Q: “Can give advice on BLW (baby led weaning) from a medical point of view. Thank you” ( Haliza )
A: Dear Haliza, baby led weaning ( BLW) is gaining popularity with most parents compared to the traditional “spoon feeding” . The whole concept of baby led weaning centers around the research by Gill Rapley the ex-Deputy Programme Director of UNICEF UK Baby Friendly Initiative but just as yourself, Haliza, there are still questions asked with regards to baby led weaning.
In the medical standpoint there are many reasons why baby led weaning (BLW) is becoming more popular however there are still some concerns with regards to BLW.
Pros of BLW
1. BLW Enhances Development
Readiness of babies for solid foods coincides with their developing abilities to take food to their mouths and begin to chew. If they have the opportunity, many babies will show their parents they are ready simply by helping themselves to food from someone’s plate. Allowing the babies to follow their instincts plays an important part of their development.
BLW infants have lots of practice exploring different shapes and textures in food, learning how to grip them and get them to their mouth. This improves both hand –eye coordination and dexterity.( Study on BLW led by Professor Charlotte M Wright, Professor of Community Child Health from University of Glasgow which has shown the following 1 Infants who had reached out for food at six months were more likely to be walking unaided at one year than those who had not. 2 They were also more likely to be speaking meaningfully at one year. For example children who reached out for finger foods between four and five months were speaking, compared with those who reached out at seven to eight months. )
2. BLW enhances digestion
BLW experience a range of textures from the start, allowing chewing skills to develop naturally. This helps speech development and reduce the need for orthodontic treatment later. Food that requires chewing spends longer time being mixed with saliva in the mouth hence BLW may promote enhanced digestion. However this issue is still debatable as there are some who disagree as there infants have immature gut with immature digestive systems.
3 BLW reduces incidence of obesity in childhood
When an infant starts weaning on solid foods traditionally he will be spoon fed pureed food, one taste at a time, in a schedule decided by his parents. This causes mealtime battles and many children end up with a diet which is essentially soft processed foods giving rise to childhood obesity.
By allowing your child to explore healthy foods in his own time allows gradual transition and your baby sets the pace for progress with solid foods and decides how quickly he cuts down his milk feeds. Your baby is allowed to eat according to their appetite. They can stop eating when they are no longer hungry and are not encouraged to eat more quickly than they want to, or forced to have ‘one more spoonful’ /’make a clean plate’. Many non-BLW babies have their natural appetite recognition overridden and are encouraged to eat more than they need from the earliest age. Research suggests lower BMI in children age 2-6 years who have done BLW.
Cons of BLW
1. Concerns of choking or gagging
Literatures published about BLW suggests that associated choking is actually LESS compared with traditional spoon feeding. The gag reflex prevents food being pushed too far back without having been chewed adequately, and it is particularly sensitive between six and eight months.
Although gagging is alarming to parents, babies are rarely bothered by it, and it may be that it is an important part of helping them to learn not to overfill their mouths. A paper published earlier this year by researchers in University of Otago revealed that there were incidences of choking however all the incidents were dealt by the infant independently by expelling the foor from their mouth through coughing and parents did not intervene with first aid. However it is a good idea to be prepared on how to deal with a choking incident.
2. Nutritional problems
Parents maybe concerned that their infant will not eat as much as he actually needs. You maybe reassured to discover that babies are actually very good at deciding just how much food their bodies require.
Energy needs maybe insufficient if food is predominantly fruit and vegetable based. There are concerns about intake of nutrients such as iron which is given in fortified infant cereal and pureed meat which may not be given to BLW. To date no research has examined the food and nutrition intake of children following BLW. There is a need for good quality research before firm guidelines and recommendations can be made. There are many trials still ongoing with regards to BLW.
3. Food intolerance/ allergy and digestive problems
If you are starting baby led weaning it has been suggested the 4 day rule – that is if you try new food introduce them separately at least 4 days apart. This will help you spot any sigh of digestive discomfort or allergic reaction.
4. BLW not feasible for infants with delayed motor skills and premature babies
BLW may not be appropriate for children with delayed motor skills or oral motor function who would need to wait before they could self feed effectively. BLW may not be suitable for babies with specific dietry needs such as infants with reflux, low birth weight or premature babies.
Haliza, I hope that I was able to answer your question and the choice to either follow the conventional feeding or “ baby led feeding” should be a informed choice. The topic is still debatable with no clear guidelines however there are many clinical trials which are still ongoing to help answer many of the parental concerns.
Professor Wright at the end of her study suggested that baby led weaning maybe feasible for most infants, it is more realistic to encourage infants to self-feed with solid finger food during family meals but also give them spoon fed purees.
( answered by Dr Charlotte Jane Joseph )