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Baby-Led Weaning

Introducing Real Foods to Babies

Megan McNamee MPH, RD

What is Baby-led Weaning (BLW), also known as Baby-led Feeding?

According to the book by Rapley, BLW is a “way of introducing solid foods that allows babies to feed themselves – there’s no spoon feeding and no purees. The baby sits with the family at mealtimes and joins in when she is ready, feeding herself first with her fingers and later with silverware.”

Megan’s take: the best thing about BLW is that baby learns to feed himself in a safe way that honors his developmental stage, preferences, sensory experiences, and physiology. Baby is in charge of how much and what he eats, which is tantamount in establishing a good feeding relationship. BLW is not all-or-nothing, however, so if using pouches or purees is something you would like to incorporate or need to do while baby is with a caregiver, there are ways to integrate both approaches.

General Concepts (aka if you forget everything about this class…):

1. Don’t stress! This approach is supposed to be easy and fun.
2. Wait until approximately 6 months to introduce solid foods.
3. BLW is all about making things simple – baby eats real foods and eats what the family eats. Start with foods that are simple to grab such as avocado and sweet potato.
4. The only true foods to avoid are honey and fluid cow’s milk. Also avoid choking hazards like chips, popcorn, whole grapes/cherry tomatoes and whole nuts (nut butters are OK).
5. Baby feeds herself – parent’s job is to offer a variety of safe, nutritious foods.
6. Milk feeds continue and will not decrease for many months. For the first few months, BLW is mainly about exploration, learning, and fun.

What about spoon-feeding?

-Spoon-feeding recommendations originated when parents were told to start feeding at 3-4 months – prior to them being developmentally able to feed themselves.

-Now that we know feeding should start closer to 6 months, spoon-feeding is not necessary, and some babies even refuse it. Furthermore, there is no research supporting purees as the necessary first step in solid food introduction, and babies can become very confused when given lumpy foods because they’re not sure whether to swallow or chew.

-Research suggests that spoon-feeding can lead to overfeeding because parents can spoon in a lot of food before baby realizes she is full. This can also lead to constipation. With BLW, babies gradually increase solid intake, lowering the risk of constipation.

-This doesn’t mean that you “shouldn’t” do purees. If purees seem to work better for your baby, or if she has developmental or medical issues that make BLW unsafe for her, then purees may be a smart move for you. Furthermore, all babies need to learn to eat a variety of textures, and purees can be given in a baby-led way – especially once baby is able to feed herself with a spoon. (Think: applesauce, guacamole or mashed potatoes.)

Why choose BLW?

•Allows baby to move onto solids at a developmentally appropriate time without cutting out milk feedings too early. / •Allows babies to participate in mealtimes at a young age and makes it easier to be present for social opportunities where food is involved, since they can join in the fun.
•Develops hand-eye coordination, dexterity and chewing skills. / •Helps prevent mealtime battles and picky eating because pressure is removed.
•Allows baby to eat what and as much as she wants, establishing healthy feeding dynamics and potentially avoiding obesity and food issues later. / •Encourages confidence, enjoyment, and a healthy love of food, taste, aroma, and textures. Meals are more relaxed and fun. Baby can learn by imitation.
•No need to buy purees or special foods – cheaper and easier for everyone. / •Allows for development or strong family bonds, since families can eat together.

Potential disadvantage of BLW:

• May be inappropriate for children with medical issues or developmental delays
• It’s messy! (A dog is a good investment)
• Mealtimes may take longer (which can ultimately be a good thing – slowing our rate of eating too)
• Parents may offer less balanced meals in effort to reduce mess
• Have to be aware of salt content of food and offering foods that can actually be eaten to avoid baby getting only one food group, such as carbohydrates (think spaghetti with meat sauce – baby may only get the noodles)
• Parents worry about choking – more on this later.

Assessing Readiness

Current research suggests that most babies are ready for food around 6 months of age. Although some pediatricians recommend starting at the 4-6 months (and never before 4 months), the WHO, AAP, UNICEF, and AAFP recommend waiting until around 6 months. Furthermore, according to Kellymom.com there are many reasons to delay solids until around the 6 month mark.

1. Better protection from illness.
2. Allows the digestive tract time to mature. Certain digestive enzymes and stomach acid are not ready until around the 6 month mark, and introducing solids before then can lead to digestive upset, gas and constipation.
3. Protects against allergies. Gut doesn’t usually mature, or “close,” until near the 6 month mark. An “open gut” allows macronutrients to pass into the blood stream, increasing the risk for allergies. This usually also coincides with developmental ability of baby to bring food to mouth, chew, and swallow.
4. Protects baby from iron-deficiency anemia. It is theorized that introducing solids, especially iron-fortified ones (rice cereal), actually decreases absorption of iron from breast milk.
5. Protects baby from obesity. Early introduction of solids is related to obesity later in life.
6. Helps mom maintain milk supplyand helps space out pregnancies.
7. Makes starting solids easier – baby can feed herself, and allergies are less likely.

With all of these considerations, it’s important to remember that you as the parent know your child best. When they are exhibiting signs of readiness and are nearing the 6 month mark, they may be ready for solids. Let your baby lead you!

Signs of Readiness / NotSigns of Readiness (Necessarily)
-Baby can sit on her own or with minimal assistance and holds her head up
-Baby draws food to her mouth with her hand
-She reaches and grabs accurately
-Baby has stopped thrusting tongue out
-Baby is interested in food and mealtimes* / -Baby suddenly starts waking more often at night
-Baby doesn’t sleep through the night
-Baby seems to want to nurse/feed more
-Baby is interested in food and mealtimes*
* Baby may or may not be interested in food when exhibiting other signs of readiness. You can choose to start (especially if baby is 6 months) and see how she likes it once she can play and explore. On the reverse side, sometimes younger babies seem interested in food when they’re usually more interested in watching you eat. It is not necessarily a sign of readiness, especially when baby is much younger than 6 months and is not exhibiting other signs. Babies at 4-6 months are naturally curious in everything – it doesn’t necessarily mean they’re ready to eat.

Getting Started

-Equipment: high chair or Bumbo, bib (or strip down to diaper), cover for floor/dog

-Mealtimes are playtime in the first few months. Don’t worry about following a “schedule” or eating 3 square meals per day. This time is for exploration. Include baby as often as you have a meal (as possible).

-Start with something that’s easy for baby to grab in her hand yet still bite – slice of avocado, strip of boiled sweet potato, banana cut lengthwise.

-Other great first foods:

• Cooked broccoli florets
• Chicken and meat strips
• Steamed/roasted vegetable strips (squash, pumpkin, zucchini)
• Whole cooked vegetables (green beans, baby corn)
• Strips of bell pepper, raw cucumber
• Hard cheese sticks
• Whole grain bread strips

-Offer food when baby isn’t too tired or hungry, and allow baby to explore and play with the food. Never put whole food in baby’s mouth for her. This could cause her to choke.

-Baby chooses how much, how fast, and whether to eat. This concept will be very important later in life and is coined the “division of responsibility in feeding” by nutrition expert Ellyn Satter, RD.

The parent is responsible for what.

The infant is responsible for how much and whether.

-Offer a variety of foods throughout the week, aiming for different tastes, textures, and food groups. (In the first 2 weeks of BLW, Hannah had eaten avocado, sweet potato, chicken, eggs, lentils, hummus, plum, banana, applesauce, broccoli, zucchini, kiwi, yellow squash, chicken meatballs, pasture cheese, quinoa, quinoa/amaranth pasta, whole grain bread, salmon, and brown rice.)

-Be patient. Baby will eat when she is ready. Avoid coaxing her to eat or persuading her to eat more than she wants. Watch for signals that she is full (turning away, dropping or pushing around food, fussiness, disinterest).

-Usually babies start by exploring the food and potentially chewing it, but it will likely fall out of her mouth. Eating time can be just for fun for many days or weeks without any food getting in their mouth. Chewing is important when they start, even if they’re not swallowing much, because it teaches them to do it effectively. As her chewing capabilities progress over the first few weeks, she will begin to bring food to the back of her mouth to swallow it.

-Offer 1 or 2 pieces of food at a time so baby doesn’t get overwhelmed.

-Baby may gag, especially at the beginning. Gagging is not choking. Babies’ gag reflex is further forward in their mouth, and gagging is a way for them to protect from choking.

Gag Reflex

The gag reflex is baby’s natural protective mechanism when eating. It is further forward in her mouth than an adult’s and can be very sensitive. When gagging, baby will retch and look like she’s vomiting/coughing. This pushes food that wasn’t swallowed forward in the mouth to be spit our or chewed. Fortunately, most babies don’t seem to mind gagging. Some gag more than others – in the first two weeks of giving solids, Hannah gagged about 5 times.

Interestingly, kids that do BLW may learn how to be safer eaters because they understand from the start that food should be chewed first, then swallowed. Spoon feedingmay encourage simply swallowing. If you do decide to spoon feed, angle the spoon to either side of the mouth so that baby learns to push food to the side (and will eventually chew when doing more lumpy/hard foods).

Safety

Some parents are really worried about choking with BLW. In reality, babies can choke just as easilywith purees because parent-led feeding bypasses baby’s sensitive gag reflex. It is the responsibility of all caregivers to understand basic infant first aid for choking and CPR because babies can choke on anything, not just food. Being prepared is critical. Preparation will give you confidence. Fortunately, choking is far less common with BLW than one would believe. Babies are designed to gag when food is too big for them to swallow. Their bodies and mouths are very smart!

It is important to follow a few safety guidelines:

1. Sit baby upright and don’t allow her to lean backwards or slump. Even slightly forward leaning is OK.
2. Do not offer choking hazards such as whole nuts, whole grapes/cherries, popcorn or really hard foods such as chips.
3. Remove skin from sausage/meats and small bones from fish. Large bone (poultry, lamb, beef) can be helpful for baby to grab.
4. Cut bananas lengthwise and offer cooked carrot sticks instead of coins.
5. No one feeds baby – including other children. Putting whole food in her mouth is something that many parents want to do, but it’s often not safe for baby.
6. Never leave baby alone with food.
7. Make sure food is not too hot in temperature.
8. Offer baby water or milk with food to help them wash down stickier foods like bread, meat and shellfish.

Allergies

Traditional feeding philosophies recommend waiting 3-4 days between introducing new foods. BLW advocates watching for allergies but suggests that this wait time is not necessary, especially for low allergy risk foods. If baby does exhibit an allergy or intolerance, stop solids and reintroduce more slowly to identify an issue.

**When introducing allergenic foods, it may be wise to wait a few days in between these foods. If baby already has food allergies or intolerances, work with your pediatrician. Current recommendations are suggesting that even family history of allergies should not prevent early introduction of allergenic foods for kids who don’t have a personal history of intolerance Allergenic foods include:

-cow’s milk

-peanuts

-tree nuts (almonds, cashews, pistachios)

-eggs

-wheat/gluten

-soybeans

-shellfish

-non-shellfish

-nuts

-other foods like strawberries, citrus and nightshades (eggplant and tomato) may cause allergies or intolerances but are often very well tolerated

Contrary to old belief, research now suggests that allergenic foods should be offered around 6 months. Introducing allergens to babies at this time reduces the risk that baby’s system will hyper-react. We don’t have all the answers in the allergy puzzle, but we do know that delaying allergenic foods for babies that don’t have a strong personal history of food allergies actually increases their allergy risk.

To reduce likelihood of allergies:

-Wait until about 6 months to introduce solids and breastfeed as long as possible.

-Optimize vitamin D – offer supplementation to babies from birth and get 10 minutes of sun daily on exposed skin.

-Take probiotics if nursing and consider offering them to baby.

What about breastfeeding/formula feeding?

-Breast milk/formula remains baby’s main source of nutrition. Intake will likely not decrease until at least 9-10 months or more.

-Think about adding to, not replacing milk feedings.

Drinks

-Offer water in an open cup with each meal (shot glass is ideal). Teach baby how to use an open cup.

-She may play with the water and will let you know when she wants to drink it. Offer water at the end of each meal to make sure baby has swallowed all of her food.

-Avoid hard spout sippycups as these can be detrimental to language development. Open and straw cups are ideal.

-Juice is not necessary for babies and may get them accustomed to drinking sweetened beverages. Fruit is a much better option.

Foods to Avoid

-Honey (until age 1): honey may contain the botulism toxin.

-Cow’s milk (until age 1): cheese/yogurt/cottage cheese are OK, but don’t offer fluid cow’s milk in the form of a beverage. Small amounts of milk used to cook a dish are OK.

-Excess salt: sodium can taxing on a baby’s small kidneys. Avoid salting foods given to baby. You can add seasoning, but if you must add salt apply after taking out baby’s portion. Inherently salty foods include ham/bacon, smoked salmon, pepperoni, salami, and chorizo.

-Choking hazards: whole nuts, whole grapes or fruit with seeds/stones, chips, popcorn hot dogs (not cut), whole bananas, raw carrots; nut butters are OK, just watch baby carefully because they can stick to roof of mouth.

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-Sugary foods: avoid candy, chocolate, donuts, cake, etc.

-Low-fat foods: babies need a lot of fat. Avoid fat-free yogurt or low-fat cheese.

-Very high fiber foods: avoid cereals like Fiber One or wheat germ as they can upset baby’s digestive tract.

-Raw dairy, raw shellfish, undercooked meats, or other food borne illness hazards

-Carbonated beverages: avoid soda, seltzer, soda water, etc.

-Juice: small amounts of juice are OK, but breast milk/formula and small amounts of water are theonly beverage babies need. Whole fruits are much better than juice and are lower in concentrated fruit sugar.

-Caffeine

What about Nutrition?

-Important to offer a balance of foods each day so baby doesn’t just get starch and fruit (high carbohydrate foods); veggies, protein, and fat are important. As baby hits 9-10 months and may take in less milk, providing a range of foods (even if she doesn’t eat all of them) is important for diet quality.