Baby-led weaning

Baby-led weaning (aka skipping purees and just giving your child solid food) seems to be everywhere. Moms tout the ease of just feeding your child whatever it is your family is eating for dinner, perhaps with some additional cooking to make sure vegetables are soft enough. They also recite a ton of health benefits, including the idea that letting children control their food intake early on will lead to better eating habits and lower chances for obesity later in life. It sounds too good to be true. When considering whether we wanted to use baby-led weaning with Little Bear, I started off talking to a friend of mine who used that approach. She started her littles with large pieces of soft foods like banana and avocado and then gradually worked up to sharing meals with them. This sounded great, and I was on board and ready to go!

At our 6 month checkup, I asked our pediatrician (who I completely trust) about this approach. She was not a fan. Specifically, she was worried that babies would "bite" off too big a chunk and then choke. Honestly, this is something that I was worried about too, even though all the BLW blogs say it's not really that big of a deal. I pressed her and asked more questions, but she was still reluctant to support BLW. She said she would start with cereal (although the American Academy of Pediatrics says there's no reason you HAVE to start cereal instead of going straight to fruit or veggie puree) and then pureed foods. She said she would not recommend finger foods until baby developed a pincer grasp (around 8-9 months) and could pick up small pieces of food (cut to the size of the baby's smallest pinky joint). So, all told, our pediatrician did not recommend giving giant hunks of food right off the bat like BLW suggests. She did say that we could give mashed banana, mashed avodaco, or grated apple (never give raw apple pieces until much older) if we insisted on the BLW approach.

Now I was torn. The mommy blogs were leading me toward BLW, but my pedi was against it. So, I tracked down the research myself. It turns out that there's not much formal research on BLW; most things are just people anecdotal postings online (lots of blogs on this topic). The term BLW was coined by Gill Rapley who did her master's thesis on this approach to introducing solids.

BLW supporters say that it exposes your child to a wider range of flavors and textures. There is evidence that exposure to a variety of fruits and vegetables early on is beneficial; for example, children who eat a variety of flavors are more likely to accept new foods and those who are consuming home-cooked fruits/vegetables at 6 months of age are more likely to consume fruits and veggies at 7 years of age (Emmett, et al., 2007). However, early exposure to a variety of flavors and textures is not exclusive to baby-led weaning; you could easily accomplish the same goals using the traditional puree-introduction approach.

BLW advocates say that letting children pace their own food intake leads to better health outcomes down the line. Research by Townsend & Pitchford (2012) investigated whether feeding style impacted BMI and food preferences. They found that the BLW group had increased liking for carbohydrates and lower BMI. However, the BMI analysis did not adjust for other variables that could affect BMI and may differ between the BLW group and the spoon-fed group, like maternal and paternal BMI, SES, parental education, etc. Other studies (Brown & Lee, 2010) have shown that people following a BLW approach are more likely to be highly educated, which could have an impact on those kids having lower BMI aside from any BLW effects. So I wouldn't take this study at face value until more follow up was done with better controls. Another study by Brown & Lee (2013) investigated the role of feeding style in satiety-responsiveness (knowing when you're full). The BLW group had greater satiety responsiveness and healthier weight trajectories compared to standard weaning. This study controlled for maternal education, breastfeeding duration, and time of introduction of solids, so this is a better study than the Townsend and Pitchford in that sense. Education, age of solid introduction, and breastfeeding duration were associated with satiety-responsiveness across both groups. Although the satiety-responsiveness difference between BLW and standard was significant, the difference is only 0.21, which is numerically very small. They don't report effect sizes, so it's hard to know whether the statistical significance translates to any practical significance. I would keep in mind that this is only one study and needs to be replicated, preferably with a controlled trial. However, the results do suggest that there could be some benefits of BLW for later appetite control and weight.

The American Academy of Pediatrics still recommends starting with purees and moving slowly to chunkier textures. I can't find any real evidence that this approach is worse than BLW, although I still like the BLW concept of letting children feed themselves. The AAP does encourage that behavior, but not until 8-9 months (again, when babies have the pincer grasp rather than the palmar grasp).

So, what did we decide? We're going to go the traditional puree route, perhaps with some chunkier mashes that she can try to pick up (and we'll just see how it goes). The book "Baby 411" has an excellent table that lists out phase 1, phase 2, and phase 3 foods for all different food groups (fruits, veggies, meat), so that's what I based our choices on. We also decided to make our own purees rather than buying premade baby food; it's much, much cheaper and not at all difficult as long as you own a food processor. We started out with sweet potatoes, then moved to peaches, pears, banana, carrots, cereal, applesauce, squash, etc. (in that order, waiting about 3 days between introduction of each new food).