13 June 2018
Lately, several of my patients have asked me about baby-led weaning. To be honest, at first I thought, “baby-led what?”, but then I did some research and have become very interested in this newer approach to feeding babies from 6 months of age and onward.
In the United States, “weaning” means the cessation of breastfeeding. However, in other countries, weaning refers to the introduction of complementary foods. (In this context, complementary foods refers to any nutrition given to an infant that is not breast milk or formula.)
While baby-led weaning (BLW) is just starting to become popular here in the U.S., it is much more widespread in the UK, Australia and New Zealand.
So, how does baby-led weaning work?
Ideally, a baby should be exclusively breastfed until 6 months of age. When you think about it, breastfed babies already know how to self-regulate their caloric intake. They’re the ones who decide when to end a feeding session, as opposed to formula-fed babies who are offered a set amount of milk determined by the person feeding them.
As a parent, you can still decide to use baby-led weaning even if you’ve been formula feeding your baby, or if your baby has had both breast milk and formula.
Recommendations for when to start baby-led weaning
Years ago, the American Academy of Pediatrics recommended that solid foods should be introduced to babies around 4 months of age. It has since been established that introducing solids earlier than that can led to increased risk of diabetes, obesity and even allergies.
In the past 10 years, however, the AAP has revised its recommendation and now, along with the World Health Organization, advises that infants should be breastfed exclusively from birth until 6 months old and that complementary foods should not be introduced until after that.
Before these recommendations came out, infants were being offered complimentary foods as young as 4 months old, in the form of purées fed with a spoon. However, by 6 months of age, most healthy babies have the gross and fine motor skills to able to eat more solid, larger pieces of food by picking them up on their own.
Age is not the only important factor in determining when to start baby-led weaning
As well as being at least 6 months old, a baby must have certain gross motor skills to be weaned off milk and introduced to complementary foods. In order to be successful and safe (i.e., not choke), babies must be able to hold their head up well, sit on their own with little or no assistance, no longer have a tongue thrust reflex (where the baby reflexively pushes food out of their mouth) and be able to reach for and grab an object.
By around 6 months of age, most healthy babies have acquired these skills. If not, we at Westchester Health Pediatrics recommend postponing complimentary foods until your baby does exhibit these skills. Until then, feed traditional purées.
With BLW, you provide healthy foods of an appropriate size and texture and your baby decides what to eat and how much
The thinking behind this approach is that if babies regulate their own intake of healthy foods, they learn to read their own hunger cues and know when they’re full. This in turn may lead to less obesity, less pickiness/food aversion and a healthier outlook on eating in the future. (There have not yet been any well-controlled studies to prove this theory, but hopefully there will be some soon.)
So how do you as a parent help your baby self-regulate his/her eating? First, start by establishing mealtime as a relaxed part of the day or evening, without pressuring your baby to eat a certain amount of food in a set amount of time. Ideally, your baby will be eating at the same time as the rest of the family.
Your baby should be sitting upright and always under adult supervision during mealtime. Place appropriate foods in front of your baby but DO NOT FEED HIM/HER. Only your baby actually puts the food in his/her mouth.
Parents, keep in mind that at first, babies may only play with the food without eating much. Also, many foods may need to be presented to your baby up to 10-15 times before he/she will accept this new taste and texture. During this process, patience is a must!
Most traditional baby foods that are offered as pureés can also be prepared in a way that is appropriate for BLW
Baby-led weaning should not be started until 6 months because by then, a baby’s digestive system is ready for more complex foods. Soft, cooked vegetables cut into sticks and soft fruits such as bananas and avocados in “graspable” pieces are perfect choices for this stage of feeding your baby. Meatballs, meats cooked well and cut into pinky-size pieces, cheeses, well-cooked eggs and fish are also great options. At this stage, we recommend giving your baby water in a straw or sippy cup during meal time.
Infant cereal probably should not be offered to a baby being fed this way because it requires spoon-feeding. However, since meats and other iron-rich foods can be offered, feeding your baby cereal is not important.
What foods are not ok to feed your baby at this stage?
- Babies should not have any raw honey before they turn 1 year old because of the risk of botulism.
- No nuts, raw vegetables or hard fruits such as apples.
- No foods cut into a “coin” shape.
- The AAP recommends that babies and toddlers should not be given fruit juices unless it’s to treat constipation.
Certain rules apply to both baby-led weaning as well as spoon-feeding
- New foods should be introduced one at a time.
- Wait 3-4 days before introducing another new food. This does not decrease the likelihood of an allergy, but it does make it easier to discern which food a baby has reacted to.
- Babies should not be given foods with added sugar or salt.
- Mealtime should be relaxed and not pressured.
- Ideally, parents should model healthy eating habits.
Does baby-led weaning result in more frequent choking since babies are offered larger pieces of food?
One randomized control study done in New Zealand in 2015 showed that there were no more choking episodes in the baby-led feeding group than in the spoon-fed group. However, we at Westchester Health Pediatrics want to emphasize that parents should always keep their child upright, never leave them unattended at mealtimes and offer only “safe” foods.
Yes, mealtimes with your baby can be fun!
Hopefully, you and your baby will find mealtime a safe, fun, relaxing time where you can both enjoy healthy foods together. When you allow your baby to self-wean, he/she can explore new tastes and textures and practice some autonomy, while you get a lot of great photo opportunities. A true win-win!
To learn more
Have questions about when and how to introduce solid foods? Come see us
Knowing when and how to wean your baby from milk, either breast or formula, and onto solid foods can be an anxious time for some parents. We understand, we’re parents too. For information, guidance and support, please make an appointment with American Academy of Pediatrics to see one of our pediatricians. We’ll share our years of experience with you and answer any questions you may have. All along the way, we’re your partners in raising a happy, healthy child. Whenever, wherever you need us, we’re here for you.