Donner Les Bases du Goût: Adventures in Baby-Led Weaning

Donner Les Bases du Goût : providing the foundation of taste

As one embarks on the adventure of parenthood, there are endless choices for child-rearing methodologies from day one.  Will you breastfeed? If so, will you nurse on demand or on a schedule? Will you co-sleep or use the crib? If a crib, will it be in your room or a nursery? Will you use child-care or stay home? If child care, will you use a day-care center or nanny?  And those are just decisions you have to make in the first couple of months.

One decision we faced in the past few months was how to introduce Tess to table food. 

Many people may wonder what decision is there to make in introducing solid food: rice cereal then eventually jars of pureed baby food, right?

In this age of “über-parenting,” nothing is so straightforward.

First, there is the issue of when to start feeding your baby something other than breastmilk or formula. A comprehensive review published in 2001 highlighted the critical developmental changes that occur between 4 and 6 months that enable more efficient digestion of whole foods. These findings prompted the World Health Organization and the American Academy of Pediatrics to recommend delaying the introduction of solid foods until 6 months. This conclusion has been confirmed by further studies and is fairly widely accepted in the medical community.

We personally made the choice to delay introduction of solid foods until Tess was 8 months old. It was difficult, for sure, to nurse and produce enough milk to supply her caloric need until that age, but for me it was worth it. My choice was based primarily on research suggesting that early introduction of solid foods can lead to long-term consequences for gut and brain development. I wrote about that here.

Other research suggests that extending the breastfeeding period itself is correlated with lower levels of obesity later in life.  A commonly held belief states that this may be because nursing infants control their milk intake and thereby learn to self-regulate when feeding^{1, 2}.

In addition, breastfed infants typically gain weight more slowly in infancy, which is associated with lower levels of obesity later in life^{3, 4}. Finally, there are molecules in breastmilk such as leptin and adiponectin that are thought to help establish proper endocrine responses to feeding and appetite regulation⁵. One study even showed that each additional month a mother breastfeeds decreases the child's risk of obesity in later life by 4%⁶.

Delaying the introduction of solids is similarly beneficial in preventing development of obesity.

In a study of nearly 700 children up to 7 years old in Dundee Scotland, introduction of solid foods prior to 15 weeks was associated with increased body fat later in childhood⁷. In another study that examined over 10,000 subjects from across the globe (Brazil, Guatemala, India, Philippines and South Africa) delayed introduction of solid foods was linked to lower body fat into adulthood⁸. These studies controlled for things like income, education level, maternal BMI – anything that could affect infant outcomes.

Shorter durations of breastfeeding and earlier introduction of solid food are associated with greater weight gain by 1 year of age, according to a study of Danish babies⁹. In a study of infants and children in the UK, early introduction of solid foods and early cessation of breastfeeding are both risk factors for obesity in 3-year old children¹⁰.

There are some studies that do not corroborate these findings, but studying these measures and behaviors in humans can be difficult due to ethical restrictions and problems with memory retrieval when reporting on feeding behaviors. Animal studies, on the other hand, provide the ability for researchers to control variables not feasible in human studies.

A study on marmoset monkeys showed that infant monkeys who initiated an earlier weaning period were prone to developing obesity later in life. These monkeys were not larger at birth, at the beginning or even later during the weaning period. The development of obesity happened well into adolescence, so the authors of this study do not believe the development of obesity is driven by nutritional status¹¹. 

BABY-LED WEANING

BLW POWER!

Once I worked out when to feed Tess solid food, I had to decide how and what to feed her. We decided to give baby-led weaning (BLW) a try.  We have been following this method for the last 3 months and we couldn’t be happier with it.

Baby-led weaning, I think, is a bit of a mis-nomer. Really, I don’t even know if what we’re doing is deserving of a name.

It is easier to say what BLW isn't:

It isn't spoon feeding.

Since we don't do spoon-feeding,

when I actually TRY to give her something like soup on a spoon

she gives me this blank stare.

"What is this voodoo, mom?"

BLW is really quite simple. The theory is that once a baby’s GI system is capable of breaking down and digesting food, they will have developed the skills necessary to feed themselves: to sit unassisted, to pick food up, place it in their mouth, mash it up and swallow it. If a baby cannot self-feed, they are not ready. Readiness is thought to occur somewhere around 6 months old¹².

Perceived hunger or refusal to night-wean are often given as reasons for introducing solid foods, but these are not accepted as true signs of “readiness” by the medical community.

Tess' very first taste of food!
Wasn't convinced.
Glad she gave it another go.

BENEFITS TO BLW

Delayed introduction of solids is actually the first benefit to baby-led weaning.  From all the research I have mentioned above and in my other blog post, this is hugely beneficial to a baby’s body and brain development. In one of the few studies to date on BLW, 55% of mothers who used this method waited until at least 26 weeks to introduce complementary foods¹³. This is far later than parents who use traditional spoon-feeding typically choose to begin solids according to many epidemiological studies.

First raspberries!

Looks like something out of a horror movie...

One study in the UK showed that BMI scores were lower in baby-led weaned babies and spoon-fed babies showed above average BMIs. There was an increased incidence of obesity in the spoon-fed group even when controlling for socioeconomic status and breastfeeding duration.¹⁴ It is likely that, as with breastfeeding, self-feeding with finger foods teaches self-regulation of food intake, which is important for maintaining a healthy weight throughout life¹⁵.

Of course, it's not all healthy all the time.

Sometimes we are naughty and eat graham crackers!

Mr. Fenway was hoping to steal one I think.

Some studies suggest that obese children tend to eat at a faster rate and take bigger bites^16, 17.  BLW also helps prevent against learning to eat too fast.  I only put one piece of food in front of Tess at a time and she can only eat so fast since she has to mash up the food with her gums and tongue. Meal times are very slow, sometimes it takes us an hour to eat lunch, but I hope this is teaching her good habits right from the very beginning.

BLW has also encouraged us to wean very slowly. Tess was only eating once a day for the first 6 or 7 weeks, then twice a day, and only in the last couple of weeks have we transitioned to 3 meals a day. She is 11 months as of 10 days ago. It took us 3 months to get to 3 meals a day. I still nurse her 5 or sometimes 6 times a day, as well. Slowly weaning is also associated with healthier weight later in life.

Tess LOVES plums,
and is sad they are now out of season.

BLW is great for development of motor skills like a pincer grasp. In baby-led weaning, foods are offered in their whole rather than pureed form¹⁸.  Foods such as boiled carrots, sweet potato, and banana are great first foods.  Tess has loved avocado and mango as well. Anything that can be cut up into “fist-sized” chunks is great at the very beginning when they do not have the dexterity to pick up anything finely-diced. With little time, though, Tess was able to get the hang of Cheerios, chickpeas and black beans.

BLW also allows us to eat as a family.  It conveys the idea that meals are meant to be shared, to encourage a sense of community and coming together.  From the beginning of her introduction to food, we don’t have an arrangement where one parent spoon-feeds the baby while the other parent gobbles down some food so they can switch half-way through the meal.  We are able to sit together and each of us feeds ourselves.

Sometimes we also like to eat lunch in front of the TV.

Red Sox parade time!

We also get to eat the same things, for the most part, at least. It’s important that the foods a baby eats are low in salt, and sometimes I have to scoop out some food for Tess before adding the salt that Andy and I are accustomed to in our food. But for the most part, we have a similar diet.

It’s also important to encourage food diversity so the baby has a balanced diet. Because babies are not limited to bland rice cereals and overly sugary processed jars of pureed baby food, they gain familiarity with many different fresh fruits, vegetables and more exotic flavors. Tess even loves curry.  

First curry!

Another study on baby-led weaning showed that when compared to spoon-fed babies, starches and proteins were the most well liked food categories among BLW babies. Whereas sugary or sweet foods were most enjoyed by spoon-fed babies. Furthermore, the baby-led group preferred all food groups except sweet foods compared to the spoon-fed group¹⁴. I think Tess is also more adventurous in what she eats because it is exciting for her to have control over her meals.

This was a pretty typical meal, but Tess tried okra for the first time.

She wasn't a fan.

Finally, one study even suggests BLW is good for Mom and Dad’s diet too. One study showed that three months after beginning BLW, calorie consumption by parents decreased, particularly their consumption of sugar. Sugar was only 17% of total calories in this particular cohort¹⁹.

I don’t monitor my calorie intake, but personally, since beginning BLW with Tess 3 months ago, I have lost 15 pounds without consciously trying. Is it from BLW? I have no idea, but I do know that I have struggled with my weight my entire life - 15 pounds hasn’t ever just dropped off me. I once did Weight Watchers for 6 months and only lost 8. I even went to see my doctor after I lost the first 10 pounds because I thought I had cancer or a parasite or something! I am happy to report, however, that I am perfectly healthy. She suggested that the weight loss is from chasing around an active almost-toddler and burning extra calories. I’m skeptical though. I once trained for a marathon and didn’t lose any weight.

Papaya!
She ate an entire papaya in about 4 days.
There were a lot of diapers that week...

DRAWBACKS

Of course, like most things, nothing is perfect.  As much as I am absolutely convinced BLW is the best practice for us, it has been difficult at times. For example, the mess. When Tess was first learning to eat … she would nearly require a bath after eating, I would literally hose down her high chair outside, and I think the dogs ended up eating more than she did for all that would drop on the floor. It was very exhausting. Avocado also stains like the dickens so I have emptied almost an entire bottle of stain remover while trying to keep her clothes clean the past 3 months. She often eats in a diaper (which, because we use cloth, also gets stained!)

Messy Tessie!

It is awkward to go to a restaurant or someone’s house and get food everywhere. You quickly learn to identify foods that are less messy, Cheerios are great for eating in public.

Mango at the Marlay House.

Pizza crust in Napa, CA.

Avocado in San Francisco.

Avocado with a white shirt in public.

I was playing with fire this day...

It does improve, however. With time, their dexterity improves and they learn to get (almost) all their food in their mouths.

Sometimes she just likes to share with the dogs.

Another fear in BLW is choking. I was personally a little paranoid about choking, but I just have to keep a close eye on her while she eats.  One study showed that 94% of BLW mothers never experienced a choking incident¹⁴, so this actually shouldn’t be a great concern.

I personally had one experience with choking that was pretty scary. I made stuffed green bell peppers and topped them with some cheese that got pretty hard while in the oven.  Tess couldn’t break down the cheese with her gums so she swallowed a piece that was a bit too big, we scooped her up and Andy did one back blow before it came flying out. In the last 3 months that was our only real near-choking incident and it was my fault, I gave her something without checking to see if it was something she could chew with her gums.

These were the peppers.

Cheese was a bit too toasty and not melty!

Another concern in BLW is whether the nutritional needs of a baby are met as they are choosing their own foods. You can’t force them to eat anything, obviously (although, you can’t necessarily force a spoon-fed baby to eat anything, either).

I found a fascinating study from 1939 by a pediatrician, Clara Davis, that addresses this²⁰. In this study, children were studied from weaning until 6 years of age. They were presented with 33 different food items at mealtimes and were allowed to choose everything they ate without encouragement or intervention, from weaning onward. All foods were in their “pure form,” nothing like custard or pasta that contain various foods in combination (milk and eggs or flour and eggs, etc).

The study showed that all of the babies and children, while sometimes choosing seemingly odd meals (like orange juice and liver for breakfast), fully satisfied all their nutritional needs. In the early days, they tried many different foods, but with time slowly developed taste preferences. While all the children in the study had vastly different diets and taste preferences, as Davis writes in the paper, “They achieved the goal [of nutritional fulfillment] but by widely various means, as Heaven may presumably be reached by different roads.” How very poetic!

Another meal:

Kale, sweet potato, chickpeas and brisket 

(slow cooked in a crock pot, nice and tender and easy to eat!)

Meat is still relatively new to her, 

still trying out things that she can breakdown with her gums.

Even the babies that entered the study with severe rickets recovered completely. For those infants, they gave them the additional choice of cod liver oil.  Astoundingly, those babies did occasionally choose to eat cod liver oil and only until their blood calcium and phosphorous levels were normal and their bones healed according to x-rays! After they were cured of rickets, they never again took the cod liver oil.

The author concluded that there exists an innate, automatic mechanism in the human body that motivates us to balance the dozens of nutritional essentials we require to function.

Another example of this was that the babies only preferred to eat beets in the first year of life, unless they were suffering from acute glandular fever. During those periods, they again suddenly chose to eat beets again, as if they knew the beets contained essential nutrients they needed to fight their illness. 

Her enjoyment of different foods waxes and wanes.

Sometimes she likes something, other times she doesn't.

Avocado is the one thing I know she will always eat.

The exception she found to this existed when one’s diet consists of primarily sugar and white flour. The paper reads “Self-selection [of food] can have no, or but doubtful, value if the diet must be selected from inferior foods.”  Davis describes the “nutritional evils” in the “modern diet” (in 1939), and suggests that sugar and white flour lead to “fallibilities of appetite” and a desire to eat these foods to excess and ignore the body’s innate sense of what it needs. She even claims that the widespread excess of sugar in “civilized diets” of the time was decried by nutritional authorities. In 1939. What would they possibly think of TODAY’S modern diet?!

I am sure this study is hugely flawed in many ways (methods are not supplied, how were they able to control each child’s meal for up to 6 years, were they in an orphanage? These details are not provided). I still think it is important to recognize that, to a certain extent, humans likely have some innate mechanisms to motivate us to properly provide for our nutritional needs. It’s evolution. Early man somehow existed without processed, fortified food and vitamin supplements.

DISCLAIMER

Of course, for any parent the questions of how, what and when to feed your baby are important. For me, these decisions have been particularly significant.  Not only is food a big part of my life – I love cooking, trying new foods and I believe that meal times serve as a cultural experience, but also because obesity has plagued my family for some time.  Everyone in my family struggles with their weight, including myself, there have been some family members who have even undergone weight loss surgery. Not all have been successful.  If there is anything I can do at this stage of Tess’ life to ensure she may be free of those same struggles I will certainly try it.

 Baby's first kale!
I don't think I had heard of kale until I was well into my twenties.

For some families, baby-led weaning isn’t possible. Maybe your baby is in day care where they may not be supportive. Maybe you fear nothing more than the idea of your baby choking and you would be panic-stricken during meal times.  In these cases, you shouldn’t do BLW despite the research showing any benefits, and most of all should not feel guilty for it! 

We are not completely militant about food here.

We went to a fair and let her have her first taste of ice cream.

After one bite she developed a vice-like grip on that spoon.

She LOVED it!

For example, I have a completely irrational fear of SIDS.  It was truly my biggest fear despite the fact that the chances were so infinitesimally small.  Despite a lot of research showing the benefits of “co-sleeping” (baby sleeping in bed with mom and dad), I was too paranoid for it. I would have never slept and I would be miserable.

Sometimes she doesn't like something and I can't understand why.

She is not a fan of oranges!

Oranges are so good!

Not interested though. Maybe too acidic?

Do I feel guilt that I may have deprived Tess of the developmental benefits of co-sleeping? Absolutely not! It was my choice and I feel comfortable in that choice, just as any mother or father should do if they decide to spoon-feed.

This post is only meant to educate anyone who has not made a decision and is curious about this particular method.

I personally think baby-led weaning is great.  I love watching Tess feed herself – I get a kick out of watching her enjoy her food. I am convinced by the benefits shown in the research and am hopeful it will help develop her palate so she is an adventurous eater. Nothing would make me happier than Tess loving sushi and hating chicken nuggets!  I’m sure that is impossible, but a girl can dream, can’t she?

She wasn't feeling the chickpeas this day. 

We tried mixing them in with Cheerios to fool her.

Didn't work.

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