Baby Led weaning- born to eat !!

Whenever possible, I try to keep myself updated in various parenting trends being followed in society especially in Parent support groups on social media, as most of the methods and issues discussed there are not traditionally being taught in our medical textbooks.

And that’s how I stumbled upon a concept called Baby led weaning around 2 years back. I had fed my child the traditional way and this was something new to me. It sounded surreal as in no special preparations of foods, no running around with food and finding ways to entertain your baby while feeding them. So I decided to research more on it. Surprisingly I found out that its been there for quite a while, but like most people, we resist change and thats why the concept is still in early stages in India at least. And thankfully this research came in handy when in my clinic one of the moms asked me about baby led weaning, as she wanted to start it for her baby.

Learning to accept and eat solid foods is an essential and major milestone for infants. By 6 months of age, infants require an introduction to a variety of foods, as breast milk and infant formula no longer fulfill their nutritional needs. Since time immemorial I should say, whenever it was decided to start solids for a baby, it was always food in pureed or mashed form and the responsibility was of the primary caregiver (most commonly the mother), to feed the baby, with the contribution of baby being limited to open the mouth and swallow the food. But off lately, focus has been shifting to an entirely new concept, that is baby led weaning or auto weaning (as the name suggests), in which the baby herself tries to feed, the role of primary caregiver just being, to offer the food and supervising the intake.

Is it actually advisable?

What are the pros and cons of BLW?

What is the current research on it regarding fulfilment of nutrition requirements, risk of choking etc.?

For many people like me, who are still new to this concept, I have tried explaining it in the easiest way possible. Though most pediatricians are still skeptical about this approach, this is the “IN” thing at present. Lots of parent groups go for it and with the current social media boom, it’s the talk of the town, with everyone wanting to try the new method.

To use or not to use, is purely your choice. Dont be judgmental about other parent’s choice. Every home is different, what they decide to chose for their baby is entirely up to them.

So what exactly is Baby led weaning?

The baby-led weaning (hereon referred as BLW), is an approach to introduce solids to babies, which has three main features.

1. Baby foods, including first foods, are provided in a whole food form as finger food rather than the more traditional purée.
2. The baby feeds themself by selecting and picking up their food of choice from what is on offer, instead of being fed by someone else.
3. As with the currently recommended approach, BLW starts when the baby is ready for solid food, which is usually around 6 months of age. When ready for solids, baby:
   • Can sit up with less help
   • Can pick up foods and bring them to their mouth
   • Shows signs of being interested in foods.

In short: The parents pick what foods to offer, when to offer them, and in which form to offer them, so that their babies can best feed themselves. In turn, the baby gets to pick what, how much, and how quickly to eat.

Developmental shifts signalling the need for starting solids in infants (usually seen at around 6 months) are:

• They are able to sit, without slumping to the side (even if it is with support) and have good head control and improved hand eye coordination.
• The infant’s protective tongue thrust reflex is no longer present (means they stop pushing the food out with their tongue when offered with a spoon.) and they are learning to chew (Fun Fact:  babies don’t needs teeth for chewing; babies can chew food with their strong gums, even without teeth!),
• They voluntarily place items in their mouths and show an interest in reaching for parents’ food and cutlery at mealtimes

This can happen not necessarily at 6 months for all babies, but sometimes even at 8 months. So BLW is started anywhere between 6 to 8 months depending on baby’s development. This is not in conformation with the currently recommended timing on weaning wherein the babies should ideally be started weaning foods by at the most 6 months, because by then the nutritional requirements of the babies are not fulfilled by milk alone. However through delaying, proponents of BLW suggest that the child is more developmentally prepared to feed itself and consume solid foods

Why should one choose BLW?

I read somewhere about a common saying in the BLW community that “Food is for fun until age 1,” meaning that in the first few months of starting complementary foods infants should be allowed to explore the new concepts of touching, manipulating, smelling, and chewing solid foods, without a focus on consumption. So, If we talk about the advantages of choosing BLW over the traditional method of weaning, there are many which must be by now easily understandable like:  

• It is a low pressure approach: both for parents and babies.
• It gives the child the control and decision making skills – All parents who favour BLW;  swear by this. Babies are in full control of their eating and set the pace of their meal, deciding when they are “done.”  The baby decides what and how much is eaten, not the parent. In the long run, the baby learns to read his own hunger cues, and self regulate his intake, thereby reducing the risk of obesity by developing a healthier relationship with foods.
• Children’s later food preferences are thought to be influenced by early food exposures. As BLW infants are exposed to “table foods” from the beginning, it is thought that they may have preferences for a wider variety of foods than traditionally fed infants, when they become older (although research has still to document this, but parents perceptions are different).
• You save ample time and money: BLW doesn’t involve lots of food preparation actually, so you can save a lot of time and money.
• It helps you to cut out processed foods from your baby’s diet including instant cereals, instant purees etc. which are loaded with sugar and preservatives (even if they say they aren’t).
• Good for development: It builds hand-eye coordination of the child – when you let your baby handle the food pieces on their own
• Early and easy introduction to variety of family foods- Such a baby has a head start when it comes to family foods, because they can be introduced to a wider variety of foods rather than being limited to the usual norms of giving mashed and pureed food (which sometimes causes difficulty in transitioning to solid foods when need arises). Also since babies join the family table, they observe and learn from the family’s eating practices.

How to introduce foods as per age?

• Between 6 – 7 months – Babies develop palmar grasp first, meaning they will use their entire palm to pick up food, so offer long strips of vegetables or fruits just plain steamed; long wedges of finger foods – adapt your family food in an appropriate manner.
• Between 7-9 months –– Babies develop pincer grip around this time and are developmentally ready for self feeding smaller pieces of food, so you can start giving the same food in smaller bite sized portions, which is easier to pick up with thumb and finger. Gradually transition on the consistency of food.
• By one year – baby should be completely on family food.

What are the risks or disadvantages of BLW?

 A common concern from us healthcare providers and most parents about BLW is its safety; specifically with regard to risks of choking, growth faltering, and anemia.

1. With regard to choking, it is understandable concern that an infant may be at greater risk of choking on a firmer piece of solid food as opposed to a pureed version of the same food. But in actuality it doesn’t happen. A baby might gag on food (which is a normal thing to happen) but usually does not choke on the food unless the food is too hard, which is anyways not advisable in BLW. Gagging is a kind of inherent protective reflex that helps the baby to keep bigger pieces of food near the front of the mouth while allowing only very well-chewed pieces to be swallowed. At six months, the gag reflex is towards the front of tongue vis a vis as they age, when it moves farther back.

But still choking can happen, if your baby puts something which is hard and round in his mouth by mistake. Ways to avoid choking are;

• Supervise always, never leave the baby alone while they are eating.
• Avoid the urge to put pieces of food in the baby’s mouth, let the baby do it.
• Always try to ensure that baby is sitting properly without slumping. If possible get a high chair.
• Avoid round and hard items like nuts, peas, grapes etc. and similar foods. Slice them into smaller slices or boil and slightly smash or powder them depending on the food type.
• Steam hard foods to make them softer – Some foods when offered as raw slices are a huge choking hazard. Steam them to a softer consistency or grate them when offering.
• And lastly but most importantly always Learn CPR and First Aid so that you are prepared to deal with choking when it happens as it can happen even when your baby is not feeding. .

2. Growth faltering is supposed to be one potential disadvantage of BLW. Because the infant is given the “responsibility” of feeding itself, there are concerns that he or she may not consume enough calories to sustain growth on a healthy trajectory. Inadequate caloric consumption from BLW may result from an infant not being developmentally ready to self-feed (fine motor, gross motor, or coordination skills), or from not having the physical stamina or attention to sustain intake.

So specifically, the originators of BLW recommend offering an infant solids when he/she is not hungry, so that milk will remain the main source of nutrition and that too prior to offering solid foods. This again goes against the current recommendations, however whatever minimal research is done on this aspect shows non significant or no growth faltering in these babies.

3. As BLW infants forego purees, including the iron-fortified cereals that are common and recommended first foods, it is thought that they could be at greater risk of anemia. In India though, as, most Indians still rely on feeding cow’s milk predominantly to child less than 1 year rather than introducing proper solids, anemia is already rampant in this age group.

4. The final, and least serious, potential disadvantage in a BLW approach is the mess created by allowing an infant autonomy over his/her own food and intake. Through the exploration of foods, BLW infants have free reign to mash their food and cover themselves. Also it leads to lots of wastage of food. So in developing nations or poorer sections of society, it might not be a feasible option.

To summarize, BLW is an alternative approach to the introduction of complementary foods that finds its roots in a framework centered around promoting autonomy with regards to feeding.

Current evidence is equivocal with regard to the potential health benefits in terms of eating behaviors, dietary intake, and weight outcomes. There is also little-to-no current evidence to support an increased risk of choking, anemia, or growth faltering associated with BLW, especially when BLW is done in a modified way.

Some parents prefer baby-led weaning to spoon feeding, while others combine a bit of both. There’s no right or wrong way – the most important thing is that your baby eats a wide variety of food and gets all the nutrients they need.

Key takeaways:

• Ensure your baby is showing signs of being ready for solids before you start their food journey
• Do not delay introducing solids past six months as your baby needs additional iron and nutrients found in food.
• Solids should not replace breast milk or formula. It is recommended to provide this to your baby until at least 12 months of age.
• Educate and train yourself on what to do in case your baby chokes

Its high time for us pediatricians to be in sync with the current parenting trends and therefore I familiarized myself with BLW, so that I can advise parents in a way acceptable to everyone without compromising the health and safety of the babies. 

If you ask my take, I still root for a modified BLW or a combined approach.

I will come with more on this, this was just a teaser albeit a tad long….!!

Happy feeding !!

Dr Garima | themoppetsclinic 🙂