ‘The FSA has an important role to play in funding research such as the EAT Study that helped expand our knowledge about how allergies develop. This further analysis of data collected during EAT could be of interest to parents, however, there are limitations to the findings.
‘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.’
Funding: Food Standards Agency, Medical Research Council funded this study.
Source: Garfield Myrie – King’s College London
Publisher: Organized by NeuroscienceNews.com.
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Original Research: Open access research for “Association of Early Introduction of Solids With Infant Sleep: A Secondary Analysis of a Randomized Clinical Trial” by Michael R. Perkin, PhD; Henry T. Bahnson, MPH; Kirsty Logan, PhD; Tom Marrs, MB, BS; Suzana Radulovic, MD; Joanna Craven, MPH; Carsten Flohr, PhD; and Gideon Lack, MB, BCh in JAMA Pediatrics. Published July 9 2018.
Association of Early Introduction of Solids With Infant Sleep: A Secondary Analysis of a Randomized Clinical Trial
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.
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.
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.
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.
isrctn.org Identifier: ISRCTN14254740