- What is Baby-Led Weaning and when should it begin?
- Can parents wait until six months to introduce solid food to their infant?
- Can infants self-feed successfully from six months of age and is it safe for them to eat unmodified family foods this early?
- Can parents meet expectations around family meals and continued breastfeeding?
2. Search Methods
- published in English;
- conducted in an industrialized country (for the purposes of this review: Australia, European countries, New Zealand, United Kingdom, United States of America), i.e., in order to discriminate from countries with a lower standard of living and poorer health status which would complicate the cross-country comparisons of infant feeding practices;
- reported original data;
- reported multivariate analysis (only applies to complementary feeding studies);
- published from 2002 onwards (i.e., since the WHO changed its infant feeding guidelines).
|Search terms used to identify Baby-Led Weaning studies|
|Search terms used to identify factors associated with introduction of complementary foods at 6 months|
3. What Is Baby-Led Weaning and When Should It Begin?
|Food||Conventional method||BLW at age 6 to 7 months|
|Broccoli||Puréed or mashed||Served as a floret-sized piece, large enough for the infant to hold with some protruding from the fist. Steamed to a soft consistency.|
|Banana||Puréed or mashed||Skin is left on the bottom section of the banana (this gives the infant something to grip) and the top section is peeled for infant to eat.|
|Pasta||Puréed with meat or vegetables||Large pieces such as spirals or strips of lasagne are offered as part of the meal.|
|Beef||Puréed with liquid||Slow cooked or stewed, offered as a chunk or a strip of meat, large enough for the infant to hold with some protruding from the fist.|
3.1. How Is BLW Defined?
3.2. What Do We Know to Date?
|Author (Date) [reference]||Participants||Design and Methods||Definition of BLW||Main findings|
|Brown and Lee (2011) ||n = 655||Cross sectional||Spoon-feeding and purée use ≤10% of time||Mothers using BLW had higher education, were more likely to breastfeed and were less likely to be returning to work before 12 months postpartum.|
|UK mothers with infant aged 6-12 months||Online questionnaire|
|Recruited online and from community groups||Infants following BLW were more likely to have meals with family and eat the same food as family.|
|Brown and Lee (2011) ||n = 652||Cross sectional||Spoon-feeding and purée use ≤10% of time||Mothers following BLW reported lower levels of restriction, pressure to eat, monitoring and concern over child weight compared to mothers following SW.|
|UK mothers with infant aged 6-12 months||Online questionnaire|
|Recruited online and from community groups||No association between weaning style (SW or BLW) and infant weight.|
|Brown and Lee (2011) ||n = 36||Cross sectional||Self-reported||Mothers reported:|
|UK mothers following BLW with infant aged 12-18 months||Semi-structured face-to-face interviews||(1) Positive experiences including: more convenient (at meal times and when out and about), reduced cost, didn’t have to worry about following a plan, thought baby would develop healthier eating patterns, thought baby enjoyed it more and “it made sense”.|
|Recruited online at BLW websites|
|(2) Infants participated in family meals and generally ate what the family ate.|
|(3) Some challenges including mess, food wastage, and anxiety about potential choking in the first few weeks of BLW.|
|Rowan and Harris (2012) ||n = 10||Cross-sectional||Planned to use BLW techniques and had read the BLW book by Rapley and Murkett ∗||Parents offered 57% of family foods to infant.|
|Parents of infant aged 6 months||Two 3-DDR at 6 and 9 months||No change in parents’ diets.|
|Recruited at BLW websites|
|Townsend and Pitchford (2012) ||n = 155||Case-control||Self-reported||Compared to the SW group, the BLW group demonstrated significantly increased liking for “carbohydrates”.|
|UK parent of infant aged (20-78 months)||Questionnaire|
|There appeared to be an increased incidence of underweight in the BLW and obesity in the SW group (significance not tested).|
|Recruited online at BLW websites (cases) and from laboratory database (controls)|
|Moore, Milligan and Goff (2012) ||n = 3607||Cross sectional||Self-reported||“Baby-Led” or “finger foods” weaning approach was the strongest predictor for weaning at or later than 26 weeks.|
|UK parents||Online questionnaire|
|Recruited at parenting groups and online forums|
|Cameron, Heath and Taylor (2012) ||Healthcare professionals (n = 31)||Cross-Sectional||Self reported||Health professionals suggested potential benefits of BLW such as greater opportunity for family meals, fewer mealtime battles, healthier eating behaviours, greater convenience, and possible developmental advantages. However they also had concerns about potential choking, iron intake and growth.|
|Mothers who had used BLW (n = 20)|
|Recruited by advertisement, email and parenting groups|
|Mothers considered BLW to be a healthier, more convenient and less stressful way to introduce complementary foods.30% (n = 4) mothers reported at least one choking episode-most commonly with raw apple.|
|Responsive Feeding as Defined by Black  in the Context of Obesity Prevention||Responsive Feeding Defined by WHO  in the Context of Health and Illness|
3.3. At What Age Should BLW Commence?
4. Can Parents Wait until Six Months to Introduce Solid Food to Their Infant?
4.1. Risk Factors for Introducing Complementary Foods before Six Months
|Author, year [reference] country||N||Study Type and Methods||PositiveAssociation||Negative Association||No Association||Confounders Adjustedfor|
|Alder et al. (2004)  UK||286||Prospective Cohort||Influenced by grandmother’s opinion, high deprivation score, disagree with IFR, friends disagree with IFR, received free sample of baby food||Maternal age, infant sex, employed before pregnancy, looking forward to giving solids, giving the infant solids <4 months means they have reached a milestone, people who are important to me say wait until 4 months||Maternal age, infant sex, influenced by grandmother’s opinion, high deprivation score, disagree with IFR, friends disagree with IFR, received free sample of baby food, employed before pregnancy, looking forward to giving solids, giving the infant solids <4 months means they have reached a milestone, influence of others|
|Interview at 12 weeks, & Questionnaire at 20 weeks postpartum|
|Coleman et al. * (2009)  Canada||2153||Cross sectional||Maternal smoking during pregnancy, FF infant, living with a smoker, maternal age (≤27 years) not attending prenatal class, low, first child||Parity||Maternal age, maternal smoking during pregnancy, parity, marital status, method of infant feeding at 3 months, living with a smoker, prenatal class attendance, income|
|Phone survey at 3 & 9 months postpartum|
|Crocetti, Dudas and Krugman (2004)  USA||102||Cross sectional||Ethnicity (Hispanic)||Maternal age (<20 years), maternal ethnicity, maternal education, BF, Medicaid||Maternal age, caring for 1 child, awareness of infant feeding guidelines, race, insurance, maternal education, type of milk feeding|
|Questionnaire at 4 months postpartum|
|Dratva, Merten & Ackermann-Liebrich (2006)  Switzerland||2868||Cross sectional||Multiparous (Swiss mothers only), allergic predisposition (Swiss mothers only)||Maternal age (<20 years), residing in French & Italian speaking region of Switzerland, high maternal BMI, maternal smoking before birth||Mothers attentiveness to own diet, health problems at birth, health problems now, birth weight||Income, maternal education, work after birth, raising child alone, infant sex, nationality|
|Questionnaire & 24 h dietary recall|
|Erkkola et al .(2005)  Finland||429||Prospective cohort||Maternal age (1 year increments), high maternal & paternal education, infant sex (girl)||Not listed||Maternal age, maternal education, infant sex, parity, infant’s ponderal index at birth|
|Questionnaire at 3, 6, 12, 18, 24 months postpartum|
|Fewtrell et al. (2003)  UK||Data from >2000 infants from 7 prospective randomised trails||Maternal age||Smoking, not BF||Birth weight||Type of milk fed, maternal age, birth weight, sex, whether mother and father smoked during 2nd and 3rd trimesters, social class, child’s birth order, maternal education|
|Giovannini et al. (2004)  Italy||1221||Cross sectional||Introduction of formula, not BF infant, infant weight at 1 month, maternal smoking||Maternal age, pacifier use at 1 month||Maternal age, maternal BMI, maternal education, maternal smoking, type of delivery, mother having been breastfed, infant sex, infant weight at 1 month, pacifier use at hospital ward & at 1 month, parity, introduction of formula, formula promotion at discharge, time of initiation of BF|
|Phone Interview at 30 days, 1, 3, 6 & 9 months postpartum|
|Griffiths et al. (2007)  England||11,286||Cross sectional analysis of MCS||Ethnic minority, mother not returning to work ≤4 months postpartum||Low maternal education (non-white), high SES (non-white), stopped BF ≤4 months||Maternal qualification (white), lone mother status,||SES, maternal education, maternal employment status, lone mother status, maternal age at MCS birth, maternal age at first birth, parity, BF|
|Questionnaire at 9 months postpartum|
|Grummer-Strawn et al. (2008)  USA||2707||Prospective cohort (IFPS II)||Maternal age (>25 years), high maternal education, living in western region, BF in hospital||WIC participant, Income (185%-350%, of federal poverty level)||Race, parity||Maternal age, education, ethnicity, race, parity, income, WIC participant, region, BF in hospital & BF at 24-28 weeks|
|Questionnaire (1-6 months) then 7½, 9, 10½, & 12 months|
|Hampson et al. (2010)  Norway||37,919||Prospective cohort||High negative affectivity score||Not listed||Maternal age, maternal BMI, maternal education|
|Questionnaire at 17 & 30 weeks gestation & 6 months postpartum|
|Hart & Drotar (2006)  USA||98||Cross sectional||Doctor’s recommendations to start food, marital status||Number of solutions generated to child-rearing problems||Marital status, child’s age|
|Questionnaire (infant aged 6-18 months)|
|Kim et al. (2008)  USA||8150||Cross sectional||Attending childcare before 3 months of age||Not listed||Infant age, sex, race/ethnicity, birth weight, prematurity, household poverty, maternal education, maternal employment, marital status, maternal smoking, maternal pre-pregnancy BMI, BF initiation or early introduction of food|
|Interview at 9 months|
|Lande et al. (2003)  Norway||2383||Cross sectional Nationwide survey||Maternal age (>25), maternal education, degree of urbanization, infant sex (girl), geographic region (east, south, top, north)||Maternal smoking, geographic region (west)||Not listed||Maternal age, maternal education, maternal smoking, degree of urbanization, infant sex, geographic region|
|FFQ at 6 months & retrospective FFQ for ≤5 months, birth records|
|Rebhan et al. (2009)  Germany||3103||Prospective cohort||Maternal age (>34 years), low maternal education, country of birth (outside Germany), maternal smoking, not BF at 4 months||Family status, infant sex, parity, BF problems, attitude of father to BF, parents with allergy, caffeine, maternal BMI, districts of Bavaria, clinic size||Maternal age, maternal education, country of birth, maternal smoking, infant sex, BF at 4 months, family status, parity, BF problems, attitude of father to BF, parents with allergy, caffeine, maternal BMI, districts of Bavaria, clinic size|
|Questionnaire at 6 days, 2, 4, 6 & 9 months|
|Schiess et al. (2009)  5 European countries (Germany, Belgium, Italy, Poland, Spain)||851 FF, 349 BF||Multicentre intervention||Low maternal education (FF & BF), maternal smoking (FF), country of residence (Belgium & Spain) for BF, only Belgium for FF||Maternal age (BF), maternal smoking (BF), birth weight, birth order, infant sex||Country of residence, maternal age, maternal education, maternal smoking|
|3-DDR at each completed month from 1-9 &12|
|Scott et al. (2009)  Australia||519||Prospective cohort (PIFSII)||Maternal age (<20 years), maternal smoking, fully FF at 4 weeks, partially BF at 4 weeks||Infant sex, birth weight, admission to SCN, infant feeding at discharge, maternal education, marital status, country of birth, parity, mother returning to work at 12 months, infant feeding attitude score||Maternal age, maternal smoking, infant sex, birth weight, infant feeding at 4 weeks, admission to SCN, infant feeding at discharge, maternal education, marital status, country of birth, parity, mother returning to work at 12 months, infant feeding attitude score|
|Baseline Qu, phone Intvs at 4, 10, 16, 22, 32, 40 & 52 weeks|
|Tatone-Tokuda et al. (2009)  Canada||2223||Cross-sectional analysis on QLSCD||Low maternal self-efficacy ‡, immigrant||Maternal smoking during pregnancy, low maternal education, maternal age (<35 years), parental impact ‡, low SES, infant sex (boy), infant birth weight (>2.5 kg)||Mother’s perception of overprotectiveness, main employment status of the mother||All variable in model (maternal self-efficacy, mothers perception of parental impact, mother smoking during pregnancy, maternal education, maternal age immigrant status, SES, infant sex, infant birth weight|
|Interviews & Questionnaires at 5 months, birth records|
|Tarrant et al. (2010)  Ireland||401||Prospective cohort||Public health nurse as principal source of advice||Maternal age (≤34), low maternal education, mothers reporting infants should start at 12 weeks, FF at 12 weeks, maternal grandmother as principal source of advice||Smoking status during pregnancy, birth weight||Maternal age, maternal education, smoking status during pregnancy, parity, infant birth weight, gestational age of infant at birth|
|Questionnaire & DH at 6 weeks & 6 months|
|Wasser et al. (2010)  USA||217||Cross sectional anaylsis of the Infant Care study||Any BF, maternal education||Distress to limitation, activity level, maternal obesity (BMI ≥ 30)||Soothability, infant sex, infant age, social desirability||Maternal BMI, soothability, infant sex, infant age, social desirability, distress to limitation, activity level|
|Infant DH, 24 h DR at 3 months postpartum|
|Wright et al. (2004)  UK||207||MCS||BF at 4 months||Baby seemed hungry, high deprivation score||Not listed||BF at 4 months, baby seemed hungry, high deprivation scores, infant weight gain|
|Questionnaires at 6 weeks, 4, 8, 12 months postpartum|
4.2. How Modifiable Are These Risk Factors?
4.3. Implications of Waiting until Six Months to Introduce Complementary Foods
4.4. What If Parents Can’t Wait until 6 Months to Introduce Complementary Foods?
5. Can Infants Self-Feed Successfully from Six Months of Age, and Is It Safe for Them to Eat Unmodified Family Foods This Early?
6. Can Parents Meet Expectations around Family Meals and Continued Breastfeeding?
7. Conclusion: What Questions Remain and How Feasible Is BLW as an Approach to Infant Feeding?
- (1) Do parents who follow a BLW approach generally wait until the infant is six months of age before starting complementary foods? If not, do they use formula, introduce BLW early, or use purées until the child is able to self-feed?
- (2) How is BLW defined; can a limited amount of spoon-feeding and purées be used and what commonly occurs in practice?
- (3) Does responsive parenting lead to BLW or are people interested in BLW more likely to use responsive parenting practices?
- (4) Do infants following BLW obtain sufficient nutrients, including energy and iron, or eat a more diverse range of foods?
- (5) Is BLW a viable approach for obesity prevention, via improving self-regulation of energy intake?
- (6) Are iron deficiency, choking and growth faltering real concerns for those following a Baby-Led approach?
Conflict of Interest
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