Breastfeeding, Nutrition

Baby-led weaning: a good idea or not?

by Dr Rachel Moon MD, Assistant Editor, Pediatrics

While I have been aware of different philosophies with regards to how one should start feeding complementaryfoods to babies (Should you give fruits or vegetables first?), I was not aware of the idea of "baby-led weaning."While it hasn't seemed to gain much traction yet here in the U.S., it is apparently all the rage in the UK,Australia, and New Zealand. In the U.S., "weaning" refers to ending breastfeeding. However, in many othercountries, "weaning" refers to the introduction of complementary foods. The whole idea behind baby-ledweaning is that the baby controls what and how much she eats, beginning at 6 months, by feeding herself.

There is no such thing as spoon-feeding or baby food. (Nor are thereany airplane spoon games.) Instead, once the baby can sit upright, you place finger foods in front of her, andshe picks up and puts into her mouth whatever she wants. The theory behind this is that babies will becomemore adventurous eaters and will also learn how to control their own intake. Of course, the first question thatmany people (including me) will ask is, "Won't the baby choke?" Some researchers in New Zealand had thesame question and studied this in a randomized controlled trial, which appears in this month's Pediatrics. (Ref)Babies were randomized to either normal care or modified baby-led weaning. Parents were provided with someguidelines to baby-led weaning, including keeping the baby in an upright sitting position while eating, insuringadult supervision while eating, and not letting anyone put food into the baby's mouth (only the baby is allowed todo that). They were also given a list of foods to avoid, including nuts, raw vegetables, hard fruit, popcorn, andfood cut into " coins." They then collected data about the infant's food intake and any possible choking orgagging episodes by a combination of questionnaire and food diary.

I was intrigued that there was no difference in the number of choking episodes in the 2 groups. However, morethan half of the infants were offered at least one food that posed a choking risk. You will be fascinated - andsurprised - to see the types of foods that were offered to babies, and the foods that were associated withchoking episodes. It appears that babies can choke on almost anything, and this study provides reassuranceabout baby-led weaning, in that the risk of choking seems to be comparable to traditional spoon-feedingmethods.

I'll certainly be ready when a parent wants to talk about baby-led weaning after reading this article. It also hasmade me rethink my anticipatory guidance about introducing solid foods - perhaps the emphasis should not beon the way that it's done (spoon-fed or baby-led), but on adult supervision and what foods are inappropriate forinfants.

Copyright © 2016 American Academy of Pediatrics

Breastfeeding, Nutrition

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