Association of Early Introduction of Solids With Infant Sleep: A Secondary Analysis of a Randomized Clinical Trial

JAMA Pediatr. 2018 Aug 6;172(8):e180739. doi: 10.1001/jamapediatrics.2018.0739. Epub 2018 Aug 6.


Importance: 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.

Objective: 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.

Interventions: 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.

Results: 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.

Trial registration: Identifier: ISRCTN14254740.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Age Factors
  • Allergens / administration & dosage
  • Breast Feeding* / adverse effects
  • Female
  • Humans
  • Infant
  • Infant Food*
  • Infant Nutritional Physiological Phenomena / physiology
  • Male
  • Sleep / physiology*
  • Sleep Wake Disorders / etiology
  • Sleep Wake Disorders / prevention & control
  • Wakefulness / physiology


  • Allergens

Associated data

  • ISRCTN/ISRCTN14254740