Home Health Care Baby-Led Weaning: A Developmental Perspective

Baby-Led Weaning: A Developmental Perspective

by Melanie Potock MA
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One of the things I like best about teaching courses on feeding to parents and professionals around the United States is learning what new trends are evolving around family mealtimes. Over the past year,  one of the common questions I’m asked is, “What about Baby-Led Weaning?”

Baby-Led Weaning (BLW) is a term coined by Gill Rapley, co-author of “Baby-led Weaning: The Essential Guide to Introducing Solid Foods.”  Rapley graciously chatted with me about her philosophy and explained that although she did not invent BLW, she found the method to be successful in her work as a former health visitor and midwife in the United Kingdom and continues to study the topic today while earning her PhD.

In a nutshell, BLW centers on the philosophy that babies are developmentally capable of reaching for food and putting it in their mouths at about 6 months of age. As stated on the BLW website “You just hand them the food in a suitably-sized piece and if they like it they eat it and if they don’t they won’t.”  Please note that the word “wean” is not referring to weaning from breast or bottle, but instead refers to a term commonly used in the United Kingdom for adding complementary foods to the baby’s current diet of breast milk or formula.  According to the BLW website, ideas for first foods include “chip size” steamed vegetables such as a broccoli spear with the stem as a handle, roasted potato wedges, meat in large enough pieces for the baby to grasp and chew, rice cakes, cucumber, celery and dried apricots.

As a SLP who focuses on pediatric feeding, I view feeding as a developmental process.  Whether I’m working with a child experiencing delays in development or offering advice to a parent whose child is meeting milestones with ease, I always ask myself “How can I respect and support this family’s mealtime culture while guiding this child safely through the developmental course of learning to eat?”  Thus, for families who are interested in following the BLW method, whether their child is in feeding therapy or not, I try to support their wishes if the child is capable,  while offering the following BLW points to consider:

BLW encourages parents to eat with their children, since everyone is eating the same food. 

In today’s busy culture, it feels easier to many parents to feed the baby prior to the adult or family meal, and in BLW the thought is that jarred purees contribute to this habit and it’s important to include baby at the table at an early age.  Even in feeding therapy,  the ultimate goal is for families to be able to gather around the table at mealtimes with everyone enjoying the same foods.  Plus, Columbia University reports that consistent family dinners are an integral and valuable part of raising children.

BLW emphasizes that babies must be the ones to put the food in their mouths.

Feeding therapists encourage self-feeding  for all kids because it allows them to get messy.  Babies are programmed to explore the world with all of their senses, especially their hands and mouths, and often the two together!  BLW notes that the time to begin self-feeding is at 6 months when baby can sit upright on his/her own. I explain to parents that first, every child must have the gross motor stability to support fine motor skills, including reaching and raking for food and controlling their grasp to bring the food to the mouth to be chewed.  For children who have this capability, I feel comfortable with large pieces of food that will not snap off (or allow a solid chunk to fall into the mouth) in addition to short spoons and chewable toys for practicing the skills that will eventually lead to self-feeding.

BLW follows the baby’s cues rather than the parent controlling the feeding via the spoon.

I explain that whether presenting food to your child by placing it on the high chair tray in front of them, directly on a spoon or even mouth to mouth as done in some cultures, reading baby’s cues for readiness is crucial.  Like a beautiful, flowing conversation, feeding children is a reciprocal experience.

According to the BLW blog, BLW introduces chip-size foods (rather than purees or mashed foods) so that baby learns to chew first and then spit out if unable to swallow, noting that with purees on a spoon, babies learn to swallow first and then chew.

From a developmental perspective,  this doesn’t quite fit with my understanding of how infant reflexes integrate  and babies acquire oral motor skills. Babies can begin the process of BOTH spoon and finger feeding between the ages of 5 and 6 months using both purees and soft, safe foods.  Why?  Because this is when babies acquire better lip control and movement as they suck the puree off of a parent’s finger, their own hands or a spoon. As noted in Diane Bahr’s book “Nobody Ever Told Me (or My Mother) That!” this is when babies use their rhythmic bite reflex to bite off soft pieces of safe, soft or meltable foods that they can hold in their tiny fists or when presented by a parent to their open mouths. If the food is placed onto the gums where we will one day see molars, a rotary chew pattern will begin to emerge over time, thanks to reflexive patterns that soon become purposeful movements.  It’s a developmental process and BOTH purees and finger feeding facilitate the progression of skills. It makes sense to me to transition gradually from thinner  liquids (breast milk/formula) to thicker (thus, a smooth puree) to consistently mashed or chopped  while introducing soft meltables over time.

Keep in mind that I also encounter families who are moving too slowly through graduation of textures, as noted in this article by Bahr.  But, jumping straight to only large pieces of foods to be chewed and then either swallowed or spit out feels like skipping crucial steps in the developmental process.  “Feels like” is the key phrase here: We need research to determine if children who follow this model eventually acquire skills traditionally learned prior to chewing chunks of food as listed in this article found in ASHA Perspectives.  Unlike my previous post on sippy cups, where therapists have raised concerns based on their professional experience over several years and observation of prolonged sippy cup use,  consistent BLW practices are a relatively new phenomenon in the United States.  So, when any parent asks “What about Baby Led Weaning?” I try to integrate my own practitioner expertise and knowledge of feeding development while honoring the family’s preferences and mealtime culture.  Still,  my biggest concern for any 6 month old child is choking.

BLW encourages parents to become comfortable with gagging episodes and understand the difference between gagging and choking. 

Gagging versus choking are two different experiences.  Typically, an infant’s gag reflex is triggered when the back three quarters of the tongue is stimulated, but by the time a child reaches 9 months of age, the reflex covers less area, lying on the back third of the tongue. Eventually, the gag reflex shifts posteriorly even more as the child learns to tolerate the stimulation. Gagging is nature’s way of protecting the airway, where true choking occurs.  Choking happens when food (or other substances) obstruct the airway and thus, often has no sound or intermittent, odd sounds.  Other signs of choking include but are not limited to: gasping for breath, turning blue around the lips and beneath the eyes and/or staring with an open mouth while drooling.

Gagging is an uncomfortable sensation where the soft palate suddenly elevates, the jaw thrusts forward and down, and the back of the tongue lifts up and forward.  It is not unusual for a child to vomit after gagging.  In between the gags, the child is still able to breathe, cry and make vocal noises.  The occasional gag is an important built-in safety mechanism, but frequent gags and/or vomiting can lead to an aversion to food.

In summary, when asked for advice from any family that would like to follow Baby Led Weaning principles, I stress the importance of reading baby’s cues and monitoring them closely for safe feeding while supporting them through the developmental process of learning to eat, no matter what age.  This includes proper positioning in the feeding chair for optimal stability and presenting only manageable pieces of safe, meltable and/or solid foods that do not pose a choking hazard.  For children in feeding therapy, incorporating some aspects of BLW is dependent on that child’s individual delays or challenges and where they are in the developmental process, regardless of chronological age.  My primary concern for any child is safety – be aware and be informed, while respecting each family’s mealtime culture.

Melanie Potock, MA, CCC-SLP, treats children birth to teens who have difficulty eating.  She is the author of Happy Mealtimes with Happy Kids and the producer of the award-winning kids’ CD Dancing in the Kitchen: Songs that Celebrate the Joy of Food!  Melanie’s two-day course on pediatric feeding is  offered for ASHA CEUs and includes both her book and CD for each attendee. Melanie@mymunchbug.com.

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Jena February 4, 2014 - 10:34 am

Thank you for this fantastic article Melanie! A few months before my son was born I observed an OT friend of mine doing BLW with her child and thought it was brilliant. Now that my son is 4 months old, I am interested in learning more so that in a few months we can try this out. Thank you for the valuable information!

Melanie Potock February 4, 2014 - 10:54 am

Hi Jena! I’ll be excited to hear how it goes – take lots of pictures – it’s a precious time! Thank you for your kind words about the article. It’s a new trend in the U.S. and something for all of us to explore, keeping safety in mind and sharing our experiences as we learn more.

Melanie Potock February 4, 2014 - 1:06 pm

I’d like to clarify, for all readers, that Ms. Rapley recommends visiting the BLW website noted in this article, but does not have any direct connection with the site.

Katie February 4, 2014 - 5:24 pm

Hi Melanie,

I am glad to see this post. I personally used baby food with my daughter and BLW with my son…and I have to say I prefer BLW 100%. To me, it actually makes more sense developmentally. I never understood the “rice cereal” thing. Why do we need to give our children highly processed and “made up” foods? I mean, as adults we do not eat “rice cereal.”

We did sometimes use a spoon to feed my son here and there but we used foods that were NATURALLY eaten with a spoon, like yogurt or apple sauce, but we didn’t waste money on packaged and processed baby food, nor did I waste my time making “baby food.” Interestingly, my son will eat ANYTHING and it is my daughter who is the picky eater. I will be using BLW with my 5 month old when we introduce solids, sometime after 6 months of age.

My mother in law fed her kids like this as well…there just wan’t a “term” for it back then. I think that maybe we are going back to the way “it used to be” before the industrial/technological era. There as a time when formula was treated like the “better” option for babies and women were encouraged NOT to breastfeed. We know now that is totally incorrect, and I feel the baby food industry may have had a similar effect on our babies’ eating.

Thanks again for this post!

Melanie Potock February 4, 2014 - 11:20 pm

Hi Katie, Thank you for your thoughtful, insightful comments. Always great to hear first hand of one person’s experiences – that’s terrific! I love purees – and yes, like you, shy away from rice cereal, for a variety of reasons. The thing I love most about discussing all the options is it gets parents thinking about all the possibilities and what might be best for each their child. Thank you for your kind words about this post and thanks once more for your input!

Natalia February 4, 2014 - 10:44 pm

Wonderful post, Melanie. Thanks so much for your perspective on responsive feeding, it warmed a dietitian’s heart :). I absolutely agree, regardless of the feeding approach the most important thing is to stay attuned to baby’s cues and enjoy mealtimes together. I feel like a spoon/finger foods combo is the best way for most parents to go. The discussion on chewing vs swallowing mechanisms was particularly useful for me, it is always great to learn new things that help me understand my little patients better. From my point of view the biggest advantage of BLW is that it makes it really hard for parents to get the baby to eat more than the baby wants, while it is relatively easy to get pushy with a spoon. But it does not mean that feeding with a spoon must result in overfeeding the baby. If the parents are practicing the Division of Responsibility (responsive feeding approach applicable to ALL ages, not just babies), their baby will learn to accept a variety of foods and stay attuned to inner hunger-satiety cues. Another attractive point about BLW is that babies get to learn to like the food their parents are eating. But it is also very easy to mash up some roasted or steamed veggies that are served for the family and feed them with a spoon if the baby os not interested in finger foods. In two words, BLW is not the only way to raise healthy and adventurous eaters, being responsive and positive at mealtimes is more important than following any feeding philosophy.

Melanie Potock February 5, 2014 - 10:53 am

Nicely said, thank you Natalia!

Silvia February 5, 2014 - 2:20 am

Hi Melanie,

I was introduced to BLW five years ago when my first daughter was born. It was through an English friend, many moms use this method of feeding in the UK. At first I didn’t like the mess, I was doing a mix of purée and BLW, but I wasn’t so sure. After a few months into it I totally stopped spoon feeding and embraced BLW. It was so much easier, so much more fun for me and the baby and she was developing so well. When my second daughter came I had no problem doing BLW. My girls now ages 2 and 5 did really well and meal time is never a problem at our house. They eat almost everything we eat and they enjoy going to restaurants and trying new foods. Now that my son is 6 months old of course I will do the same because that is what works for our family.

I am happy to see that BLW has finally “arrived” in America and others families will have a chance to try it as well. I have been giving the BLW book to new moms as part of a gift package that I put together with my “all time favorites must have baby things” since 2012 🙂

Melanie Potock February 5, 2014 - 10:52 am

Hi Silvia, so great to hear this, thank you!

Heather Fyffe Dunham February 5, 2014 - 12:35 pm

I appreciate that you said ” “Feels like” is the key phrase here” — because my personal opinion is that it really is only because we have been taught that the liquid-mush-thick mush-solid progression is what is normal. It’s the only experience most of us had. It does make *some* logical sense, but that doesn’t mean it’s the “normal”, the “only”, or even the “best” progression.

Many developmental stages happen in leaps and not in miniscule graduated steps. A baby does not learn to walk by first commando crawling, then hands and knees crawling, then bear crawling (hands and feet), then upright shuffling on their knees, then duck walking, then walking with a crouch, then walking upright. They sit, then they crawl, then they walk.

The intermediary steps of infant feeding “feel like”, to me, utterly something imposed by the adult, and not something inherently, biologically demanded. Why would chewing need to be practiced and stimulated with soft mashed foods on the gums, when it is equally practiced with more solid foods on the gums?

The ‘logic’ of the standard progression comes more directly from the early-20th-century practice of bottle-feeding (believed by doctors at the time to be ‘more scientific’ and thus superior to breastfeeding) when formula did not contain iron, due to manufacturing limitations of the day. Pablum was invented specifically to provide an iron source, and was designed to dissolve in a bottle, and was introduced as early as 3 weeks. But rather than being seen as a ‘supplement’ to formula, it was seen as “first food”. Gradually, the formula/pablum mix was thickened. And because these infants were just a few months old, they had to be given this mush — they are not yet capable of chewing and manipulating food in their mouths. By the time they were 6 months old, they were progressing quite naturally to finger foods.

Over the decades, we have increased the recommended age for starting solids (and rightly so), but we did not change the schedule of implementation. The schedule of liquid to mush to semi-solid etc is still based on the requirements of starting with a 3-month old infant, who is not able to chew and self-feed. The requirements of the 6mo child are completely different, and these intermediary stages are completely unnecessary.

While I’m not an expert on the research, anecdotally you hear many more stories of older babies having texture issues when attempting to move on the ‘next stage’, especially in regards to the stage where baby food is still mostly soft but with some lumps in it. Understandably so, how confusing must that be? I would suggest that it’s not different *enough* from puree for babies to understand that they must not simply suck the food off the spoon as they’re accustomed to.

And also anecdotally, every parent I know who has done BLW, reports it to be a great success. There are no issues with any developmental skills, no transitional problems, they grow into healthy eaters with, in general, a greater awareness of their own appetite and a greater variety of flavours and textures enjoyed. My own daughter is an example of this. My older son, who was traditionally weaned with rice cereal and progressive mush, is a “white bread and pasta” kind of kid.

One final note for clarification — the term ‘weaning’, as used in the UK, is actually the more accurate and original usage of the term. It does not actually refer specifically to the *onset* of solid foods. It refers to the entire process, the gradual weaning from all breast to all solids. In other usages of the word you’ll see that meaning — “weaning off” a medication, for instance. It means a “gradual process”, not a particular moment or event. When a child has their first taste of solid foods, they have begun the weaning process — and they are continually ‘weaning’ until they are ‘weaned’ — when they no longer have any breast milk or bottles.

The difference in the cultural usage is that the UK tend to refer to ‘weaning’ – quite correctly – from the beginning of the process, whereas over here, we focus on the end of the process.

Melanie Potock February 5, 2014 - 10:08 pm

Hi Heather, I think your points are something to consider. Thank you for taking the time to write such an eloquent comment. You’ve got me thinking!

Alexandra Ameen February 11, 2014 - 10:57 am

Hi Melanie
many thanks for your excellent article. I work as a speech language pathologist in Malta and part of my caseload are kiddies with feeding and swallowing difficulties. I found your ideas really helpful which I have shared with my colleagues. I’m currently in the process of writing a brief article in a local journal that deals mainly on babies and nutrition. This journal is geared for new mummies. I was wondering whether it was okay that i use your material for my short writeup. I will be of course be quoting you as being my source of information. I will send you a draft of the article prior to its publication should you wish to.
Many thanks once again and sending my best regards

Alexandra Ameen

Melanie Potock February 11, 2014 - 1:26 pm

Hi Alexandra, Thank you for your kind words! Please email me at melanie@mymunchbug.com and let’s chat.

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