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.