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Baby-Led Weaning

Baby-led weaning (BLW) is a method of introducing complementary foods to an infant’s diet. The premise of BLW is to allow the infant to guide consumption through self-feeding from the very beginning.1 Traditional puréed baby food is not used, instead the infant is offered whole pieces of food and is allowed to consume as much or as little as they desire.1 Despite its name, BLW is not meant to initiate weaning from breastmilk as infants should continue to be offered breastmilk based on the infant's cues.

Anecdotally, BLW has increased in popularity and it is likely that healthcare providers will face more questions from parents about the methods and benefits of BLW. Healthcare providers should be familiar with current research in order to guide families to safely introduce complementary foods to their infants regardless of feeding method chosen. The amount of research available on BLW is currently limited, although it is ongoing. The results of many studies addressing the risks and benefits of BLW are discussed below.

 

Principles of Baby-led Weaning

While there are many different variations of baby-led weaning, they share a few common principles.

  • Infants are encouraged to feed themselves from the beginning of introduction of complementary foods. There is minimal to no spoon-feeding by caregivers, although infants may be given a spoon to feed themselves.2 Instead, infants are provided ‘graspable’ pieces of whole food that allow self-feeding, while engaging in the family meal.3
  • Infants are exclusively breastfed or formula fed until about six months of age when they are showing signs of developmental readiness to self-feed, including sitting independently and being able to rake, scoop or hold food and bring it to their mouth.3
  • A responsive style of eating is encouraged and infants self-regulate the amount and type of foods that they will eat from what is offered by parents and caregivers.3

Potential Advantages of Baby-led Weaning

Anecdotally, mothers felt that BLW is healthier, less stressful, more convenient and resulted in less picky eating.4 There is a limited amount of research regarding the long-term health impacts of BLW. Proponents suggest that BLW will lead to decreased picky eating, a reduced risk of overweight and obesity, and a healthier eating relationship with food.5

Limited research available suggests that infants following BLW may be more responsive to hunger and satiety cues suggesting better appetite control, although sample size was limited and results were based on self-reports.6 Furthermore, at 24 months of age, infants showed greater enjoyment of foods and less fussiness, although these infants were part of a treatment group specifically aimed at promoting safe, healthy eating in BLW infants and results may not be applicable to individuals engaging in BLW without health professional support.7 Infants participating in a BLW treatment group were exposed to more varied and texture foods at an early age, however, by two years of age there were few differences in intake.15  BLW may help infants to better self-regulate their food intake as they are in control of how much and which foods to eat, which may help promote healthier eating habits.

 

In relation to claims regarding overweight and obesity status, the research is limited and conflicting. One study found no statistically significant difference in rates of overweight and obesity between infants following BLW compared to traditional spoon-feeding.7 However, another study found that traditional spoon-fed infants had higher rates of overweight and obesity compared to BLW infants.8 Limitation of both studies include small sample size and reliance on self-reporting. Further research is needed to determine long-term effects on rates of overweight and obesity.

Potential Disadvantages of Baby-led Weaning

There are generally three main concerns of BLW shared by healthcare providers, which include increased risk of choking, suboptimal iron and energy intake and potential for growth faltering.4 These concerns are not usually reported by mothers’ who have engaged in BLW.4

The potential risk of choking is a significant concern and often is the reason healthcare providers with little experience with BLW are hesitant to recommend it to parents/caregivers. Approximately 30% of parents/caregivers in one study reported an episode of choking.4 They also reported that raw apple was the most common food to cause a choking episode and that the infants were able to recover independently.4 Infants following BLW approach that includes advice from healthcare professionals on introducing foods safely do not appear to be at increased risk of choking compared to traditionally spoon-fed infants, however, this may not be applicable to infants following BLW without support and education.9 Infants following a traditional spoon-fed approach actually experienced significantly more choking episodes when offered finger foods compared to infants following BLW, however, overall risk of choking was not significantly different.10 Furthermore, infants participating in a supported BLW approach were less likely to be offered high-choking risk foods compared to infants not receiving education on BLW.2 Further research is needed to confirm risk of choking, however, the most concerning aspect of the current research is the frequency of which all infants, regardless of method to used, are offered high-choking risk foods suggesting that further education is needed to reduce choking risk to all parents and caregivers.291011

Iron-rich foods should be offered as an infant’s first complementary foods to help decrease the risk of iron deficiency.12 There is concern among healthcare providers that infants following BLW may not meet their requirements for iron.4 When compared to traditional spoon-feeding, infants following a BLW approach may receive lower amounts of iron in their diets, however, these results may be influenced by the lack of iron-fortified infant formula in their diets as they are more likely to be breastfed.11 Infants following a BLW approach with support from healthcare professionals are offered high-iron food sources earlier and more frequently compared to infants not receiving education about BLW.2 Further research is needed to determine if adequate iron intakes are feasible with BLW.

Ensuring adequate energy intake, and subsequently healthy growth and development, are primary concerns regarding feasibility of BLW. There does not appear to be any statistically significant differences in energy intake in BLW approaches versus traditional spoon-feeding.26711 However, one study found an increased incidence of underweight in the BLW group.8 Further research is required to determine if BLW leads to an inadequate energy intake and subsequent growth faltering.

How to Support Families Interested in Baby-led Weaning

While there are many potential concerns associated with BLW, many of these can be resolved with proper education of parents/caregivers. Currently many mothers rely on social media and non-evidenced based internet sources for information about BLW as they do not feel their healthcare provider is knowledgeable or supportive of BLW.13 Many healthcare providers are hesitant to support BLW due to the concerns listed above, however, Health Canada’s recommendations for introducing complementary foods includes many components of BLW and can be used as a guide to help parents/caregivers interested in BLW do so in a manner promoting optimal growth and development of their infant.12 It is also important to note that many of the same concerns may be present when using traditional spoon-feeding methods, if current guidelines and recommendations are not followed.

  • Remind parents that exclusive breastfeeding is recommended until six months of age. Complementary foods can be introduced at about six months of age. Breastfeeding should continue until two years of age or longer as desired by the mother and infant.12
  • Encourage that an infant should show signs of readiness prior to introducing complementary foods, which include holding their head up, sitting in a high chair, opening their mouth to accept food, closing their mouth around a spoon and refusing food by turning their head away.12
  • Discuss potential risks of choking with BLW. Parents should be encouraged to avoid foods that pose a choking hazard or prepare them in a way to reduce the risk. Foods that pose a choking risk include nuts, whole grapes, hot dogs, popcorn, hard candies, sticky foods (peanut butter), raw/hard vegetables and fruits, and dried fruits. Round foods, like grapes, cherry/grape tomatoes, blueberries and hot dogs should be cut in half or quartered. Infants should always be seated upright in an appropriate high chair for all meals and snacks.12
  • Discuss foods to avoid. Regardless of the method of introducing complementary foods, honey should be avoided until after one year of age due to risk of botulism. Cow’s milk should not be introduced until nine to 12 months; however, cow’s milk containing foods, like cheese and yogurt can be introduced at about six months of age.12
  • Encourage iron-rich foods as an infant’s first foods, such as meats, fish, eggs, tofu, lentils, beans, iron-fortified infant cereals.12
  • Finger foods should be long enough and in a shape for an infant to grasp. Parents should test the food to ensure it is soft enough for an infant to squash/mash with their tongue. The size of the food will vary depending on the infant’s stage of development. For example, a six month old infant will require larger pieces of food to pick up as their pincer grasp is not yet developed.
  • A combination of spoon and finger food feeding is a nutritionally appropriate and safe way to introduce complementary foods to infants.12
  • Encourage nutrient-dense foods, such as meat and alternatives, milk products, whole grain products and vegetables and fruits.
  • Health Canada encourages responsive feeding based on the child’s hunger and satiety cues.12 Parents/caregivers are responsible for deciding what foods are served, where they are served and when they are served.14 Infants and children decide how much and whether to eat what is provided.14
  • Consider a referral to a Registered Dietitian for further education and support regarding the introduction of complementary foods.

Further research is required to address the potential risks and benefits of BLW, as well as the long-term implications of BLW compared to traditional puréed foods. Regardless of method chosen to introduce complementary foods, healthcare providers should support families to ensure they are introducing foods in a safe manner to promote healthy growth and development. 

 
Date of creation: December 21, 2017
Last modified on: January 17, 2020

References

1Beal JA. (2016). Baby-led Weaning. The American Journal of Maternal/Child Nursing. 41(6):373.
2Cameron SL, Taylor RW, and Heath AM. (2015). Development and pilot testing of Baby-Led Introductions to SolidS – A version of Baby-led Weaning modified to address concerns about iron deficiency, growth faltering and choking. BMC Pediatrics. Retrieved from
https://bmcpediatr.biomedcentral.com/articles/10.1186/s12887-015-0422-8
3Cameron SL, Heath AM and Taylor RW. (2012). How Feasible is Baby-Led Weaning as an Approach to Infant Feeding? A Review of the Evidence. Nutrients. 4(11):1575-1609.
4Cameron SL, Heath AM and Taylor RW. (2012). Healthcare professionals’ and mothers’ knowledge of, attitudes to, and experience with Baby-Led Weaning: a content analysis study. BMJ Open. 2(6).
5Daniels L et al. (2015). Baby-Led Introduction to SolidS (BLISS) study: a raondomised controlled trial of a baby-led approach to complementary feeding. BMC Pediatrics. 15:179.
6Brown A, Jones SW, Rowan H. (2017). Baby-Led Weaning: The Evidence to Date. Current Nutrition Reports. 6(2): 148-156.
7Taylor RW et al. (2017). Effect of a Baby-Led Approach to Complementary Feeding on Infant Growth and Overweight: A Randomized Clinical Trial. JAMA Pediatrics. 171(9): 838-846.
8Townsend E and Pitchford NJ. (2012). Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample. BMJ Open. 2(1).
9Fangupo LJ et al. (2016). A Baby-Led Approach to Eating Solids and Risk of Choking. Pediatrics. 138(4)
10Brown A. (2017). No difference in self-reported frequency of choking between infants introduced to solid foods using a baby-led weaning or traditional spoon-feeding approach. Journal of Human Nutrition and Dietetics. E-publication
11Morison BJ et al. (2016). How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6-8 months. BMJ Open. 6(5).
12Health Canada, Canadian Paediatric Society, Dietitians of Canada and Breastfeeding Committee for Canada. (2015, January 19). Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months. Retrieved from
https://www.canada.ca/en/health-canada/services/food-nutrition/healthy-eating/infant-feeding/nutrition-healthy-term-infants-recommendations-birth-six-months/6-24-months.html
13D’Andrea E et al. (2016) Baby-led Weaning: A Preliminary Investigation. Canadian Journal of Dietetic Practice and Research. 77:72-77.
14Satter E. (2017). Division of Responsibility in Feeding. Retrieved from
https://www.ellynsatterinstitute.org/how-to-feed/the-division-of-responsibility-in-feeding/
15Morison BJ etal. (2018) Impact of a Modified Version of Baby-Led Weaning on Dietary Variety and Food Preferences in Infants. Nutrients. 10(8).