Baby-led weaning: Best practices

Pediatricians should counsel caregivers on when the ideal time is to start BLW, specifically, when their infant is developmentally ready to ingest solids safely. This does not necessarily correspond to a chronological age, but rather developmental abilities that typically occur around or after age 6 months. Infants need to be able to sit unsupported; have good head control; have raking and grasping abilities; and show the capability to direct an object into their mouth. If an infant is not felt to be ready for BLW by age 8 months, he/she should be evaluated for developmental delays and traditional feeding approaches should be strongly considered.

Infants being fed by BLW should always be supervised and should never be left alone when eating. Parents should be counseled to avoid high-risk choking foods that are typically firm and round. Infants should be fed in an upright supported position (eg, in a high chair), and not reclining. First foods should be soft, easily “mushed” in an infant’s mouth without teeth, and easily grasped in the infant’s hand.  In addition, all parents and caregivers, regardless of weaning style, should take infant cardiopulmonary resuscitation (CPR) and first-aid courses, such as those provided by the American Red Cross or many hospitals, to learn how to intervene in case of a choking incident.

Parents should be encouraged to offer a wide variety of foods to their infant at every meal, including at least 1 high-energy food and 1 high-iron food. Typically, infants should be offered 3 to 4 foods at each meal. An iron supplement may be appropriate for infants who do not eat much meat or iron-rich foods. During the first months of the introduction of complementary foods, breastmilk or formula should be offered at the same volume (if being consumed from a bottle) and frequency. Milk feedings should be offered before solid meals to ensure the infant continues to obtain adequate calories and nutrients.

Caregivers should be encouraged to include their BLW infant in family mealtimes. Caregivers should talk to their infant about the food he/she is exploring but avoid pressuring the infant to “finish.”