March 2019 Issue

Children’s Nutrition: Embracing Baby-Led Weaning
By Diana K. Rice, RD, LD, CLEC
Today’s Dietitian
Vol. 21, No. 3, P. 10

Here’s what RDs need to know about the practice and how to counsel parents.

In this day and age of parental involvement in every aspect of children’s lives, it’s no wonder that parents are paying more attention to how their infants start solid foods.

Ironically, the attention paid in this regard involves a hands-off approach to complementary food introduction. More conscientious parents are turning to baby-led weaning, a method of starting solids in which parents forgo traditional purées and allow infants to self-feed. Parents who take this approach offer babies as young as 6 months old foods from the family table, including soft fruits and vegetables, meats, fish, and whole grains. This method encourages babies to figure out how to pick up, chew, and swallow each food at their own pace. Although babies likely will consume very little food at first and make a mess, they soon become adept at self-feeding, making baby food and the transition to self-feeding a thing of the past.

Families may have been using the principles of baby-led weaning for decades, but the method has risen in popularity over the last 10 years due in large part to the publication of the 2008 book Baby-Led Weaning: The Essential Guide to Introducing Solid Foods and Helping Your Baby to Grow Up a Happy and Confident Eater by Gill Rapley, PhD, an infant feeding and child development expert, and Tracey Murkett.

Parents are drawn to baby-led weaning for a variety of reasons. Many hope it will help reduce picky eating and help their children self-regulate food intake later in life. But parents also are drawn to the convenience of baby-led weaning and the fact that the feeding method prioritizes fresh, whole foods.

“Parents are eager to provide high-quality foods for their infants whether that’s by purchasing or preparing them,” says Leslie Schilling, MA, RDN, CSSD, CSCS, coauthor of a book on baby-led weaning called Born to Eat: Whole, Healthy Foods From Baby’s First Bite. “Since baby-led weaning uses foods of the family, it offers an alternative to spoon-feeding baby that prioritizes family mealtimes without making baby separate meals. It’s a logical and economical choice for many parents.”

“Not having to sit and feed an infant [and] then eat your own meal is time-saving,” says Wendy Jo Peterson, MS, RDN, coauthor of Born to Eat. “Eating together helps also drive home self-feeding principles, and seeing caregivers eat encourages variety. Win-win!”

Pros and Cons
But as the method has grown in popularity, many parents and professionals have expressed concerns regarding the safety of baby-led weaning and whether it truly leads to the benefits that its supporters profess. These questions inspired the most comprehensive study on infant self-feeding to date, a 2016 randomized study called the “Baby-Led Introduction to SolidS (BLISS)” trial. The trial compared infants whose parents followed a modified version of baby-led weaning with a control group that followed traditional weaning practices.

Although the BLISS study didn’t find that following a self-feeding approach resulted in any differences in the children’s BMI at 24 months old, parents in the self-feeding group did report that their babies exhibited less overall food fussiness and a greater enjoyment of food compared with the control group.1 Such benefits could have lifelong implications, including a healthy relationship with food and the prevention of selective eating, which can lead to nutrient gaps and stressful family conflicts.

“Self-feeding is a natural first step that can foster feeding confidence and oral skills, and prevent overfeeding,” Schilling says. Baby-led weaning also helps parents practice Ellyn Satter’s division of responsibility (DOR), a principle of child feeding that encourages parents to be responsible for what, where, and when food is served, while children are responsible for whether and how much to eat. “We believe baby-led weaning works beautifully with Satter’s DOR and supports intuitive eating. With baby leading the way in their own feeding while being supervised at family meals, it can support their innate self-regulation skills.”

Still, parents must contend with the perceived risks of baby-led weaning before beginning. The potential for infants to choke on solid food is the most concerning element of the practice. The BLISS trial examined this risk and found there were no significant differences in the number of choking episodes between the groups.1 A 2018 study out of Swansea University in the United Kingdom found similar results and discovered that, among babies who did experience choking episodes, those who were offered finger foods and lumpy purées the least often were likely to have the most choking episodes involving these foods.2

“The research tells us that, when done properly, there is not an increased risk of choking associated with baby-led weaning,” says Meghan McMillin, MS, RDN, CSP, LDN, CLC, owner of Mama & Sweet Pea Nutrition outside of Chicago. “Parents and dietitians should know basic safety precautions about introducing solids including foods that aren’t appropriate and the signs of developmental readiness.”

In addition, parents and professionals often are concerned that if adults don’t feed their babies, they might not consume enough food or might be at risk of nutrient deficiencies, namely anemia. However, the available research, including the results from the BLISS trial, alleviates these concerns.3,4 “Most research has shown that there is no difference between baby-led weaning babies and purée-fed infants when it comes to caloric intake or iron status,” McMillin says.

Although the available research suggests baby-led weaning is safe, it’s important to note that the practice generally isn’t a good fit for babies born prematurely or who have certain genetic syndromes, developmental delays, or congenital deformities, including cleft lip and palate. Parents who wish to adopt baby-led weaning when one of these conditions is present must seek expert guidance and approval. “It’s very important to include an occupational therapist or speech language pathologist if there are delays,” Peterson says.

Yet even in cases of healthy infants, parents will benefit from working with a skilled professional. Notably, families in the BLISS intervention group received eight educational sessions with professionals.1 Dietitians who work with families are well positioned to provide such support, especially considering the misinformation about the practice that parents are likely to encounter. Common and potentially dangerous myths about baby-led weaning that RDs should address include the notion that adult food doesn’t need to be modified at all for the baby, that baby-led weaning can’t be combined with purée feeding, and that it’s alright to delay solid foods altogether until 12 months of age if the baby can’t self-feed earlier.

“Guidance from a dietitian will ensure a baby is getting enough iron, growing appropriately, and feeding in a safe manner,” says McMillin, who teaches baby-led weaning workshops and is a member of the International Baby-Led Weaning Network of Registered Dietitians founded by Jessica Coll, RD, IBCLC. Coll’s network (jessicacoll.com/BLW_network.html) is available only to dietitians and provides training on baby-led weaning best practices, support from other pediatric RDs, and resources to host baby-led weaning workshops for consumers.

Schilling and Peterson’s book, Born to Eat, is another excellent resource for dietitians, as it combines the basic how-tos of baby-led weaning with practices dietitians have long supported, including regular family meals, relying on whole foods, and instilling body confidence.

As the popularity of baby-led weaning grows, so do opportunities for dietitians to learn more about the approach and position themselves as baby-led weaning experts. “Parents who’ve researched the practice for their infants are likely to use it—with or without our guidance,” Schilling says. “It’s in the best interest of our clients and our practices to be well-versed in baby-led weaning or refer to an RD who is.”

— Diana K. Rice, RD, LD, CLEC, is known as The Baby Steps Dietitian and is the founder of Diana K. Rice Nutrition, LLC, where she works with families so they can eat well and reduce the stress surrounding their food choices. She specializes in pre- and postnatal nutrition and feeding young children and is a strong advocate for cooking with kids, family meals, and body positivity.

References
1. Fangupo LJ, Heath AM, Williams SM, et al. A baby-led approach to eating solids and risk of choking. Pediatrics. 2016;138(4).

2. Brown A. No difference in self-reported frequency of choking between infants introduced to solid foods using a baby-led weaning or traditional spoon-feeding approach. J Hum Nutr Diet. 2018;31(4):496-504.

3. Daniels L, Taylor RW, Williams SM, et al. Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial. BMJ Open. 2018;8(6):e019036.

4. Williams Erickson L, Taylor RW, Haszard JJ, et al. Impact of a modified version of baby-led weaning on infant food and nutrient intakes: the BLISS randomized controlled trial. Nutrients. 2018;10(6).