- Denise Scott
Baby-Led Weaning - One Pediatrician’s Perspective
Baby-led weaning (BLW) is a bit of a misnomer, per the author of this feeding method. The term should be baby-led solids since the premise is to allow your infant to lead the way in eating solid foods. Weaning from breastmilk or formula comes later. This method skips the baby foods or purees and goes straight to offering the foods the rest of the family eats. Instead of you feeding your baby, you allow your baby to fully be in charge, which is a change for many of us.
Baby girl eating a banana
I must admit, when I first heard about baby-led weaning, I cringed! My first thought was choking. I felt that the foods promoted were full of choking hazards. Having had a baby who choked frequently brought back frightening memories.
Then…I read the book! My perspective has since changed. I am now more educated in this method. Although I don't agree with it entirely, I differ in several areas I will outline in this article.
My intent is not to sway you one way or another but to give a few more precautions and the pros and cons after thirty years of experience in pediatrics.
First, a bit about the person who started the trend in England, which has become extremely popular in the U.S., since her book came out in 2008. Gill Rapley, the primary author behind the book, has a Ph.D. and lives in England. She is the mother of three and first began the baby-led weaning method with her third child after feeding her first two more traditionally with pureed foods. The author worked early on as a public health nurse and later briefly as a midwife and breastfeeding counselor. She began suggesting to parents at her home visits to delay feeding solids until six months, rather than four, since she found this was easier. Rapley wrote her Master's degree on whether babies spontaneously move to solids after six months if given the opportunity, rather than being spoon-fed. She completed her Ph.D. in 2015. Her research project compared spoon-feeding with self-feeding and looked at transitioning to solids at the infant's pace.
Reading her book shows that she understands infant development. What she has written, in many ways, does make a lot of sense. When you think about it, this type of feeding has been done for centuries before baby food became available; it just now has a name attached.
For those of you who have not read Gill Rapley’s book, the primary premises of baby-led weaning include:
Infants are exclusively breast or formula fed until 6 months.
Infants feed themselves once solids are introduced. No spoon feeding by another person, thus no purees.
The infant is offered the same foods the family eats, in a size that they can grasp with their entire hand. (The pincer grasp, in which small objects are picked up with the thumb and forefinger, develops around 9-10 months.) Food pieces will become smaller over time, in line with developmental skills.
The family eats together at mealtimes - no more feeding your baby separately.
An infant will not actually eat much for the first 1-3 months of feeding solids; their milk feedings provide most of their nutrition for the first year.
Baby boy eating with baby-led method
Baby fed by more traditional spoon-feeding method
Traditional infant feeding that is advocated by the American Academy of Pediatrics (AAP) is as follows:
0 – 6 months Liquid - breastmilk or formula
6 – 7 months Puréed
7 – 8 months Mashed and “Finger” foods*
8 – 12 months Chopped
12 – 24 months “Family” foods*
*Finger foods can be picked up by the child and eaten with their hands. Family foods are in the same form as the rest of the family.
BLW simply skips the pureed and mashed stages and goes straight to family foods but in a form that can be grasped by the baby. BLW starts foods at 6 months that would not traditionally be started until closer to a year. This is with the assumption that the baby will not actually eat these foods for the first couple of months.
I will first outline the pros of this method and the parts I like about it. I will then outline the cons and the precautions.
First, her recommendation of waiting until six months to introduce solids is in line with the current AAP recommendations. The AAP, however, recommends starting with infant cereals as first foods, unlike BLW, which advocates starting with table foods, such as soft vegetables, that an infant can grasp.
BLW emphasizes exploring foods through the senses - touch, smell, taste - without concern for actual eating. The focus is to introduce them to numerous flavors, textures, colors, and aromas. After all, an infant of this age is not familiar with food as a way to satisfy hunger. That will come much later. In the meantime, you are letting them learn new skills regarding fine motor and oral skills.
The baby is part of family mealtime at each meal and learns by imitating family members. Your baby learns the importance of family mealtimes as a social gathering.
An emphasis of BLW is that infants should be developmentally ready for solids. This means they can sit upright on their own, in a high chair or lap, have complete head control, and not be fed in a reclined position. They should NEVER be left alone when eating. She does emphasize taking all precautions to avoid choking.
Infants should decide when they are done or to self-regulate, which can avoid overeating. Instead of a parent spooning in one more bite, the baby decides when enough is enough. Feeding is not necessarily associated with hunger since milk feedings are offered when they are hungry. Bear in mind that minimal, if any, eating is involved in the first 1-2 months; it is primarily exploration. The primary source of calories is breastmilk or formula until they eat enough to want less of their milk. If truly hungry, an infant will want milk at this age, not solids. The theoretical advantage is that BLW babies will have better appetite control and not be as prone to overeating and obesity. This has not been proven but is theoretical.
Offering healthy, natural foods is promoted in BLW
6. Healthy, natural foods are encouraged for snacks and meals, and the avoidance of processed foods high in sugar, saturated fats, and salt. In addition, variety is encouraged. In doing so, an infant may develop a preference for healthier foods and may be more likely to try new food items. They may also have greater acceptance of more variety of food textures. BLW does promote a healthy diet, and the author has a good understanding of nutrition. Exposing your baby to as many tastes and textures safely between 6-12 months is a great way to develop healthy eating habits. Some families find that their eating habits improve as they are more aware of healthy items to feed the baby.
7. BLW is promoted as simple and less expensive since the infant will eat the same items as the rest of the family. This is true to some degree however, some foods must be cooked longer for a baby to ensure they are adequately soft and cut into “finger shapes” or thick matchsticks so that a baby can grasp them properly. Small chunks and round items are not as conducive to an infant’s grasp. Preparation is required, and certain foods are inappropriate for this age. An infant may not always be able to be offered what the family is eating. More about this is in the Cons section.
Iron deficiency. With the BLW method, an infant won’t eat a substantial volume of food until possibly 8-9 months. This means that a parent shouldn't worry about intake and will continue to breastfeed or bottle feed the same amount for longer than traditional feeding. Since you are skipping specific iron sources, such as baby cereals, there is potential for developing low iron, and a supplement may be needed.
Choking hazards. This has always been my primary concern; I advocate that all parents take an infant/child CPR course to know what to do for an obstructed airway. BLW emphasizes that an infant be developmentally ready and be fed while sitting fully upright to best avoid choking. Gagging can occur from anything in an baby’s mouth; most often, an infant will do fine and not progress to choking. The argument is made that an infant is more likely to choke on something placed in their mouth with a spoon than if the baby puts items in their own mouth. This is due to it being placed too far back in the mouth or by their slurping it. Most six-month-olds don’t yet have teeth, so will gum foods or move them around with the tongue. They tend to place food toward the front of their mouths and spit them out initially. The idea is to give them a “stick” of food they can hold their hand around that sticks out at both ends, so they can first gnaw on it while holding onto it.
Slowing of an infant’s growth due to lack of consuming solids. This is a legitimate concern but thus far not proven. Babies weight gain normally begins to slow after six months. BLW recommends that on-demand milk feedings be maintained until the infant gives you a clue that they don’t want as much milk. This occurs once they begin taking a substantial amount of solids. This may not happen until close to a year. The AAP does differ in this approach as their recommendation is to give food first, then milk, to gradually decrease the volume of milk taken.
Messiness! BLW is considerably messy, but no infants who feed themselves should be expected to be neat. Realize that most of the food given will not be eaten and will end up on the floor in the first couple of months. Again, with BLW, it is all about experimentation. Neater eating will evolve with time. If you can’t stand messes, this may not be for you. It may be easier to feed your baby in their diaper for a while and then bathe after. Taking a relaxed attitude and being prepared in advance for messiness will help.
Longer mealtimes. This is not a bad thing but something to get used to. An infant should not be rushed and be allowed the time to explore food. They should be allowed to take their time to eat once they actually consume the food. Gnawing food, especially before teeth, Can. Take. A. Very. Long. Time. Again, plan ahead to avoid family mealtime occurring right before rushing off to activities.
Food waste. Realize that in the first 1-2 months, most of the food offered will not be consumed but wasted. This initially will be fairly minimal since this is the period of experimentation and important developmentally. Understand that those finger sticks you prepare will likely end in the trash.
Due to messiness, it may be easier to feed your baby unclothed!
Potential allergenic foods (see post on Food Allergies, 10/19/22 ). The recommendations differ between BLW and the AAP on some of the common allergenic foods. Nuts can be introduced as nut butter as early as six months. Eggs should probably not be one of the first foods until several non-allergenic foods have been given. Shellfish should be delayed until a year. The book describes giving eggs, seafood, and milk earlier than what is typically advocated. Also, nuts (either whole or pieces) should be delayed until age four. These are recommended somewhat earlier in BLW. Introducing an allergenic food with too many others may make it difficult to tell which food an infant is reacting to. The recommendation now is to offer those foods in small amounts alone (or with an already known tolerated food) for several days in a row.
Unless they are on an iron-fortified formula, they potentially could develop iron deficiency since they are skipping iron-fortified cereals as their first foods. Giving iron-rich foods and/or an iron supplement may be needed, especially in those that follow a vegetarian or vegan diet. There could potentially be risk for deficiencies in other micronutrients as well depending on the type of diet followed.
Supposedly, choking events are not increased in BLW infants as opposed to traditional feeding methods, but it still makes me nervous. At the very least, anticipate a lot of gagging and possibly coughing. There is a definite difference between gagging and choking. As long as your baby can make noise or elicit a cough, they are not choking and will likely resolve any issues themselves, but BE PREPARED. I always tell parents that since babies don’t chew well, consider EVERYTHING a choking hazard. I differ over some of the foods promoted early in feeding. My recommendation is that the foods offered should be able to be easily mashed between your two fingers as a sign that they can be gummed.
The foods promoted are not all appropriate for six months, despite their not actually eating them. This is my impression. Specific examples include chunks of meat, chicken legs, fruit with skin, grape halves (these should be quartered), and nuts. (Rapley does recommend that nuts be chopped or ground). Also, very chewy items such as raisins and dried fruits should be held off until a year.
Baby eating fruit with peel left on
I would love to see more research on differences in the outcome between children fed by these different methods, such as later healthy food choices, less pickiness, and obesity development. The BLISS Study (Baby-Led Introduction to Solids) in New Zealand, a randomized, controlled, 2-year study, looked at multiple parameters comparing baby-led feeding with more traditional spoon-feeding methods. At the end of the study, they did not find a significant difference in the weights or BMI of children at 24 months between the two groups, but parents did report less “food fussiness” in the baby-led group.
Understanding the factors that promote healthy nutrition in children and that influence later food choices and disease processes need to be studied before fully advocating this as the best feeding method. In the meantime, it is an option as a way to feed your baby. At this point, we don’t know if there are actual differences or later benefits with BLW.
Finally, be prepared!
for your infant not eating much for the first couple of months,
for constant supervision while eating,
and most importantly, what to do for a choking infant, which hopefully you will never encounter!