Complementary feeding approaches - a review of the benefits and risks
Whether an infant self-feeds or is spoon fed has impacts on more than just nutrition. According to a 2021 review article, it actually has the potential to influence the lifelong relationship between food, body, nutrition, and related skills.
An infant self-feeding (left) and an infant being spoon fed (right) Source: Canva.com
A recent review of 29 original research studies was performed by Boswell, N, with the aim of clarifying the risks and benefits of the complementary feeding method known as Baby Led Weaning (BLW) especially with respect to growth, development, and health.
Many parents and health professionals are cautious of BLW due to lack of knowledge and understanding of what it entails. They often have many questions to do with the method; this article examined the outcomes of these questions in the literature.
A study from New Zealand revealed the top concerns that parents and health care practitioners raise (n= 199)
Fear of infant choking (55.3%)
Concerns about the infant’s ability to eat enough (44.2%)
Reservations that the infant would not have the necessary motor skills to self-feed (27.6%)
Perception that “parent-led feeding” had worked fine previously, so there was no need to change (27%)
The studies included in this review looked at the following primary outcomes: food and nutrient intake (n = 12), prevalence, parental experiences, or practical aspects of BLW (n = 5), eating behaviors (food fussiness, satiety responsiveness) (n = 4), choking (n = 3). Many of the studies assessed growth as a secondary outcome.
An infant offered family foods in appropriate size and texture for developmental stage.
Source: canva.com
Below are some key points found by the researcher.
Prevalence, practice, and BLW
In the UK between 30-60% of parents strictly follow BLW
In New Zealand 70% of parents used a traditional spoon-feeding method
In a sample from Australia the key factor for choosing to implement BLW was trust
Health care providers in New Zealand identified potential benefits to BLW such as: convenience, greater opportunity for shared mealtimes, fewer mealtime struggles, healthier eating behaviors, and potential developmental advantages.
Why does this matter?
Knowing that the prevalence of BLW is increasing allows us to infer that feeding dynamics and environments are shifting. It is thus important to stay up to date with current practices, recommendations, and literature.
A caregiver preparing broccoli for the infant to self-feed.
Source: canva.com
Risk and Benefits
Eating behaviors
In a study among 876 infants aged 6-36 months, those who followed a BLW approach were less likely to be fussy with food.
A study including 565 infants found that infants following a BLW approach were less fussy with food and had more food enjoyment.
Infants who were BLW’d versus traditionally spoon fed scored lower on food responsiveness and fussiness, and higher on satiety responsiveness at 18-24 months old (n=298). Restrictive feeding, on the other hand, was associated with lower satiety responsiveness and pressure to eat was positively associated with food responsiveness, regardless of weaning group.
An infant with a variety of fruits for self feeding. Source: canva.com
Growth
Weight-for-age z-score at 6-36 months old was not different based on complementary feeding methods, as reported by multiple studies.
More data is needed as growth was not a primary outcome for any of the studies.
Nutrient Intake
Dietary intake data show that there is no difference in total energy intakes between BLW versus traditionally spoon-fed infants.
Two studies (n= 51 and n= 134) found that infants who were BLW’d consumed more dietary fat than their counterparts.
BLW’d infants consume less zinc and iron than their spoon-fed counterparts and both groups consume insufficient iron and zinc. Of note is that the type of iron (heme vs non-heme) for each group was not specified.
As compared with a BLW group, traditionally spoon-fed infants were offered dairy and dairy-based desserts at 9-12 months of age and salty snacks at 6-8 months more frequently.
Infants fed via BLW were more likely to be offered fruits or vegetables as first foods versus iron-fortified rice cereal for their spoon-fed counterparts.
BLW infants consume less iron-fortified infant cereal than their spoon-fed peers, however they consume more red meat.
An infant eating a meat patty. Source: canva.com
Choking and oro-motor skills
In a study including 75 infants aged 9 months who had aspirated, 80% occurred during self-feeding while only 14% during caregiver feeding, however to note is that seeds and nuts were the most frequently reported aspirated food; known unsafe foods for all infants.
Parents and caregivers need to be aware of high-risk choking foods.
The literature does not demonstrate a difference in the incidence of choking between weaning groups.
Infants given finger foods the least often have the highest risk of choking.
BLW and increased exposure to finger foods may lead to improved oral motor skills.
Why does this matter?
Knowing the potential impacts that a particular feeding method has is important to help guide practice. It is well documented that responsive feeding has a positive effect on the food and body relationship throughout life and is protective against obesity. BLW is a responsive feeding method that lends to the exposure to a greater variety of textures and flavours than traditional spoon feeding.
An infant eliciting the spoon from her caregiver.
Source: canva.com
In summary, This review of 29 scientific articles found that BLW (a responsive feeding method consisting of baby self-feeding with a variety of soft solids) was associated with lower food fussiness, higher food enjoyment, higher satiety responsiveness, and lower food responsiveness.
In other words, babies who self-feed seem to be less picky, enjoy the foods they choose to eat more, are more in-tune with hunger and satiety cues, and are less inclined to eat simply because food is available.
They are not more at risk for iron or zinc deficiency, nor are they more at risk of choking.
In fact, the implementation of BLW may impart benefits beyond autonomy and nutrition; it may provide an advantage to oral motor development and healthier eating behaviours in the long term.
All babies start solids a bit differently and there is no right or wrong way to do it, however this study points out many advantages to a baby-led approach. If you’re a health professional and curious to obtain in-depth training about starting solids, join the Starting Solids Network.
Reference:
Boswell, N. (2021). Complementary feeding methods - a review of the benefits and risks. International journal of Environmental research and public health. 18; 7165. https://doi.org/10.3390/ijerph18137165
