- Weaning is the time when infants transition from breastfeeding or infant formula to solid foods.
- Traditional weaning involves introducing solid foods to babies via spoon-feeding; with a “baby-led” weaning (BLW) approach, parents offer baby-sized pieces of whatever the family is eating from the start.
- Baby-led weaning relies on a baby’s innate ability to respond to cues for hunger and satiety and is thought to promote healthy weight gain. However, some health professionals are concerned that baby-led weaning increases the risk of choking and may not provide adequate nutrients to a growing baby.
- More studies are needed, but the evidence on BLW is advancing. Parents following a BLW approach may require deeper awareness and infant nutrition knowledge to prepare a safe, healthy and nutritious diet for their baby.
Weaning is the time when infants transition from breastfeeding or infant formula to solid foods. The process is not immediate, but incremental. It’s an important time in the development of a baby’s food preferences and impacts a baby’s eating behaviors and body weight.
Traditional weaning involves introducing solid foods to babies via spoon-feeding. In recent years, an alternative approach to introducing complementary foods has gained popularity: baby-led weaning (BLW).
The baby-led method was first coined by Gill Rapley in 2005. It’s a type of weaning that involves a baby being offered solid foods for self-feeding, with no help from an adult. This style of infant feeding is meant to encourage self-regulation and simpler feeding experiences due to the baby eating with the family instead of separately.
How does it work?
In traditional weaning, babies are spoon-fed purees or mashes and are eventually offered the same foods as the family. With baby-led weaning, parents offer baby-sized pieces of whatever the family is eating from the start.
With baby-led weaning, parents oversee what foods to offer as well as when and in what form they will be presented. Babies then choose from the parents’ food offerings and decide how much and how quickly to eat.
- Parents choose what type and how many foods to offer, as well as when and in what form food is offered.
- Infants choose from the foods offered, deciding how much and how quickly to eat.
Baby-led weaning relies on a baby’s innate ability to respond to cues for hunger and satiety and is thought to promote healthy weight gain. However, some health professionals are concerned that baby-led weaning increases the risk of choking and may not provide adequate nutrients to a growing baby.
Let’s look at what the evidence says about this alternative feeding approach and whether it might be something worth trying.
What does the evidence say?
One systematic review critically examined the current evidence about the baby-led weaning approach and assessed whether or not it is safe and advisable for parents and babies. Twelve articles (ten observational cross-sectional studies and two randomized controlled trials) were included to examine the following questions:
- Does BLW increase the risk of choking?
- Does BLW determine adequate energy intake and normal growth?
- Does BLW cause an increased risk of inadequate iron intake, resulting suboptimal iron status?
- What effects does the BLW approach have on satiety-responsiveness and weight?
- Does BLW influence food preferences and diet quality?
- Does BLW improve family relationships during shared meals?
- Do mothers who adopt a baby-led approach differ from those who choose traditional weaning regarding the starting time of complementary feeding?
- Does BLW have positive effects on a mother’s anxiety and attitude towards complementary feeding?
This review noted that “while in … traditional weaning infants are offered pureed infant foods that are often made up of several ingredients, in the baby-led weaning a variety of single picked foods is offered to the baby. In the former approach, the tastes of the single foods are mixed together and the child is not always able to distinguish them; conversely, the baby-led weaning approach might provide an early and more stable learning about the satiating capacities of foods and therefore … may enable a better satiety-responsiveness.”
Choking: One of the studies in this review found no differences in choking incidence between BLW and traditional weaning groups. In 199 BLW infants, 30% had at least one episode of choking with solid food ingestion (of an apple). It is possible that this high rate was due to the inability of parents to distinguish choking from gagging.
Adequate energy intake and normal growth: This study reported that even though total energy intake was similar between a BLW and a traditionally spoon-fed group of infants, BLW infants appeared to consume more total fat and saturated fat than did traditionally spoon-fed infants.
One randomized study showed no differences in energy intake between the BLW group and the traditionally spoon-fed control group. The researchers noted that this BLW group was modified to address concerns about iron deficiency. Results showed the baby-led approach to complementary feeding did not result in more appropriate BMI than traditional spoon-feeding, although BLW children were reported to have less food fussiness.
Risk of inadequate iron intake: BLW infants may be at risk of inadequate iron intake since the consistency of many iron-rich foods makes them difficult for babies to self-feed. Furthermore, easy foods to grasp, such as fruits and cooked vegetables, which are the most commonly introduced foods during BLW, are generally low in iron.
Food preferences and diet quality: It has been hypothesized that BLW may promote the acceptance of more types of food due to a baby’s exposure to a wider range of tastes and textures. One study found no differences in food preferences between BLW and traditionally weaned infants. Conversely, another study observed that BLW-weaned children preferred carbohydrates, whereas spoon-fed infants preferred sweets. Interpreting these results requires caution, as this observational study was based on parents recalling their weaning approach.
Family relationships: It has been proposed that BLW children may participate in mealtimes more easily than traditionally spoon-fed children, because they eat the same foods with the rest of the family. Additionally, as BLW infants are never forced to eat food, there may be less mealtime pressure and anxiety. A single non-comparative cross-sectional study found that while parents offered their children 57% of the same foods they were consuming, BLW did not improve or change the family’s dietary intake.
Complementary feeding start time: The American Academy of Pediatrics recommends infants begin complementary feeding around 4–6 months of age. According to data from this observational study, mothers choosing to follow a baby-led approach appeared more likely to begin complementary feeding at six months of age. Data derived from randomized trials are lacking.
Mothers’ anxiety and attitude: Baby-led mothers reported lower anxiety, lower obsessive-compulsive disorder scores, lower eating restraints and higher conscientiousness than traditional weaning mothers according to this observational study. These maternal characteristics might make a BLW approach more feasible; however, this finding may also be explained by reverse causality, given the possibility that mothers high in anxiety may be more likely to choose a traditional weaning approach.
Because there is not one formal protocol that guides the baby-led weaning approach, most existing studies on the subject include families who self-identify as baby-led weaners, which leaves open the possibility that these families may be defining, and thus practicing, baby-led weaning differently.
Moreover, the evidence about BLW is mostly derived from observational studies, which can inform us about associations that generate hypotheses but do not prove cause and effect.
Currently, there is only insufficient and low-quality evidence for drawing conclusions about the BLW approach in terms of the adequacy of its energy and nutrient intakes.
Though more studies are needed, the evidence on BLW is advancing. Parents following a BLW approach may require deeper awareness and knowledge about infant nutrition to prepare a safe, healthy and nutritious diet for their child.
This article contains contributions by Kris Sollid, RD.