“...while there is much promise in relation to the benefits of baby-led weaning to infant eating, growth, development, and health, much remains unknown…” 

 

– Boswell, 2021

Every time I do any teaching about pediatric feeding, I inevitably get the question, “So… what do you think about baby-led weaning?” Seriously, every time! And rightly so—baby-led weaning (BLW) is gaining popularity across social media and mothers’ group circles everywhere.

If you’re not familiar with solids introduction, from about six months of age, infants start to make the transition from being fully milk-fed. They are commonly offered pureed foods via spoon to begin with, and the texture is then slowly upgraded to include lumpy purees and finger foods (Please note: This is common practice in countries like the US and Australia, but may not be the most common form of solids introduction in all sociocultural contexts.) In BLW, parents provide the infant with chunks or strips of finger food and allow the infant to make decisions about what and how much they will eat (subtext = no/few spoons allowed!).

The theory behind BLW is responsive feeding, where the parent provides the food, and the child decides what and how much they will eat, with no pressure from the parent. Responsive feeding models are increasingly being established in the literature as having positive impacts on eating behaviors and dietary intake in children.

As with any change to typical practice, there are the early adopters, who fly the flag and make all sorts of anecdotal claims about the benefits of the new practice, and the laggards, who refuse to adopt the change at any cost. But what does the evidence really say about the benefits and risks of BLW?

MythBusters… weanie-style!

Myth #1  Children who follow BLW don’t get enough to eat (cue concerns regarding growth faltering, iron deficiency, and so on…).

Myth (kind of) busted. In fact, a large and recent RCT from Williams Erickson and her team in New Zealand found that there was no difference in dietary adequacy between BLW* infants and a control group at two years of age. (In fact, both groups consumed excessive sodium and added sugars, so there are other concerns here!) Another RCT from Dogan et al. in 2018 found similar results, and this group also used blood tests to verify their findings.

Conversely, in her recent review of the area, Boswell observed that many studies that examined infant growth in BLW used only parent reports of height and weight, which may have compromised the results. She suggested further research is required in this area before making decisions regarding growth in children who follow BLW.

*This group did a large RCT and are referenced multiple times in this article. They used a ‘modified BLW approach’, which involved education for families regarding food preparation and dietary balance and encouraging families to offer one iron-rich food, one energy-rich food, and one “easy-to-eat” food per meal.

Myth #2  Children who follow BLW are at increased risk of choking.

Myth (somewhat) busted! There are actually a couple of different studies (see Brown and Fangupo and colleagues) that say the same thing about this. Contrary to what your intuition might suggest, children who follow BLW have been found to choke and gag less than children on a traditional puree weaning pathway. The theory is that earlier and more frequent exposure to finger foods encourages more mature oral motor skills. A common extension to this line of thought is that BLW leads to improved speech development, but myth totally busted–we couldn’t find any quality research that supported this claim and remember, early oral motor development is widely held to be task specific.

The caution? Some of this research was based purely on parent recall. The bigger caution? There are still foods that are a no-go for children following either pathway, like whole nuts and seeds, hard dried fruit, pieces of raw carrot, celery or apple, popcorn, whole grapes or cherry tomatoes, and marshmallows. Ix-nay on the arshmallow-may, SLPs!

Myth #3 Children who follow BLW will not be picky eaters.

This is anecdotally reported a lot, and coincidentally is REALLY difficult to measure accurately, as it’s mostly done via parent questionnaire.

Fu and colleagues explored food fussiness in 6–36 month old children who followed a spoon-fed pathway vs. children who underwent BLW. They found that parents who reported using BLW also reported lower food fussiness scores across all ages. These findings were echoed by Komninou et al., who found significantly lower levels of food fussiness and higher levels of food enjoyment in their cohort following BLW. On the other hand, a study from Townsend and Pitchford found no difference in reported picky eating between children who were spoon-fed vs BLW. Myth status unknown! 

Myth #4 Children who follow BLW are less likely to be obese.

The jury is out on this one. While some studies suggest that BLW infants are less fussy, enjoy food more, and are more tuned in to feelings of fullness, there really haven’t been enough long-term studies to demonstrate a long-term impact on weight and health. In her review, Boswell suggested that with the research available to date it’s not possible to determine whether these factors are specific to BLW or just responsive feeding in general. So perhaps watch this space as more long-term studies are published!

Myth #5  BLW results in mess and waste.

Well. This one is true. But so does “traditional weaning.” Learning to eat is a messy endeavor!

A giant caveat for all of the research into BLW to date is that there is no accepted standard definition of BLW, and so comparing the different studies is difficult. Additionally, research to date has found that parents who use BLW tend to have higher levels of education and differ in other personality traits to parents who follow a spoon-fed weaning pathway (Boswell, 2021; Brown, 2016). This suggests that the impacts and outcomes of BLW might not necessarily just be attributable to BLW itself, so further research (as always!) is needed. 

So, what DO you think about baby-led weaning?

Given the evidence to date, I’m OK with it. BUT I work closely with families to make sure foods offered are safe, nutritionally appropriate, and will support oral skill development.

Hot tips from a feeding therapist in the field?

1. Always supervise mealtimes. I cannot stress this enough!
2. Offer stick-shaped foods that are generally hard enough for the baby to grasp, but soft enough for them to manage without choking risk. Think well-cooked vegetables, pieces of fruit, cheese sticks, etc.
3. Offer harder foods for mouthing/chewing experience, and dipping into iron-rich purees such as hummus.
4. Avoid putting too many foods on the baby’s tray at one time.
5. Offer a wide variety of foods and flavors, focusing on iron-rich foods as first foods, and avoiding foods high in salt or sugar.
6. In both types of weaning, provide adequate postural support at mealtimes to allow the child to do their best eating and reduce choking risk.
7. As with all children, monitor growth.

Daniels and her team include a beautiful visual regarding their modified BLW approach in Figure 2 of their open access article, here. Well worth checking out!

A final note, dear readers. BLW does not have to be an all-or-nothing feeding plan! Mush is not the enemy—custard, ice-cream, and tapioca pudding can all be part of a typical diet (and frankly, are delicious!) Many families adopt a hybrid approach, offering both spoon and finger foods from the commencement of weaning. The key thing to remember is to take pressure to eat off the table.

Members can learn more about responsive feeding here and here.