Baby Led Weaning: The Good, the Bad and the Unknown

By Alice Phillips, M.D.,  Cook Children's Pediatrics Cityview

Let’s start with a story. 

As I began the introduction of solid foods to my first child, I was by the book! One food at a time. Slow introduction to make sure it was safe.  That kid was pretty picky but as an adult eats just about everything.

Then came my second.  At 7 months, we were out to dinner with family and enjoying some crab dip.  She was begging for it so…. she ate a bunch.  That kid was never picky but as an adult eats just about everything.

Different paths to the same ending

Flash forward to now, as I took on a challenge to dig into baby led weaning (BLW) I learned a lot.  I also learned that we have a ways to go in understanding this subject completely.

The name Baby Led Weaning (BLW) was coined as far back as 2005 by author Gill Rapley who completed some of the early studies on BLW as part of her master’s thesis.

So, what is weaning?  This is best described as the time that infants transition from breast milk or formula to the consumption of solid foods.  Traditionally, this has been recommended to begin at 6 months of age through the gradual introduction of foods via spoon feeding of purees.  As babies mature developmentally, this then transitions to finger foods and use of a spoon and fork.

Baby led weaning (BLW) differs from this classic model because spoon feeding of purees is skipped. Its basic model includes:

• Feeding of complimentary foods begins at age 6 months as infants attain the developmental ability to sit securely in a highchair, SAFETY POINT!
• The baby sits with the family during mealtime.
• An adult is always with the child while eating, SUPER SAFETY POINT
• Food is offered in pieces of shape and size which are developmentally able to be explored by the infant.  At 6 months, this is strips or fingers of foods with transition to bite sized pieces as cutlery is introduced.
• The infant self feeds from day 1.
• It is up to the baby how much and how quickly she eats.

Parents and health care providers seem to agree on the potential but unproven good parts of BLW:

• Self-feeding promotes fine motor skills
• Shared family mealtimes
• Infants develop good recognition and response to hunger and safety cues
• Prevents picky eating (no data to support)

What are the disadvantages of BLW?

It’s messy and time consuming.  When babies are given the freedom to explore food with their hands….man do they explore.  They will squeeze and squish the food with maybe a little bit ending up in their mouth.  More lands on their face, in their hair, in their ears and on the floor.

Time is not a luxury all moms have.  BLW requires giving the infants time for this exploration and when you’re trying to get the crew fed, dressed and out the door, this can be difficult to manage.

The book at first read sounds great.  However, as a pediatrician, I need to dig in on what science we have to support the safety and health benefits to kids.

The more I read and researched, the more I began to see phrases such as:

• Insufficient evidence
• More research is needed  
• Current studies inadequate to support a general recommendation

Even the reference section for the book itself only lists 10 references for the main content of the book and two of those are the author’s own studies.

The greatest concerns from health care providers surrounding BLW include the risk of choking and potential inadequate calorie/energy intake and inadequate nutrients mostly focusing on iron.

Several studies have attempted to dig in on these topics and the results are a mixed bag.

One impressive study, Baby-Led Introduction to Solids (BLISS), did a randomized control study on this topic.  These fancy words mean infants were randomly divided into two groups.  One group received standard well child information on introduction of foods at 6 months while the other had additional education provided for BLW but with something extra.

BLISS provided caretakers with focused advice on minimizing choking! This included both general advice as well as specific foods to avoid such as raw apple slices, grapes, whole nuts, popcorn, and foods such as sausages, which can be sliced into coins. With this education, there was no measurable difference in choking between the two groups.

BLISS also targeted education of the specific types of foods to offer kids for balanced nutrition.

That is a lot of information.  You're probably asking, “Yeah it sounds like a good idea if done safely, but should I do it?”

Here’s what I think.  Most parents I see in my office who try BLW tend to adopt a healthy mix of both old and new - both purees and table food when they are introducing foods to their infant.

Dr. Diane Arnaout at Cook Children's Forest Park seems to see a similar pattern.  She states, “BLW certainly seems to be growing in popularity thanks to social media and the online sharing of experiences. As a pediatrician, I don’t really mind what feeding method parents choose, as long as it seems appropriate to the infant’s developmental abilities. Parents know their baby best - if BLW seems to not be going well, I encourage them to take a few steps back and trial softer, smoother foods. If they try BLW and it just doesn’t fit for their family, no big deal. Purees are totally fine, too. I sometimes tease that this isn’t the difference between Ivy League and community college - all kids will learn to eat eventually.”

These words seem to mirror my story from the beginning.

Different paths to the same ending.

References:

• Rapley, G., Murkett, T. (2008, 2019) Baby-Led Weaning, the Essential Guide. The Experiment, LLC
• Brown, A., Jones, S., Rowan, H. ( April, 2017) Baby-Led Weaning: The Evidence to Date.  Curr Nutr Rep 6:148-156
• Azuria, E. et. Al. ( 2018) Baby-Led Weaning: What a systematic review of the literature adds on. Italian Journal of Pediatrics. 44:48
• D’Andrea, E. et. Al. (2016) Baby-led Weaning: A Preliminary Investigation. Canadian Journal of Dietetic Practice and Research. Vol. 77
• Fangupo, L. Et. Al. (2016) A Baby-led Approach to Eating Solids and Risk of Choking. Pediatrics.