While I have been aware of different philosophies with regards to how one should start feeding complementary foods to babies (Should you give fruits or vegetables first?), I was not aware of the idea of “baby-led weaning.” While it hasn’t seemed to gain much traction yet here in the U.S., it is apparently all the rage in the UK, Australia, and New Zealand. In the U.S., “weaning” refers to ending breastfeeding. However, in many other countries, “weaning” refers to the introduction of complementary foods. The whole idea behind baby-led weaning is that the baby controls what and how much she eats, beginning at 6 months, by feeding herself.

There is no such thing as spoon-feeding or baby food. (Nor are there any airplane spoon games.) Instead, once the baby can sit upright, you place finger foods in front of her, and she picks up and puts into her mouth whatever she wants. The theory behind this is that babies will become more adventurous eaters and will also learn how to control their own intake. Of course, the first question that many people (including me) will ask is, “Won’t the baby choke?” Some researchers in New Zealand had the same question and studied this in a randomized controlled trial, which appears in this month’s Pediatrics. (Ref)

Babies were randomized to either normal care or modified baby-led weaning. Parents were provided with some guidelines to baby-led weaning, including keeping the baby in an upright sitting position while eating, insuring adult supervision while eating, and not letting anyone put food into the baby’s mouth (only the baby is allowed to do that). They were also given a list of foods to avoid, including nuts, raw vegetables, hard fruit, popcorn, and food cut into “coins.” They then collected data about the infant’s food intake and any possible choking or gagging episodes by a combination of questionnaire and food diary.

I was intrigued that there was no difference in the number of choking episodes in the 2 groups. However, more than half of the infants were offered at least one food that posed a choking risk. You will be fascinated – and surprised - to see the types of foods that were offered to babies, and the foods that were associated with choking episodes. It appears that babies can choke on almost anything, and this study provides reassurance about baby-led weaning, in that the risk of choking seems to be comparable to traditional spoon-feeding methods.

I’ll certainly be ready when a parent wants to talk about baby-led weaning after reading this article. It also has made me rethink my anticipatory guidance about introducing solid foods – perhaps the emphasis should not be on the way that it’s done (spoon-fed or baby-led), but on adult supervision and what foods are inappropriate for infants.