Q. Some of my friends have started "baby-led weaning" with their children, but I am scared because their kids choke during mealtime. How can I decide if it is a good choice for my baby?
A. The newest parenting rage, called "baby-led leaning” by Gill Rapley, co-author of a book by that name, simply means letting your child self-feed. Starting when the child is 6 months old, parents provide appropriate sized table foods that baby can hold and self-feed. The baby sets the pace for the transition to solid foods. This process sounds so wonderful … how could it be bad?
* BLW gives the baby total control of feeding right around the time when they are closely watching others eat and will often reach for food. If he likes the food that was handed to him, he will eat it, and if he doesn’t, he won’t.
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* There is no pressure for the baby to eat a set amount of food or any particular food group. The emphasis is on allowing him to explore and discover a range of healthy food in his own time.
* The lack of pressure can reduce mealtime battles and makes eating as a family more relaxed and enjoyable.
* The only person who puts food in the child’s mouth is the child.
* In theory, if followed, BLW is great for parents who may be tempted to force feed their child.
* Babies are given table foods before they are developmentally ready and before they have learned how to chew foods or even swallow purees.
* Feeding skills follow developmental milestones that build on each other. BLW skips the most important skill: swallowing food in a pureed state. This foundational skill is vital to ensure safe progression of feeding skills.
* Babies following BLW are more likely to gag, cough, retch or choke during feeding. This is well-documented. These experiences during feeding can result in oral and feeding aversions.
* Chewing skills are developed around 8 months of age. Babies at 6 months have not developed the skills to eat table foods safely.
* Soft foods, especially when given in small pieces, are easy to swallow whole or incompletely chewed. A wince, grimace, shudder, retch or gag when swallowing are signs that the food was not chewed well enough to swallow safely and are the body’s way to protect the airway from obstruction.
* Digestion starts with chewing and mixing of the digestive enzymes in the mouth with the food. If this first step is skipped, the body is at greater risk for digestive difficulties.
* Providing babies table foods places them at a significantly increased risk for aspiration or airway obstruction. The American Academy of Pediatrics identifies the greatest risk of death in toddlers is by choking.
* If a child swallows a food bolus a half-inch or larger, her body does not digest the food and just passes it out. Advocates for BLW suggest that you will see food pieces in the bowel movement. This is an overt red flag for chewing difficulties and indicates that the child swallowed food pieces too large to digest.
* Swallowing pieces of food that are too large to digest places the child at significant risk for gagging, choking, coughing, aspiration, obstruction, malnutrition, under-nutrition and weight/growth issues.
* Advocates for BLW also say that it is OK for your child to gag or cough when he is first learning. They suggest that he or she will get used to the foods, and the gagging and coughing will diminish. This is true. The child will desensitize the gag reflex, allowing him to swallow larger incompletely chewed foods without difficulty. Unfortunately, desensitizing the gag reflex reduces the body’s way to protect itself.
* Consistently, children referred to Carolina Pediatric Dysphagia for picky eating have incompetent chewing skills. Competent chewing skills are required to successfully chew and safely swallow.
* A child that has not developed the correct progression of tongue patterns will not only negatively impact his feeding and swallow skills, but is also at significant risk for poor articulation of speech sounds and an increased need for orthodontic services.
* The BLW book reports: “Although gagging can appear alarming to parents, babies are rarely bothered by it.” Gagging and choking can cause a baby to stop eating, develop behavioral feeding disorders, and increase oral and feeding aversions.
In our experience, baby-led weaning is excellent in theory but very concerning in practice. As taught in BLW, we always help parents with ways to give babies choices, teach them how read their baby’s cues about comfort levels during feeding, teach how to follow their baby’s leads as to how confident he or she is with exploring foods and help them understand their baby’s behaviors. Behaviors are baby’s only way of communication. Coughing, gagging and choking during feeding is a significant sign of a feeding disorder and place baby at significant risk of aspiration or obstruction. We strongly discourage BLW. Our hope is that this parenting rage will be left along the roadside just like fad diets and other dieting advice that just doesn’t work.
If you have a question about your child's health or happiness, ask Joan or any of our experts by sending email to firstname.lastname@example.org.
Joan Dietrich Comrie of Carolina Pediatric Dysphagia (919-877-9800) has dedicated her entire career to studying, teaching and practicing in the area of dysphagia, specifically pediatric dysphagia. She received her bachelor of science degree and then her master of science degree in the area of speech pathology at the University of Wisconsin-Madison in 1986. Before starting Carolina Pediatric Dysphagia in 1996, she worked at several hospitals (Cardinal Hill Rehabilitation Hospital, Lexington, Ky., Vanderbilt Medical Center, Nashville, Tenn., and WakeMed, Raleigh) where she developed or reorganized the hospital's pediatric dysphagia program.
Joan has spoken on the topic of pediatric dysphagia nationally and internationally. She has published in a professional journal. She co-taught the first dysphagia course offered at UNC and continues to guest lecture to several university graduate level speech pathology programs and to the UNC Medical Students who complete their rotation at WakeMed. She has served as chairman and member of a subcommittee of the Special Interest Division 13 of the American Speech Language Hearing Association (ASHA). She has received her certificate of clinical competence (CCC) through ASHA and is licensed in the state of North Carolina.