Puréed foods are typically used as first foods for infants, with gradual exposure to more varied textures over time. Finger foods may be consumed but do not usually represent a large proportion of the diet until later in the complementary feeding period.^1-3 Baby-led weaning (BLW) is an alternative approach to introducing solid foods in which infants feed themselves all their food from the start of complementary feeding (approximately 6 months of age).^4,5 Proposed advantages include improved energy self-regulation (ability to respond appropriately to appetite and satiety cues),⁶ leading to improved body weight⁷ and reduced food fussiness.⁴ However, concerns have been raised that children may not eat enough, particularly if self-feeding skills are poor.^8-10

Baby-Led Weaning (BLW) is an alternative method for introducing complementary foods to infants in which the infant feeds themselves hand-held foods instead of being spoon-fed by an adult. The BLW infant also shares family food and mealtimes and is offered milk (ideally breast milk) on demand until they self-wean. Anecdotal evidence suggests that many parents are choosing this method instead of conventional spoon-feeding of purées. Observational studies suggest that BLW may encourage improved eating patterns and lead to a healthier body weight, although it is not yet clear whether these associations are causal. This review evaluates the literature with respect to the prerequisites for BLW, which we have defined as beginning complementary foods at six months (for safety reasons), and exclusive breastfeeding to six months (to align with WHO infant feeding guidelines); the gross and oral motor skills required for successful and safe self-feeding of whole foods from six months; and the practicalities of family meals and continued breastfeeding on demand. Baby-Led Weaning will not suit all infants and families, but it is probably achievable for most. However, ultimately, the feasibility of BLW as an approach to infant feeding can only be determined in a randomized controlled trial. Given the popularity of BLW amongst parents, such a study is urgently needed.

In 2002, the World Health Organization recommended that the age for starting complementary feeding should be changed from 4 to 6 months of age to 6 months. Although this change in age has generated substantial debate, surprisingly little attention has been paid to whether advice on how to introduce complementary foods should also be changed. It has been proposed that by 6 months of age most infants will have developed sufficient motor skills to be able to feed themselves rather than needing to be spoon-fed by an adult. This has the potential to predispose infants to better growth by fostering better energy self-regulation, however no randomised controlled trials have been conducted to determine the benefits and risks of such a “baby-led” approach to complementary feeding. This is of particular interest given the widespread use of “Baby-Led Weaning” by parents internationally. The Baby-Led Introduction to SolidS (BLISS) study aims to assess the efficacy and acceptability of a modified version of Baby-Led Weaning that has been altered to address potential concerns with iron status, choking and growth faltering. The BLISS study will recruit 200 families from Dunedin, New Zealand, who book into the region’s only maternity hospital. Parents will be randomised into an intervention (BLISS) or control group for a 12-month intervention with further follow-up at 24 months of age. Both groups will receive the standard Well Child care provided to all parents in New Zealand. The intervention group will receive additional parent contacts (n = 8) for support and education on BLISS from before birth to 12 months of age. Outcomes of interest include body mass index at 12 months of age (primary outcome), energy self-regulation, iron and zinc intake and status, diet quality, choking, growth faltering and acceptability to parents. This study is expected to provide insight into the feasibility of a baby-led approach to complementary feeding and the extent to which this method of feeding affects infant body weight, diet quality and iron and zinc status. Results of this study will provide important information for health care professionals, parents and health policy makers. Australian New Zealand Clinical Trials Registry ACTRN12612001133820 .

Objectives: To compare the food, nutrient and ‘family meal’ intakes of infants following baby-led weaning (BLW) with those of infants following a more traditional spoon-feeding (TSF) approach to complementary feeding. Study design and participants: Cross-sectional study of dietary intake and feeding behaviours in 51 age-matched and sex-matched infants (n=25 BLW, 26 TSF) 6–8 months of age. Methods: Parents completed a questionnaire, and weighed diet records (WDRs) on 1–3 non-consecutive days, to investigate food and nutrient intakes, the extent to which infants were self-fed or parent-fed, and infant involvement in ‘family meals’. Results: BLW infants were more likely than TSF infants to have fed themselves all or most of their food when starting complementary feeding (67% vs 8%, p<0.001). Although there was no statistically significant difference in the large number of infants consuming foods thought to pose a choking risk during the WDR (78% vs 58%, p=0.172), the CI was wide, so we cannot rule out increased odds with BLW (OR, 95% CI: 2.57, 0.63 to 10.44). No difference was observed in energy intake, but BLW infants appeared to consume more total (48% vs 42% energy, p<0.001) and saturated (22% vs 18% energy, p<0.001) fat, and less iron (1.6 vs 3.6 mg, p<0.001), zinc (3.0 vs 3.7 mg, p=0.001) and vitamin B ₁₂ (0.2 vs 0.5 μg, p<0.001) than TSF infants. BLW infants were more likely to eat with their family at lunch and at the evening meal (both p≤0.020). Conclusions: Infants following BLW had similar energy intakes to those following TSF and were eating family meals more regularly, but appeared to have higher intakes of fat and saturated fat, and lower intakes of iron, zinc and vitamin B ₁₂ . A high proportion of both groups were offered foods thought to pose a choking risk.

Objective Baby-Led Weaning (BLW) is an alternative approach for introducing complementary foods to infants that emphasises infant self-feeding rather than adult spoon-feeding. Here we examined healthcare professionals’ and mothers’ knowledge of, attitudes to and experiences with, BLW. Design, setting and participants Healthcare professionals (n=31) and mothers who had used BLW (n=20) completed a semistructured interview using one of two tailored interview schedules examining their knowledge of, attitudes to and experiences with, BLW. Interview notes and transcripts were analysed using content analysis to identify subcategories and extract illustrative quotes. Results Healthcare professionals had limited direct experience with BLW and the main concerns raised were the potential for increased risk of choking, iron deficiency and inadequate energy intake. Although they suggested a number of potential benefits of BLW (greater opportunity for shared family meal times, fewer mealtime battles, healthier eating behaviours, greater convenience and possible developmental advantages) most felt reluctant to recommend BLW because of their concern about the potential increased risk of choking. In contrast, mothers who had used this style of feeding reported no major concerns with BLW. They considered BLW to be a healthier, more convenient and less stressful way to introduce complementary foods to their infant and recommended this feeding approach to other mothers. Although mothers did not report being concerned about choking, 30% reported at least one choking episode—most commonly with raw apple. Conclusions Given the lack of research on BLW, further work is needed to determine whether the concerns expressed by healthcare professionals and potential benefits outlined by mothers are valid. The current study suggests that there is a mismatch between healthcare professionals' and mothers’ knowledge of, attitudes to and experiences, with BLW.

Rapid weight gain during the first three years of life predicts child and adult obesity, and also later cardiovascular and other morbidities. Cross-sectional studies suggest that infant diet, activity and sleep are linked to excessive weight gain. As intervention for overweight children is difficult, the aim of the Prevention of Overweight in Infancy (POI.nz) study is to evaluate two primary prevention strategies during late pregnancy and early childhood that could be delivered separately or together as part of normal health care.