Baby-led weaning

Baby-led weaning (often also referred to as BLW) is a method of adding complementary foods to a baby's diet of breast milk or formula. A method of food progression, BLW facilitates the development of age appropriate oral motor control while maintaining eating as a positive, interactive experience.[1] Baby-led weaning allows babies to control their solid food consumption by "self-feeding" from the start of their experience with food. The term weaning does not imply giving up breast milk or formula, but simply indicates the introduction of foods other than breast milk or formula.

"BLW" redirects here. For the locomotive builder, see Baldwin Locomotive Works.

Methods

Baby-led weaning (term self-attributed to Gill Rapley ) places the emphasis on exploring taste, texture, color and smell as the baby sets their own pace for the meal, choosing which foods to concentrate on. Instead of the traditional method of spooning pureed food into the baby's mouth, the baby is presented with a plate of varied finger food from which to choose. Infants are offered a range of foods to provide a balanced diet from around 6 months. They often begin by picking up and licking or sucking on the piece food, before progressing to eating. Babies are typically able to begin self-feeding at around 6 months old,[2] although some are ready and will reach for food as early as 5 months and some will wait until 7 or 8 months. The intention of this process is that it is tailored to suit the individual baby and their personal development. The 6-month-old guideline provided by the World Health Organization is based on research indicating that the time period from 6 to 18–24 months of age is when the risk of malnutrition is high in infants.[3]

Initial self-feeding attempts often result in very little food ingested as the baby explores textures and tastes through play, but the baby will soon start to swallow and digest what is offered. Formula or breastfeeding is continued in conjunction with weaning and milk is always offered before solids in the first 12 months. Although breastfeeding is the nutritional ideal precursor to baby led weaning (as the baby has been exposed to different flavors [4] via its mother's breast milk and the jaw action used during breastfeeding helps the baby learn to chew), it is also entirely possible to introduce a formula-fed baby to solids using the BLW method. Formula-fed babies can successfully wean using BLW.[5]

Providing an infant with table foods initiates the development of strong oral motor control for chewing and swallowing, including tongue lateralization and eventual bolus formation. When an infant mouths a food texture, the tongue lateralization reflex forces them to move their tongue to the side to lick and taste the food. Through continued practice, infants learn to volitionally lateralize their tongue—the first step in the development of a munching/chewing pattern.[6]

Basic principles

The basic principles of baby-led weaning are:

  • At the start of the process the baby is allowed to reject food, and it may be offered again at a later date.
  • The child is allowed to decide how much it wants to eat. No "fill-ups" are to be offered at the end of the meal with a spoon.
  • The meals should not be hurried.
  • Meals should be offered at times when parents are also eating, to set example and aid in learning through behavior mirroring.
  • Sips of water are offered with meals.
  • Initially, soft fruits and vegetables are given. Harder foods are lightly cooked to make them soft enough to chew on even with bare gums.
  • Non-finger-foods, such as oatmeal and yogurt, may be offered with a spoon so the baby can learn to self-feed with a spoon.[7]

Relation to child development

As recommended by the World Health Organization and several other health authorities across the world, there is no need to introduce solid food to a baby's diet until after 6 months, and by then the child's digestive system and their fine motor skills have developed enough to allow them to self-feed. Baby-led weaning takes advantage of the natural development stages of the child.

Motor Development

From infancy, the only oral motor pattern appreciated is suck-swallow-breathe. This reflexive way of eating allows infants to feed from birth (from a breast or bottle) while protecting their airway and meeting their nutritional needs.[6] The oral motor patterns required for eating and swallowing solids include tongue lateralization, tongue elevation, and munching/chewing, and unlike the suck-swallow-breathe sequence, coordination of these oral motor patterns is learned, not reflexive.[8] When an infant is offered a spoon of puree, the practiced or familiar oral motor pattern is sucking. As purees are thicker than formula or breast milk, puree is sucked off of a presented spoon and moved in the mouth in a similar fashion as liquid. This is generally looked at as a part of the process of introducing solid foods and parents are often encouraged to push past this. Conversely, current research supports that delayed experience with eating lumpy foods leads to poor food acceptance in later years.[9] Through playful exploration, BLW provides an opportunity for infants to practice new oral motor patterns. Through this method, infants gradually develop the oral motor patterns required for mature bolus manipulation, chewing, and swallowing, as well as allow the infant to be in charge of what goes in their mouth, how it goes in, and when.[6]

According to one theory, the baby will choose foods with the nutrients she might be slightly lacking, guided by taste. The baby learns most effectively by watching and imitating others, and allowing her to eat the same food at the same time as the rest of the family contributes to a positive weaning experience.

Self-feeding supports the child's motor development on many vital areas, such as their hand-eye coordination and chewing. It encourages the child towards independence and often provides a stress-free alternative for meal times, for both the child and the parents. Some babies refuse to eat solids when offered with a spoon, but happily help themselves to finger food.[10][11]

The authors of BLW assert other strategies which are in line with traditional feeding safety guidelines. For example, it is recommended that infants are seated upright, in a supportive high chair for all feeding experiences. This reduces the impact of gravity on swallowing, allowing for easy expulsion of the bolus by gagging, decreasing accidental movement of the food into the pharynx. Additionally, a child who has the trunk and head control to sit independently though a meal (proximal stability) will more likely demonstrate adequate distal coordination for strong oral motor control.[6]

Gag Reflex

When infants bring solid foods to their own mouth, they are the ones guiding the sensory experience, starting and stopping when they are comfortable and ready. When food does move too posteriorly in the mouth triggering a gag reflex, the entire bolus is expelled from the mouth. Also, food moves slowly in comparison to liquid, and is not often sucked into the pharynx, allowing for laryngeal penetration or aspiration of the bolus. The food bolus will trigger a gag response first and be expelled before it hits the laryngeal vestibule. Infants therefore utilize the gag reflex for learning three important concepts: the borders of their mouth, desensitizing their gag reflex, and how to protect their airway when volitionally swallowing solid foods.[7]

As infants get closer to one year old, the gag reflex moves posteriorly, closer to the laryngeal vestibule. This allows food to move closer to the laryngeal vestibule before triggering a gag. Although this allows for increased ability to safely swallow, if oral skills are immature due to lack of practice, this puts older infants at a high risk for choking and aspiration of immaturely chewed food materials into the lungs. Oral motor development would suggest that if an infant does not learn how to manage a bolus intra-orally and time their swallow, more choking would occur after the age of one, when traditionally more solid foods are added to the child's diet.[8] There have been no clinical studies completed to support this connection between movement of the gag reflex and choking. It is still suggested to avoid classic “choking hazards” or airway shaped foods: whole grapes, coin-shaped slices of hotdogs, cherry tomatoes, etc.[7]

Scientific research

Very little scientific research has been done regarding baby-led weaning.[12] However, a study headed by child health specialist Charlotte M. Wright from the University of Glasgow, Scotland found that while BLW works for most babies, it could lead to nutritional problems for children who develop more slowly than others. Wright concluded "that it is more realistic to encourage infants to self-feed with solid finger food during family meals, but also give them spoon fed purees."[13]

Conversely, the natural diet of an infant up to age one is breast milk (or a synthetic equivalent such as formula). It is important for parents to not decrease the volume of milk feeds until around one year of age or until the baby is taking in enough solid foods to support weight-gain (AAP, 2013). Proponents of BLW would argue that breast-feeding mothers should change their own diet to improve the infant's nutrition before pushing for increase solid food intake.[7]

Historically, mothers used to be told to maintain a strict schedule for breast feeding, limiting the time at breast and the frequency . As a result, many mothers had low milk supply (as breast milk is a supply-demand phenomenon), and therefore their babies “failed to thrive.” Not surprisingly, the amount of formula available skyrocketed, as did the availability of strained or mashed “baby foods.” By the 1930s, a variety of Gerber purees were available for purchase. Current breast feeding recommendations by the American Academy of Pediatrics are that infants should be breast fed for the first 6 months, then be gradually introduced to solid food between the age of 6 months and 1 year.[14]

A more recent study at the University of Nottingham by Ellen Townsend and Nicola J. Pitchford suggests that baby-led weaning may lead to less obesity in childhood. The authors conclude that the "results suggest that infants weaned through the baby-led approach learn to regulate their food intake in a manner, which leads to a lower BMI and a preference for healthy foods like carbohydrates.".[15] Feeding specialist, Kary Rappaport, OTR/L, SWC, CLE also concludes that a BLW infant, who leads their own food exploration and is exposed to a consistent variety of tastes, textures, and smells at an early age is more likely to develop positive interest in food. This may decrease “picky” eating behaviors in toddlers and young children.

Researcher Joel Voss, a neuroscientist at Northwestern University states, "The bottom line is, if you're not the one who's controlling your learning, you're not going to learn as well".[16] When an adult takes control of the activity, the inherent love of exploration and discovery is lost. BLW allows for natural, developmentally appropriate interaction and play with food, which has the potential to develop a lifelong curiosity with food.

As of June 2019, it was suggested that long-term studies need to be done on the effects of BLW on nutrition adequacy and safety in addition to previous evidence that it is useful in self-regulation of feeding with low risk of choking.[17]

See also

References

American Academy of Pediatrics (2013). Ages & Stages: feeding & nutrition. Accessed 10 October 2013. http://www.healthychildren.org/English/ages-stages/baby/feeding-nutrition/Pages/default.aspx.

Case-Smith, J & Humphry, R. (2005). Feeding Intervention. In J.Case-Smith (Ed.), Occupational therapy for children (pp. 481–520). St Louis, MO: Elsevier.

Morris, S.E, & Dunn-Klein, M.(2000).Pre-feeding skills: A comprehensive resource for mealtime development (2nd ed.). Austin, TX: PRO-ED, Inc.

Rapley, G. & Murkett, T. (2005). Baby Led Weaning: the essential guide to introducing solid foods and helping your baby to grow up a happy and confident eater. New York, NY: The experiment, LLC.

Footnotes
  1. Gomez, Melisa Sofia; Novaes, Ana Paula Toneto; Silva, Janaina Paulino da; Guerra, Luciane Miranda; Possobon, Rosana de Fátima; Gomez, Melisa Sofia; Novaes, Ana Paula Toneto; Silva, Janaina Paulino da; Guerra, Luciane Miranda; Possobon, Rosana de Fátima (13 January 2020). "Baby-Led Weaning, an Overview of the New Approach to Food Introduction: Integrative Literature Review". Revista Paulista de Pediatria. 38: e2018084. doi:10.1590/1984-0462/2020/38/2018084. ISSN 0103-0582. PMC 6958549. PMID 31939505.
  2. Brown, Amy; Jones, Sara Wyn; Rowan, Hannah (2017). "Baby-Led Weaning: The Evidence to Date". Current Nutrition Reports. 6 (2): 148–156. doi:10.1007/s13668-017-0201-2. ISSN 2161-3311. PMC 5438437. PMID 28596930.
  3. "WHO | Complementary feeding". WHO. Retrieved 2019-08-01.
  4. Mennella JA, Jagnow CP, Beauchamp GK (2001). "Prenatal and postnatal flavor learning by human infants". Pediatrics. 107 (6): E88. doi:10.1542/peds.107.6.e88. PMC 1351272. PMID 11389286.
  5. Susan A. Sullivan, Leann L. Birch 1994 http://pediatrics.aappublications.org/content/93/2/271.abstract
  6. Case-Smith, J.; Nastro, M. A. (1993-09-01). "The Effect of Occupational Therapy Intervention on Mothers of Children With Cerebral Palsy". American Journal of Occupational Therapy. 47 (9): 811–817. doi:10.5014/ajot.47.9.811. ISSN 0272-9490. PMID 8116772.
  7. Rapley, Gill (2008). Baby-led Weaning. Helping your Baby to Love Good Food. London: Vermilion. ISBN 978-0-09192380-8.
  8. Morris, Suzanne Evans. (2000). Pre-feeding skills : a comprehensive resource for mealtime development. Pro-Ed. ISBN 1416403140. OCLC 183191718.
  9. Coulthard, Helen; Harris, Gillian; Emmett, Pauline (January 2009). "Delayed introduction of lumpy foods to children during the complementary feeding period affects child's food acceptance and feeding at 7 years of age". Maternal & Child Nutrition. 5 (1): 75–85. doi:10.1111/j.1740-8709.2008.00153.x. PMC 6860515. PMID 19161546.
  10. Davis Clara M (1939). "Results of the self-selection of diets by young children". Can Med Assoc J. 41 (3): 257–61. PMC 537465. PMID 20321464.
  11. Strauss Stephen (2006). "Clara M. Davis and the wisdom of letting children choose their own diets". Can Med Assoc J. 175 (10): 1199. doi:10.1503/cmaj.060990. PMC 1626509. PMID 17098946.
  12. Anderson, Laura N; van den Heuvel, Meta; Omand, Jessica A; Wong, Peter D (13 March 2020). "Practical tips for paediatricians: Baby-led weaning". Paediatrics & Child Health. 25 (2): 77–78. doi:10.1093/pch/pxz069. Retrieved 17 November 2020.
  13. "Baby-Led Weaning Is Feasible but Could Cause Nutritional Problems for Minority of Infants" Science Daily. January 14, 2011. https://www.sciencedaily.com/releases/2011/01/110112081454.htm
  14. Section on Breastfeeding (March 2012). "Breastfeeding and the use of human milk". Pediatrics. 129 (3): e827–841. doi:10.1542/peds.2011-3552. ISSN 1098-4275. PMID 22371471.
  15. Pitchford, Nicola J.; Townsend, Ellen (6 February 2012). "Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample". BMJ Open. 2 (1): e000298. doi:10.1136/bmjopen-2011-000298. PMC 4400680. PMID 22315302.
  16. Davis, Joshua (2013-10-15). "A Radical Way of Unleashing a Generation of Geniuses". Wired. ISSN 1059-1028. Retrieved 2019-08-05.
  17. Utami, Ayu Fitria; Wanda, Dessie (June 2019). "Is the baby-led weaning approach an effective choice for introducing first foods? A literature review". Enfermería Clínica. 29: 87–95. doi:10.1016/j.enfcli.2019.04.014. PMID 31248733.
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