Expert: Sally Wendkos Olds - 4/1/2011

Question
Sally:

I am a first time mother of a 4 month old girl.  We are really enjoying breast feeding and I plan on continuing until she weans herself or until we get to 1 year.  She is 15 lbs and 26+ inches and a very active baby (rolling, interacts well with toys, lots of tummy time).  She did have bad reflux as a newborn.  I am currently continuing a dairy free diet which has cleared up all the reflux.  Now she is battling eczema.
My question is about scheduling.  I am not working and my schedule is not issue.  She currently eats every 1.5-2.5 hours during the day and then sleeps anywhere from 8-10 hours at night without feeding.  She enjoys nursing to sleep.  However, I was wondering the benefits to scheduling feeding every 4 hours during the day?  Beside having longer breaks between breastfeeding time to take pressure off of me being there all the time, do you recommend that I slowly space out her feeding times?
My second question is about starting solid foods.  I am now reading information that makes me hesitate to start rice cereals at 4 months.  We have been given the okay by the nurse practitioner secondary to strong head control, good supported sitting and lack tongue thrust.  I am now reading things about system especially the pancreas not mature enough, increase chance of food allergy because of the immature small intestine, decrease health benefits with less antibodies, increase chance of obesity, etc.  Therefore, is there a down side to waiting to start solid foods.  Since she has had the reflux with my dairy intake and now eczema does she have an increase chance of having a food allergy herself?  If yes, then would you recommend waiting to start solid foods to avoid these food allergies?

Answer
Dear Abi,

First, congratulations for giving your daughter the best start in life by breastfeeding her! It sounds as if she is thriving, over all.

At her age and good progress in development, there's no harm in spacing out her feedings during the day. You can do this by doing other things that she likes at a time when she might ordinarily nurse -- such as giving her a bath, taking her for a walk, and the like. You may find that by doing this she'll go longer between feedings. You say she likes to fall asleep nursing, but I'll raise one caution here. Babies who love to nurse themselves to sleep sometimes have trouble later on falling asleep without nursing. This can be a problem if you want to, or need to, be away at bedtime. She is still young enough to learn to quiet herself, so you may want to take her off the breast before she falls asleep.

I'm sorry to hear about her problems with eczema. One of my children had it as a baby and toddler -- and fortunately outgrew it. Eczema may or may not be a sign of food allergies, but since your baby is not, as I understand it, getting anything but breast milk right now, food allergy is probably not the culprit. You should consult your baby's doctor to assess the severity of the eczema and suggest treatment. As far as the risk of food allergy from starting solid foods too early, there are many conflicting studies going on at this time. Some of the more recent research in fact suggests that starting solids earlier actually decreases the risk of food allergies. At this point, though, the jury is still out and I can't give a definitive answer on this.

According to pediatrician Dr. Laura Marks, the consultant on my book (see below), starting solids often helps with the symptoms of reflux. She says that the upside of starting solids at 4 months (if the baby seems ready which your baby seems to be), with the increased ability to practice oral motor skills etc. outweighs the other potential downsides that you bring up.

Good luck!

Sally
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Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Olds & Marks, 4th edition, September 2010, published by Workman Publishing, and available in most public libraries, bookstores & La Leche League chapters.