BABY-LED WEANING, AN OVERVIEW OF THE NEW APPROACH TO FOOD INTRODUCTION: INTEGRATIVE LITERATURE REVIEW

Gomez, Melisa Sofia; Novaes, Ana Paula Toneto; Silva, Janaina Paulino da; Guerra, Luciane Miranda; Possobon, Rosana de Fátima

doi:10.1590/1984-0462/2020/38/2018084

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Revista Paulista de Pediatria

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REVIEW ARTICLE • Rev. paul. pediatr. 38 • 2020 • https://doi.org/10.1590/1984-0462/2020/38/2018084 copy

BABY-LED WEANING, AN OVERVIEW OF THE NEW APPROACH TO FOOD INTRODUCTION: INTEGRATIVE LITERATURE REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To analyze the scientific literature on Baby-Led Weaning with an integrative literature review to identify risks and benefits.

Data source:

The databases used were: National Library of Medicine (MEDLINE), Latin American and Caribbean Literature in Health Sciences (LILACS – Literatura Latino-Americana e do Caribe em Ciências da Saúde), US National Library of Medicine (PubMed), and Virtual Health Library (BVS – Biblioteca Virtual em Saúde) in December 2017. The inclusion criteria established were publications in English with the descriptor “baby-led weaning” in the heading, abstract, or keywords, classified as original articles, of primary nature, and available online and in full. We excluded review articles, editorials, letters to the editor, critical commentaries, and books on the subject, as well as articles not available in full and duplicates.

Data summary:

We identified 106 articles, of which 17 met the selection criteria. The Baby-Led Weaning method was significantly associated with the baby’s satiety, the start of complementary feeding, and adequacy of weight gain. On the other hand, choking and the intake of micronutrients were negatively associated, however with no statistical differences.

Conclusions:

Despite the benefits found, the risks still deserve attention and should be investigated with longitudinal randomized controlled studies to ensure the safety of the method when practiced exclusively.

Keywords:
Infant nutrition, weaning; Feeding behavior; Feeding methods; Child health

Authors	Design (n)	Summary of the studies
Brown and Lee¹⁴14. Brown A, Lee M. A descriptive study investigating the use and nature of baby-led weaning in a UK sample of mothers. Matern Child Nutr. 2011;7:34-47. https://doi.org/10.1111/j.1740-8709.2010.00243.x https://doi.org/10.1111/j.1740-8709.2010...	Cross-sectional (655 mothers)	Higher level of maternal schooling; longer breastfeeding; less anxiety; offers fresher and home-prepared foods; respects the satiety.
Brown¹⁶16. Brown A. Differences in eating behaviour, well-being and personality between mothers following baby-led vs. traditional weaning styles. Matern Child Nutr. 2016;12:826-37. https://doi.org/10.1111/mcn.12172 https://doi.org/10.1111/mcn.12172...	Cross-sectional (604 mothers)	Less food restriction, less anxiety; more confidence, and less compulsion.
Cameron et al.¹⁸18. Cameron SL, Taylor RW, Heath AL. Parent-led or baby-led? Associations between complementary feeding practices and health-related behaviours in a survey of New Zealand families. BMJ Open. 2013;3:e003946. http://dx.doi.org/10.1136/bmjopen-2013-003946 http://dx.doi.org/10.1136/bmjopen-2013-0...	Cross-sectional (199 mothers)	At six months of age, the infants eat with the family, sharing the same foods from the beginning; low iron intake.
Moore et al.²⁰20. Moore AP, Milligan P, Goff LM. An online survey of knowledge of the weaning guidelines, advice from health visitors and other factors that influence weaning timing in UK mothers. Matern Child Nutr. 2014;10:410-21. https://doi.org/10.1111/j.1740-8709.2012.00424.x https://doi.org/10.1111/j.1740-8709.2012...	Cross-sectional (n=3,607)	Low understanding of weaning guidelines and low maternal age were responsible for early weaning. Following the BLW approach had a positive influence.
Morison et al.²¹21. Morison BJ, Taylor RW, Haszard JJ, Schramm CJ, Erickson LW, Fangupo LJ, et al. How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6-8 months. BMJ Open. 2016;6:e010665. https://doi.org/10.1136/bmjopen-2015-010665 https://doi.org/10.1136/bmjopen-2015-010...	Cross-sectional (51 children)	Energy intake and the offering of foods with a risk of asphyxia were similar between the BLW and traditional groups. BLW infants eat with family more often, present a higher intake of total and saturated fat, and lower of iron, zinc, and vitamin B12.
Rowan and Harris²²22. Rowan H, Harris C. Baby-led weaning and the family diet. A pilot study. Appetite. 2012;58:1046-9. https://doi.org/10.1016/j.appet.2012.01.033 https://doi.org/10.1016/j.appet.2012.01....	Cross-sectional (10 mothers)	There was no change in the dietary patterns of parents, and 57% of the foods offered to the child were the same as those consumed by the family.
Townsend and Pitchford²⁴24. Townsend E, Pitchford NJ. Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case - controlled sample. BMJ Open. 2012;2:e000298. https://doi.org/10.1136/bmjopen-2011-000298 https://doi.org/10.1136/bmjopen-2011-000...	Cross-sectional (155 parents)	The traditional group showed a preference for sweet foods and the BLW for carbohydrate-rich cereals. Healthier food choices and self-regulation of appetite lead to lower BMI. Incidence of low weight in the BLW group and obesity in the traditional group.
Cameron et al.²⁶26. Cameron SL, Heath AL, Taylor RW. Healthcare professionals’ and mothers’ knowledge of, attitudes to and experiences with, Baby-Led Weaning: a content analysis study. BMJ Open. 2012;2:e001542. https://doi.org/10.1136/bmjopen-2012-001542 https://doi.org/10.1136/bmjopen-2012-001...	Cross-sectional (31 health professionals and 20 mothers)	Health professionals are reluctant to recommend the method. In contrast, mothers are positive in their reports about BLW.
Brown and Lee²⁷27. Brown A, Lee M. An exploration of experiences of mothers following a baby-led weaning style: developmental readiness for complementary foods. Matern Child Nutr. 2013;9:233-43. https://doi.org/10.1111/j.1740-8709.2011.00360.x https://doi.org/10.1111/j.1740-8709.2011...	Cross-sectional (36 mothers)	The sample clearly showed a positive experience after following the BLW method until the second year.
Brown²⁸28. Brown A. No difference in self-reported frequency of choking between infants introduced to solid foods using a baby-led weaning or traditional spoon-feeding approach. J Hum Nutr Diet. 2018;31:496-504. https://doi.org/10.1111/jhn.12528 https://doi.org/10.1111/jhn.12528...	Cross-sectional (1,151 mothers)	The risk of choking was the same in the BLW and traditional groups. The higher choking frequency is related to eating less with the hands.
Brown and Lee²⁹29. Brown A, Lee M. Maternal control of child feeding during the weaning period: differences between mothers following a Baby-led or Standard Weaning Approach. Matern Child Health J. 2011;15:1265-71. https://doi.org/10.1007/s10995-010-0678-4 https://doi.org/10.1007/s10995-010-0678-...	Cross-sectional (702 mothers)	Mothers show lower restriction levels when offering to the child the same foods consumed by the family, less pressure and monitoring during mealtime, and less concern with weight.

Authors	Design (n)	Summary of the studies
Brown and Lee¹⁵15. Brown A, Lee MD. Early influences on child satiety-responsiveness: the role of weaning style. Pediatr Obes. 2015;10:57-66. https://doi.org/10.1111/j.2047-6310.2013.00207.x https://doi.org/10.1111/j.2047-6310.2013...	Longitudinal (298 mothers)	Greater regulation of satiety levels and lower probability of overweight.
Cameron et al.¹⁷17. Cameron SL, Taylor RW, Heath AL. Development and pilot testing of Baby-Led Introduction to SolidS - a version of Baby-Led Weaning modified to address concerns about iron deficiency, growth faltering and choking. BMC Pediatr. 2015;15:99. https://doi.org/10.1186/s12887-015-0422-8 https://doi.org/10.1186/s12887-015-0422-...	Longitudinal (23 families)	The BLISS group offered foods with higher iron content and lower choking risk.
Fangupo et al.¹⁹19. Fangupo LJ, Heath AL, Williams SM, Williams LW, Morison BJ, Fleming EA, et al. A Baby-Led approach to eating solids and risk of choking. Pediatrics. 2016;138:e20160772. http://dx.doi.org/10.1542/peds.2016-0772 http://dx.doi.org/10.1542/peds.2016-0772...	Longitudinal (206 children)	There was no significant difference in the number of cases of asphyxia and choking in the BLISS and traditional groups.
Taylor et al.²³23. Taylor RW, Williams SM, Fangupo LJ, Wheeler BJ, Taylor BJ, Daniels L, et al. Effect of a Baby-Led approach to complementary feeding on infant growth and overweight: a randomized clinical trial. JAMA Pediatr. 2017;171:838-46. https://doi.org/10.1001/jamapediatrics.2017.1284 https://doi.org/10.1001/jamapediatrics.2...	Longitudinal (166 mothers)	There was no difference regarding BMI between the BLISS and traditional groups. The BLISS group showed less food fussiness and more enjoyment of food.
Wright et al.²⁵25. Wright CM, Cameron K, Tsiaka M, Parkinson KN. Is baby-led weaning feasible? When do babies first reach out for and eat finger foods? Matern Child Nutr. 2011;7:27-33. https://doi.org/10.1111/j.1740-8709.2010.00274.x https://doi.org/10.1111/j.1740-8709.2010...	Longitudinal (923 children)	Self-feeding is feasible for most babies, but some will develop this skill only at eight months of age. For them, the likelihood of walking without help at one year of age and saying small words is lower.
Arden and Abbott³⁰30. Arden MA, Abbott RL. Experiences of baby-led weaning: trust, control and renegotiation. Matern Child Nutr. 2015;11:829-44. https://doi.org/10.1111/mcn.12106 https://doi.org/10.1111/mcn.12106...	Longitudinal (15 mothers)	Many parents adopt a mixed method due to insecurity but declare that they follow BLW. Part of a parenting philosophy or used when the traditional approach failed; parents adhere to the method based on its “freedom.”

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[1] *Corresponding author. E-mail: nutricionista.melisagomez@gmail.com (M. S. Gomez).