THE BABY-LED WEANING METHOD (BLW) IN THE CONTEXT OF COMPLEMENTARY FEEDING: A REVIEW

Arantes, Ana Letícia Andries e; Neves, Felipe Silva; Campos, Angélica Atala Lombelo; Pereira Netto, Michele

doi:10.1590/1984-0462/;2018;36;3;00001

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Revista Paulista de Pediatria

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Review Article • Rev. paul. pediatr. 36 (03) • Jul-Sep 2018 • https://doi.org/10.1590/1984-0462/;2018;36;3;00001 copy

THE BABY-LED WEANING METHOD (BLW) IN THE CONTEXT OF COMPLEMENTARY FEEDING: A REVIEW

Authorship SCIMAGO INSTITUTIONS RANKINGS

ABSTRACT

Objective:

To review the scientific findings on the baby-led weaning method (BLW) in the context of complementary feeding.

Data sources:

Two independent examiners searched the Medical Literature Analysis and Retrieval System Online (MEDLINE)/PubMed database in August 2016. No time-period was defined for the publication dates. The following descriptors were used: “baby-led weaning” OR “baby-led” OR “BLW”. Inclusion criteria were: original studies that were available in English, and which addressed the BLW method. Exclusion criteria were: references in other languages, opinion articles and literature reviews, editorials and publications that did not elaborate on the intended subject. Of the 97 references identified, 13 were included in the descriptive synthesis.

Data synthesis:

The BLW group of babies, when compared to the traditional eating group, were less prone to being overweight, less demanding of food, and ate the same foods as the family. The number of choking episodes did not differ between groups. Mothers who opted for the implementation of BLW had higher levels of schooling, held managerial positions at work, and were more likely to have breastfed until the sixth month of the child’s life. Concerns were raised about messes made during meals, wasting food, and choking, but most of the mothers recommended adopting the method. Health professionals were hesitant to indicate this method.

Conclusions:

BLW was recommended by mothers who followed the method with their own children. However, concerns have been reported, which, coupled with professionals’ fears about the inability of infants to self-feed, reflect a lack of knowledge about the method.

Keywords:
Child; Weaning; Infant nutrition; Baby-led weaning

Author(s) (year)*	Title	Location of the study	Objectives	Design and sample
Brown & Lee¹⁰10. Brow 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. (2011)	A descriptive study investigating the use and nature of baby-led weaning in a UK sample of mothers	Swansea, United Kingdom	To characterize a sample of mothers who adhered to BLW as a strategy for feeding their children, as well as to describe attitudes and behaviors associated with the practice of this method	Cross-sectional study 655 mothers of babies 6 to 12 months old
Wright et al.¹¹11. 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. (2011)	Is baby-led weaning feasible? When do babies ﬁrst reach out for and eat ﬁnger foods?	United Kingdom	Describe the age range in which children first reached out to pick up food, relating this to self-feeding, aspects of child development, and socioeconomic status	Cohort study 510 mothers of babies born in 1999 and 2000
Brown & Lee¹²12. 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. (2011)	Maternal control of child feeding during the weaning period: differences between mothers following a baby-led or standard weaning approach	United Kingdom	To compare the feeding profile between BLW-adhering infants and infants following traditional feeding behavior	Cross-sectional study 604 mothers of babies 6 to 12 months old
Townsend & Pitchford¹³13. 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. (2012)	Baby knows best? The impact of weaning style on food preferences and body mass index in early childhood in a case-controlled sample	Nottingham, United Kingdom	To compare the dietary profile and the BMI of children who adhered to BLW and others who followed traditional eating habits	Case-control study 155 mothers of children between 20 and 78 months old
Rowan & Harris¹⁴14. Rowan H, Harris C. Baby-led weaning and the family diet. A pilot study. Appetite. 2012;58:1046-9. (2012)	Baby-led weaning and the family diet. A pilot study	United States and United Kingdom	To investigate whether the implementation of the BLW method affected the mother’s diet and whether the same family foods were offered to the babies	Cross-sectional study 10 mothers of babies approximately 6 months old
Cameron et al.¹⁵15. 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. (2012)	Healthcare professionals’ and mothers’ knowledge of, attitudes to and experiences with, baby-led weaning: a content analysis study	Dunedin, New Zealand	To evaluate the knowledge, attitudes and experiences of health professionals, as well as mothers of babies following BLW, about this method	Qualitative study with semi-structured interviews 31 health professionals and 20 mothers of babies 8 to 24 months old that adhered to BLW
Brown & Lee¹⁶16. 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. (2013)	An exploration of experiences of mothers following a baby-led weaning style: developmental readiness for complementary foods	United Kingdom	To examine the attitudes, beliefs and behaviors adopted by mothers who have opted for using BLW to feed their children	Qualitative study with semi-structured interviews 36 mothers of babies between 12 and 18 months old
Cameron et al.¹⁷17. 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. (2013)	Parent-led or baby-led? Associations between complementary feeding practices and health-related behaviours in a survey of New Zealand families	New Zealand	To compare feeding practices and health behavior between BLW adherents and others who have followed traditional feeding behavior	Cross-sectional study 199 mothers of babies between 6 and 12 months old
Brown & Lee¹⁸18. Brown A, Lee MD. Early influences on child satiety-responsiveness: the role of weaning style. Pediatr Obes. 2015;10:57-66. (2015)	Early influences on child satiety-responsiveness: the role of weaning style	United Kingdom	To compare feeding behavior between babies weaned with the BLW method and those following traditional feeding behavior	Cohort study 298 mothers of babies between 18 and 24 months old
Arden & Abbott¹⁹19. Arden MA, Abbott RL. Experiences of baby-led weaning: trust, control and renegotiation. Matern Child Nutr. 2015;11:829-44. (2015)	Experiences of baby-led weaning: trust, control and renegotiation	United Kingdom	To investigate the experiences reported by mothers who chose to practice BLW in order to understand the benefits, challenges and beliefs about this method	Qualitative study with semi-structured interview 15 mothers of babies between 9 and 15 months old
Morison et al.²⁰20. 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. (2016)	How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6-8 months	New Zealand	To compare the feeding profile between BLW-adhering infants and infants undergoing traditional feeding behavior	Cross-sectional study 51 mothers of babies between 6 and 8 months old
D’Andrea et al.²¹21. D'andrea E, Jenkins K, Mathews M, Roebothan B. Baby-led weaning: a preliminary investigation. Can J Diet Pract Res. 2016;77:72-7. (2016)	Baby-led weaning: a preliminary investigation	Canada	To investigate the practice of BLW with regard to the knowledge and perceptions of mothers and health professionals about the method	Cross-sectional study 33 health professionals and 65 mothers
Brown²²22. 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. (2016)	Differences in eating behaviour, well-being and personality between mothers following baby-led vs. traditional weaning styles	United Kingdom	To compare the demographic and socioeconomic profiles of mothers who used BLW and others who chose traditional feeding behavior	Cross-sectional study 604 mothers of babies between 6 and 12 months old

Author(s) (year)*	Main results
Brown & Lee¹⁰10. Brow 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. (2011)	the duration of exclusive breastfeeding was substantially higher among mothers who followed the BLW method; the caregivers who opted for the method were more likely to offer fruits or vegetables as the babies’ first foods; most of the children being cared for at an institution because their mothers returned to work, were fed with potatoes / pastes; the method was associated with greater participation in family meals.
Wright et al.¹¹11. 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. (2011)	56% (n=340) of the babies had stretched out their hands to grab food before their sixth month, of which 27% (n = 92) were considered to be incapable of self-feeding; in general, for many 8-month-old children, self-feeding was still not a routine part of their meals, and they were described as being fully fed by the caregiver.
Brown & Lee¹²12. 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. (2011)	mothers who adhered to the BLW method perceived that their children weighed more at 6 months old
Townsend & Pitchford¹³13. 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. (2012)	carbohydrates were the preferred food category for infants who adhered to the method, while the group following traditional eating habits preferred sweet foods; children following traditional behavior had a higher BMI, and were more susceptible to being overweight.
Rowan & Harris¹⁴14. Rowan H, Harris C. Baby-led weaning and the family diet. A pilot study. Appetite. 2012;58:1046-9. (2012)	the infants consumed, on average, 57% of the same foods ingested by the mothers, with minimum and maximum similarities of 44 and 86%, respectively.
Cameron et al.¹⁵15. 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. (2012)	90% (n = 18) of the mothers started to practice the BLW method by their children’s fifth or sixth month of life; the first foods commonly offered were fruits and vegetables; 80% (n = 16) of the mothers reported that their children shared meals with one or more family members; there were reports of offering potatoes / mashed potatoes and the use of spoons, however this was only occasionally, when the infants were sick or appeared to be too fatigued to self-feed; mothers who cited episodes of choking said that the children dealt with the problem by themselves, expelling the food through coughing.
Brown & Lee¹⁶16. 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. (2013)	the babies usually participate in family meals; in general, the mothers described that the method stimulated the consumption of in natura foods.
Cameron et al.¹⁷17. 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. (2013)	babies adhering to the BLW method were more likely to consume the same foods eaten by the family and were less likely to have received industrialized food; there was no difference between the groups adhering to the method and those following traditional feeding behavior with regard to choking episodes.
Brown & Lee¹⁸18. Brown A, Lee MD. Early influences on child satiety-responsiveness: the role of weaning style. Pediatr Obes. 2015;10:57-66. (2015)	the duration of breastfeeding did not differ between BLW groups and traditional behavior groups, but mothers who followed the method were more likely to have started breastfeeding at birth; infants who adhered to the method were characterized as less food-demanding and more sensitive to being full; in general, children exhibited eutrophy, but those in traditional management weighed more.
Arden & Abbott¹⁹19. Arden MA, Abbott RL. Experiences of baby-led weaning: trust, control and renegotiation. Matern Child Nutr. 2015;11:829-44. (2015)	many mothers who followed the BLW reported using food as a toy early on in the implementation of the method.
Morison et al.²⁰20. 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. (2016)	the duration of exclusive breastfeeding was substantially higher among mothers who had adhered to the BLW. Moreover, children following traditional behavior consumed more infant formulas; there was no difference in terms of energy consumption, but the children who followed the method ate more fat (total and saturated) and lower amounts of iron, zinc and vitamin B12.
D’Andrea et al.²¹21. D'andrea E, Jenkins K, Mathews M, Roebothan B. Baby-led weaning: a preliminary investigation. Can J Diet Pract Res. 2016;77:72-7. (2016)	the mothers started the BLW method around the fifth or eighth month of life of their children; the first foods commonly offered were fruits and vegetables. infants routinely participated in family meals.
Brown²²22. 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. (2016)	the average age at the start of food intake was lower for the traditional group (19 weeks) than for the BLW group (24 weeks).

Author(s) (year)*	Main results
Brown & Lee¹⁰10. Brow 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. (2011)	58.2% (n = 384) of mothers considered themselves to be well-informed about the practice of BLW; the degree of knowledge about the method was inversely proportional to the caregivers’ use of a spoon and to the offering of potatoes / pastes; those who adhered to the BLW were married, had more schooling, and held a managerial position at work - or their partners had these characteristics; traditional food practitioners more often resorted to the support of health professionals, seeking clarification on complementary feeding. They also reported more anxiety about whether their children’s nutritional intake is appropriate, more concern about making messes during meals, and also felt more insecure about their babies’ chewing abilities.
Brown & Lee¹²12. 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. (2011)	mothers who adhered to the BLW had higher levels of education, were employed, and were more likely to hold a managerial position and not return to work; cited less concerns about the baby’s weight, food restrictions and pressure to eat.
Rowan & Harris¹⁴14. Rowan H, Harris C. Baby-led weaning and the family diet. A pilot study. Appetite. 2012;58:1046-9. (2012)	three months after the introduction of the method, the mothers did not show modifications in their diet.
Cameron et al.¹⁵15. 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. (2012)	the BLW method was considered to be more convenient and less stressful for the introduction of food; mothers believed that the method helped their children to develop healthy eating behaviors; choking was not a concern, as mothers considered it to be natural for when children try new foods; the mess made during meals was highlighted as the main disadvantage of the method, however all mothers would recommend it to other mothers.
Brown & Lee¹⁶16. 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. (2013)	mothers considered the BLW method to be simple and convenient; meals were seen as easier and less stressful; in general, they reported that they exercised little control with regard to the amount of food ingested by the infants; the mess made at meals and food waste resulting from the practice of the method were considered challenges; they expressed concern with regard to the risk of choking, which decreased over time.
Cameron et al.¹⁷17. 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. (2013)	all of the families who adhered to the BLW would recommend it, but more than half of them would advise that the practice be completed in conjunction with traditional complementary feeding; 46% (n = 65) of mothers who adhered to traditional eating habits, said that if they had another child, they would be willing to try BLW; the main reasons for not opting for the method were: choking; fear of lack of motor ability to guide self-feeding; and uncertainty about the adequacy of the amount of food ingested at each meal, in addition to the fact that traditional behavior had worked well in the past.
Brown & Lee¹⁸ (2015)	mothers who adhered to the BLW method reported less concern about the baby’s weight, pressure to eat, and food restrictions. In addition, they spent less time watching over the children at mealtimes.
Arden & Abbott¹⁹ (2015)	mothers who adhered to BLW reported less anxiety during meals; those who followed the method reported a high degree of confidence in the babies’ ability to choose the timing, type, and amount of food to eat; some expressed fears about nutritional support for the infants, as well as concerns about the mess made during meals.
D’Andrea et al.²¹21. D'andrea E, Jenkins K, Mathews M, Roebothan B. Baby-led weaning: a preliminary investigation. Can J Diet Pract Res. 2016;77:72-7. (2016)	ch0king was the most cited concern with regard BLW, though it decreased over time; a large portion of the mothers had been introduced to the method through friends or online sources; more than 80% believed that the method would have promoted healthy eating behaviors, and improved children’s fine motor skills and oral development.
Brown²²22. 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. (2016)	mothers who adhered to BLW had higher levels of schooling and were more likely to be in managerial positions; adherents to traditional eating habits had higher scores for anxiety and obsessive-compulsive disorder.

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[1] *Corresponding author. E-mail: felipe.sneves@hotmail.com (F.S. Neves).