Starting solids! This is a huge milestone and often one that seems to have a lot of controversy surrounding it. Purees or finger foods? Rice cereal or meat? 4 months or 6 months? Allergens now or later? The list goes on and on. I work a lot with families to help them get off to a good start, working to ensure a life-long healthy, happy eater. Over the past decade or so, Baby Led Weaning (BLW) has become a major trend. What is it? Why are so many so passionate about it? What does the research say? And how do you know if it’s right for you?
What is BLW?
Baby Led Weaning is an approach to starting solids that aims to put the child in the driver’s seat. Parents allow the infant to self-feed, typically avoiding all purees and spoon-feeding in favor of the little one exploring foods on her own. In the truest form of BLW, the baby joins most family meals and family food is offered. Food is provided in large chunks or pieces that are easy for baby to grasp. Baby then chooses how much to eat, with the emphasis really being on the eating experience, and less about actual nutrition, at least at first when baby’s ability to self-feed is clumsy and mostly exploratory.
Why? What are the Benefits of BLW?
BLW appears to offer a myriad of potential benefits. Because this approach to solids relies on baby self-feeding, it naturally results in babies being offered solids closer to 6 months, as is the recommendation from multiple health organizations, including the World Health Organization (WHO). This is significant in that studies consistently show parents starting solids earlier than recommended. With purees and spoon-feeding by the parent, it’s much easier to start early, whereas BLW necessitates that baby be sitting fairly independently, have an inherent interest in food, and be able to grab the foods and bring them to his mouth without assistance. All of these factors, by the way, are recommended for starting solids, period, but often ignored in the excitement of watching baby try his first food! Additionally, BLW tends to support more family meals and improved eating patterns.
Because babe is in charge of what and how much is eaten with BLW, self-regulation is improved. Baby honors her own hunger and satiety cues, instead of eating because a parent believes he should finish a certain amount of puree, etc. Offering infants separate foods from the rest of the family may also establish an idea of “kid food” and “adult food”, promoting pickiness or reduced interest in trying new foods later. BLW appears to offer a wider range of food, as children tend to be given some of whatever the rest of the family is enjoying. This approach also allows parents to be more relaxed at meals, as they aren’t dividing their time between feeding themselves and feeding the baby, but just able to enjoy a family meal together.
The over-arching advantage of the BLW approach, in my mind, is its focus on child-led behaviors. As we’ll discuss below, I believe this can be accomplished in ANY approach to eating, and work hard to ensure the families I work with focus on allowing the child to lead, honoring his own hunger and satiety, whether that be with bottle-feeding or solids, at age 8 months or 8 years.
Research
The research shows that self-regulation is an important skills to be cultivated and the earlier and more consistently it can be supported, the better long-term outcomes. Parent-led, or non-responsive, feeding approaches like typical spoon/puree feeding, may lead to overriding a child’s internal hunger and satiety cues, resulting in the child being unable to accurately respond to her own huger signals. BLW mothers were found to have a less restrictive feeding style, use less pressure to get baby to eat, and have a decreased sense of concern around their children’s weight. BLW infants were also found in some studies to have healthier dietary intakes and body composition, with successful self-feeders having higher nutrient intake at 9-11 months than those infants not self-feeding. Additionally, BLW introduces more complex textures and typically flavors much earlier than a puree-based solids approach. Research suggests that the introduction of lumpier textures prior to 9 months is more likely to be accepted, with more feeding difficulties reported in children who had such textures introduced after 9 months.
BLW was consistently associated with later introduction of solids, higher milk feeds (which is where nutrition should really be coming from until about a year of age), increased participation in family meals, and fewer maternal concerns about weaning. This later introduction of solids (i.e. at 6 months) is significant, as early introduction of solids has been associated with an increased risk of allergies, developmental and nutritional complications, and chronic diseases. And yet, 1/3 of infants in a national study were found to have had solids prior to 4 months of age. The higher number of continued milk feeds (BLW mothers also tended to have higher rates of breastfeeding) is also protective. Longer breast-feeding is protective for multiple autoimmune diseases, like Type 1 Diabetes, Inflammatory Bowel Disease, and Multiple Sclerosis. Additionally, the infant gut is quite immature at birth, slowly maturing over the next year. At 4 months, some children’s digestive tracts may be matured sufficiently to handle the introduction of solids, but nearly all are by 6 months. In other words, why rush it? There are really no benefits suggested from the early introduction of solids, but are many associated with exclusive breastfeeding to 6 months, and then introducing solids.
Concerns
The major concerns noted by pediatricians and other health professionals were an increased concern for choking, iron deficiency, and inadequate oral intake. The research, although limited, doesn’t support these concerns. BLW infants appear to grow adequately over the course of the first year and beyond, often establishing a healthier weight/growth curve than their non-BLW peers. Iron levels were also sufficient, when BLW infants were offered iron-rich foods. The concern from pediatricians comes from the recent and heavy reliance on iron-fortified rice cereals as the typical first food for babies. Because of its consistency, BLW typically doesn’t include this new infant “staple”. However, there are plenty of iron-rich foods that DO work well in a BLW diet (or a spoon-fed one!), including egg yolks, liver, and meat. Finally, with regards to choking, studies found that although BLW parents did report more incidents of choking, this may 1) be because they were uncertain about the difference between choking and gagging (gagging being a very normal and healthy response to protect baby’s airway), and 2) appeared to correlate with a child being offered a non-BLW-friendly food (i.e. raw apple). In other words, when the correct foods are offered and parents understand what gagging looks like and that it isn’t harmful or dangerous, BLW appears to be quite safe. In all reported instances of choking with BLW, the parents also reported no intervention was necessary, with the child clearing their airway successfully on their own.
How?
So how do you begin BLW? Strict BLW relies on baby having the skills to bring food from the table to their mouth, which keeping themselves in an upright position to avoid increased risk of aspiration and choking. Parents provide graspable whole foods, soft in texture, like a strip of well-cooked meat, hard-bolied egg yolk, a slice of avocado with a small piece of skin left on for baby to grasp, soft-cooked broccoli florets, etc., while avoiding potential choking hazards like raw apple, raw pear, raw carrots, nuts, etc. Include your child in family meals, offering them appropriate selections of the family foods. Although not strictly BLW, you can also consider pre-loading spoons for baby to then self-feed if desired (like liver pate or guacamole).
Summary and Final Thoughts
Baby Led Weaning has a lot of merits. My biggest concern is the often divisive and rigorous way in which it is employed. There are numerous social media groups that would have my head for even suggesting that a parent pre-load a spoon for a child and insist that anything even resembling a puree must be staunchly avoided. This severe approach to feeding is something I try to avoid. Eating and learning to eat should be a joyous experience for everyone involved. If you’re fretting over whether the item you’re about to offer your baby is BLW-appropriate or swatting away their hand or mouth when they reach out to share something off your spoon for fear of your little one being literally fed by you (gasp!), then it’s time to re-evaluate your approach!
The major benefits of BLW, in my professional and personal opinion, are less to do with what’s offered and how, but the attitude that surrounds it, aka a responsive approach! Spoon-feeding, parent-led weaning CAN be responsive and respectful of the child. More importantly, it SHOULD be! Learning your child’s yes/no cues is essential to building a healthy, happy relationship with food. If you’re finding yourself making airplanes to get your little one to take another bite, turning on the TV or letting them play with your phone so they’ll finish the meal, or distracting them so they’ll drink another ounce from the bottle, I encourage you, emphatically, to stop and start respecting your child’s cues*. A baby that turns away from the bottle or fusses when it’s offered again is saying “no!”. A child that pushes his plate away or turns his head when the spoon is offered is saying “stop, no more!”. Honor your child! Allow them to 1) listen to their own inherent hunger and satiety cues, and 2) know they are heard and respected! And a child who eagerly opens their mouth and leans toward the spoon full of applesauce is giving a clear and decisive “yes!”. In other words, respecting your child’s cues doesn’t have to mean not being involved in feeding them at all.
The key of any approach to solids is to listen to your child. I had every intention of doing BLW with my first. He had other ideas. He was eager, ready, and willing to eat solids, but wanted absolutely NOTHING to do with self-feeding. I don’t know if he didn’t like the food on his hands or just preferred the connection of us assisting him, but for months, he would bring anything and everything to his mouth EXCEPT food. That, he determined, was for mom to do. Then, at about 9 months, he suddenly wanted NOTHING to do with use feeding him. If we so much as looked at his food or his utensils, he would scream and pout. We took his lead, respecting when he turned his head away or motioned for a different food when we were helping him eat, and allowing him to explore and exert his own preferences when he decided he no longer wanted our assistance. Our middle child developed a severe feeding aversion, resulting eventually in a g-tube, and then finally being weaned off of it to solids when she was 21 months old. She wanted us nowhere near her or her food, so purees, although more appropriate for her lack of skills and experience, were out and BLW it was. Listen to your child. Respect their cues regardless of the approach. Don’t be afraid to offer them a taste from your spoon. But, equally, don’t be afraid to let them gnaw on that piece of salmon all on their own. ANY method can be child-led.
Finally, the variety offered to your child is up to you. YOU decide the what, when, and where; your child decides how much and if to eat what’s offered at all, regardless of your approach to solids. Infant cereal never needs to be offered (I could write an entire other article about this!), but iron-rich foods should be. And any food that’s appropriate for BLW can also be offered as a mash or puree. The positive outcomes seen with BLW are likely to have more to do with the PARENT and how they approach feeding than the method itself! Please be aware that for highly allergenic foods (wheat, fish, seafood, nuts, peanuts, soy, dairy, and eggs), I do recommend introducing it separately from other foods or only in combination with foods you’ve already tried. The likelihood of a reaction isn’t higher in a combined setting, but the ability to determine which ingredient caused the reaction is greatly diminished. Unless you have a history of food allergies, I recommend all of the top 8 allergens listed above be introduced by a year of age; if there’s a history of a food allergy, please consult with your pediatrician or allergist to determine the best timing of these foods.
Have fun. Don’t rush. Your little one will eat solids for the rest of their life, so enjoy the journey and help them establish a healthy, happy, life-long approach to eating.
Aubrey Phelps MS RDN IFNCP PPCES
*if your child has feeding difficulties and this is the only way you can get them to eat enough to grow, please, please, please, reach out for help and support. It doesn’t and shouldn’t be this way.
Aubrey is a registered functional nutritionist working with Nurtured Foundation, specializing in perinatal and pediatric nutrition. Her goal is to support women in every stage of their journey, from optimizing their cycles and conception, to a healthy pregnancy, baby, and beyond. Aubrey is a mother of 3 – a sweet boy, feisty girl, and joyful rainbow baby girl. She works to discover the root causes of imbalance and empower her clients with the skills and knowledge necessary to take charge of their health and find wellness. Motherhood is hard enough; feeding yourself and your littles doesn’t have to be. Let Aubrey be a part of your village and help you along the way.
References
1) Rowan H & Harris C. Baby-led weaning and the family diet. A pilot study. Appetite. 2012; 58: 1046-1049
2) Cameron SL, Heath ALM, & Taylor RW. How Feasible is Baby-Led Weaning as an Approach to Infant Feeding? A Review of the Evidence. Nutrients. 2012; 4: 1575-1609
3) Kramer, M.S. & Kakuma, R. (2001).The optimal duration of exclusive breastfeeding: A systematic review. http://www.who.int/nutrition/publications/infantfeeding/
WHO_NHD_01.08/en/index.html
4) Wright CM, Cameron K, Tsiaka M, et al. Is baby-led weaning feasible? When do babies first reach out for and eat finger foods?. Mat Child Nutr. 2011; 7: 27-33
5) Brown A & Lee M. A descriptive study investigating the use and nature of baby-led weaning in a UK sample of mothers. Mat Child Nutr. 2011; 7: 34-47
6) Cameron SL, Taylor RW, & Heath ALM. Development and pilot testing of Baby-Led Introduction to SolidS – a version of Baby-Led Weaning modified to address concerns about iron deficiency, growth faltering and choking. BMC Pediatrics. 2015; 15: 99
7) Kuo AA, Inkelas M, Slusser WM, et al. Introduction of Solid Food to Young Infants. Matr Child Health J. 2011; 15: 1185-1194
8) Parigi SM, Eldh M, Larssen P, et al. Breastmilk and solid food shaping intestinal immunity. Front Immunol. 2015 Aug; 19: doi: https://doi.org/10.3389/fimmu.2015.00415
9) Naylor AJ & Morrow AL. Developmental Readiness of Normal Full Term Infants to Progress from Exclusive Breastfeeding to the Introduction of Complementary Foods. 2001 April: https://pdf.usaid.gov/pdf_docs/Pnacs461.pdf
10) Sevenhuysen GP, Holodinsky C, & Dawes, C. Developmental of salivary a-amylase in infants from birth to 5 months. Am J Clin Nutr. 1984; 39(4): 584-588
11) Krebs NF. Meat as an Early Complementary Food for Infants: Implications for Macro- and Micronutrient Intakes. Nestle Nutr Workshop Ser Pediatr Program. 2007; 60: 221-233
