Baby-led weaning is an alternative method for introducing complementary foods to infants, where the infant feeds themselves hand-held foods instead of being spoon-fed pureed foods by an adult.

I first came across the concept of baby-led weaning just over a year ago when I was giving a talk to a group of new parents on starting solids. One or two mums in the group had tried the approach, so I asked how this had gone for them. Their reply was that they had had limited success; by way of an example, one mum said that her baby had just “gummed a chunk of meat around his mouth and had then spat it out”. No big surprise there really!

At the time, I think my main concerns were the risk of the baby choking on large chunks of food, and also the risk of the baby not getting enough nutrition.

I started to delve into this further and realised there is actually very little evidence-based research to back what seems to be a growing trend among some new parents, although it is certainly an area of growing interest among researchers.

A paper published earlier this year (February 2012) in BMJ open suggested that infants allowed to feed themselves with finger foods from the start of weaning (baby-led weaning) are likely to eat more healthily and be an appropriate weight as they get older than infants spoon-fed purees. The study was based on a parental questionnaire, and the researchers concluded by saying:

“Weaning style impacts on food preferences and health in early childhood. Our 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. This has implications for combating the well-documented rise of obesity in contemporary societies.”

But what about the nutritional adequacy of the diets of young infants? I ask this question since infants have incredibly high nutritional needs. For example a seven-month-old, on average, has a higher iron requirement (RDI 11mg/day) than an adult man (RDI 8mg/day). If a baby can not swallow the food as it is in a whole form (a chunk of steak) rather than in puree form, which is easier to swallow, what impact will this have on the child’s nutritional status?

A paper published earlier this month in the journal Nutrients by researchers at the University of Otago reviewed the evidence on baby-led weaning as an approach to infant feeding and discusses some of these concerns. If this is a topic of interest you, I’d recommend having a read of this very comprehensive review.

With regard to choking, a common concern among children of this age, the review reports that:

“We found in our recent qualitative study that 30% of parents reported one or more episodes of choking with baby-led weaning. However, all parents who reported choking also reported that the infant independently dealt with the choking by expelling the food from their mouth through coughing, and that parents did not have to intervene with first aid.”

So that’s good news. It’s always important to keep a close eye on infants of this age, though, when they are eating, whatever approach to feeding is being adopted.

From a nutritional perspective, there are concerns about intakes of nutrients such as iron, particularly given that foods such as fortified baby cereals and pureed meat are key contributors to iron intake and may not be provided to infants following a baby-led weaning approach. The review reports that:

“Parents following baby-led weaning may require clearer guidelines around the types and amounts of high iron foods to offer their infant in place of iron fortified infant cereal, both to ensure adequate intake, and to avoid choking. To date, no research has examined the food and nutrient intake of children following baby-led weaning to determine whether they are at increased risk of iron deficiency. The high iron requirements in this age group mean that baby-led weaning is not likely to be appropriate for children with delayed motor skills or oral motor function who would need to wait before they could self-feed effectively.”

There is also a concern that energy needs may be insufficient if foods are predominantly fruit and vegetable based.

The authors of this review summarise by saying that although most infants probably have the skills to self-feed safely at six months, more research is needed to determine whether nutrient intakes are adequate and whether more guidance is needed for parents to ensure appropriate foods are provided to ensure optimal nutritional status and to minimise any risk of choking.

Basically, there is really a need for some good quality research into this approach before firm guidelines and recommendations can be made to parents. But the good news is that a randomised-controlled trial is about to start in New Zealand. Results should be available in 2015.