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Thursday, September 16, 2010

Baby-led Weaning: The Whys and the Hows

Why do BLW?

First, the AAP now recommends nothing other than breastmilk or formula until the child is six months old. Yep. If your doctor recommends it prior to that, they are not following the newest guidelines. And yes, these things change all the time, so I highly recommend doing your own research also.


(Warning: long science-y rambling ahead!)

Babies are born with an "open gut" that allows them to better absorb nutrients (meaning there are large spaces between the cells of the intestinal wall). Breast milk (and maybe formula? not sure on that)  is designed to work with that open gut; however, other molecules, such as those found in baby cereal and purees, are not. These types of foods should not be introduced until those spaces between the cells close. This closing usually corresponds to several physiological milestones, such as sitting up unassisted (well - no pillows supporting them!), losing the tongue thrust reflex, able to bring food to their mouth and feed themselves, etc. These usually occur around six months of age.

Introduction of anything to their digestive system prior to this time interuppts the development of "good" bacteria that promotes digestive health for life. It also has been shown to reduce instances of things like celiac disease, allergies, irritable bowel syndrome, and other digestive ailments. Allowing the gut to "close" prior to introducing solid foods (i.e. anything other than breastmilk, and maybe formula, but again, not sure on that) follows the physiological, natural timeline of the baby's development.

Although it is the norm now, baby cereal and oatmeal are a relatively new concept, created when doctors were sure that anything man-made was far superior to what nature could offer. New moms were given pills to immediately dry up their milk, and babies were started on a formula that was basically caro syrup and evaporated milk. Because of this, babies were developing iron deficincies, so the formula companies developed iron-fortified cereals to boost the amount of iron that the babies were receiving. However, babies are born with a tongue-thrust reflex (with good reason), and they needed to make it thin and liquid-y in order to force the cereal past that tongue-thrust reflex. If you introduce solids early, they will quickly learn to suppress this reflex, but it does not naturally occur until they are about six months old (again: this all makes sense from an evolutionary standpoint - they are trying to keep anything out of their stomachs except milk until their guts close!).  Purees quickly followed cereals, but if you wait until your child is around six months old, there's no need for purees: they can eat real food!

Also, some very very introductory studies are beginning to link obesity with the introduction of solids before four months.  The earlier solids are introduced, the more likely babies are to be obese later. One theory behind this is that introducing simple carbs (which most cereals and oatmeals are) set up a predilection for preference for this type of food later in life, and simple white carbs are one of the worst things you can eat at any time in your life in terms of nutrition. Additionally, there is little to no nutritional value (a serving commonly has little to no fat, and lots of carbs - the exact opposite of what they need at this age!).  Many of them have added iron, DHA, or other vitamins, but in reality those add very little to the value of the cereal, as vitamins as additives are not absorbed as well or as easily as those found naturally in breastmilk or foods.  And a note about iron: the iron stores a baby has are plenty to maintain their iron needs through the first six months of life. After that, they begin to deplete, but they do not suddenly disappear!

Another benefit to BLW is that it teaches babies to chew and then swallow, rather than to swallow first. When you start with purees, there's a whole new set of skills to learn when you switch to 'real" food, and many babies have difficulties with that (we'll talk about choking later). 

Oh, and there's no need to do purees for the child to "practice" eating with a spoon or get used to swallowing or any of that nonsense.  Trust me, the kid can eat everything just fine!

And no, you don't need teeth to do it (we started at six months and Carys didn't get her first teeth until around 8 or 9 months, and besides, they don't get their "chewing" teeth until much later!).

(End science-y technobabble.)

So there's a long list of reason TO wait, and none NOT to wait (note: some doctors advise that babies need cereal introduced to their milk for reflux, and some babies are not thriving and need solids introduced early to combat that. Those are obviously a totally different situation!).  Because of these reasons, I choose to wait. I have a history of obesity in my family, so anything I could do to give her an extra boost away from that was a godsend.  Plus, it's ridiculously easy. And I love eating WITH her, instead of feeding her and then eating myself. It's so easy to model good mealtime behaviors when you're eating the same thing at the same time. And I'm not going to lie - it gives me a huge incentive to eat healthier myself. There's nothing like chowing down on pizza while your child is eating spinach quiche and asking to eat some of your pizza...and you have to say no because of course you don't want to give your kid pizza! And if you don't want to give your kid pizza, why are you eating it?!? (This is a conversation I had with myself in my head.)

The site I first discovered that led me on my BLW journey is Adventures in Solid Food.  There's also a great book out there on BLW called (what else?) Baby-Led Weaning (I like the Cookbook version; it summarizes the book in the first few chapters and then follows with great recipe ideas).  The authors of that book also have a great site, which can be found here.  Again, I think it's important to note: this is not a new concept. Gill Rapley did not invent this. People did this for eons before purees were introduced, and many of our relatives did it instinctively. Gill Rapley just gave it a new name and re-introduced it to the masses. Marketing, hey!

I don't want to completely re-hash the "how to" behind BLW that can be found at the resources above, but here are some guidelines:

When to Start
You can start BLW when your child has reached all of the below milestones:
  -Is around six months old
  -Sits well
  -Grabs items and brings them to mouth
  -Chews things
  -Shows an interest in food (this one is hard, because babies are interested in EVERYTHING... remember, they'd probably be just as interested in it if it was a rock!)
  -Thrusting reflex is gone

What to Feed
Anything that you're eating (within reason), as long as you avoid high sodium foods and foods with lots of sugar. Follow the same guidelines with fish that you follow for yourself (i.e. avoid high-mercury fish too often). Avoid overly processed foods.  No honey under 1 year (due to botulism concerns).

Some good things to start with:
-Avacado (perfect first food!)
-Sweet potato fries (steamed or baked)
-Steamed carrots
-Peas (great for working on the pincher grasp!)
-Ripe pears (super soft!)

Don't be afraid of spices, olive oil, and real milk or butter!

How to Feed
When appropriate, foods should be offered in large pieces - think a big steak fry (finger length and thumb width). It should be large enough that the baby can hold it in their fist and have bits of it sticking out the top and bottom to eat from. (Obviously, this doesn't apply to something like peas).  Hard foods can be steamed or baked to soften them up (like carrots or apples).  Cherry tomatoes, grapes, etc., should be squished or cut in half.  You generally want "sticks" of food, not "discs" - so for carrots, for example, you'd want long pieces, not "coins".

Only the baby should put food in their mouth. They alone know how much food they can handle, whether they've finished what they previously were eating, and whether they want more.

The baby should be sitting upright (you may need to roll up a towel to put behind their back if their highchair isn't upright enough).

It doesn't matter how much they eat! They might throw it all on the floor. They might eat every bite. They might eat two bites and then decided they want to play with the rest. For the first year, breastmilk or formula is still the primary form of nutrition. They might not eat three days in a row and instead mush all the food into their hair, and it would be okay. They are just exploring textures and tastes at this time!

Choking versus gagging
This is one of the BIGGEST things in BLW. Every parent is worried about their child choking, and when you give your kid a big chunk of food, it's a reasonable worry. What you need to know is the difference between choking and gagging.

Gagging - even to the point of throwing up! - is a perfectly appropriate, normal reaction to solid foods. A baby's gag reflex is not in the back of their throat like an adult's - it's more forward in the mouth. Babies gag as they learn to manage the food in their mouth and learn to move the food around. Gagging is loud, and the baby usually remains fairly calm (although a severe gag may cause them to tear up or cry, or even thow up!). All of that is okay.  Gagging is loud and can be scary, but a gagging child should be left to try to work it out themselves. 99.9% of the time, they'll cough the offending piece of food out.  In the vast majority of cases, when the child starts to gag, the parents should just stand by encouraging the child. "Oh, it looks like you got too big of a piece! Whoops! Can you spit it out?" Do not panic (although this will be hard the first couple of times). Do not put your fingers in the child's mouth if they are gagging - you may inadvertently push the food further down their throat and cause actual choking. Again, these 'rules' are for gagging - not the rare act of choking. Obviously, you don't want to stand by and watch your child TRULY choke!

Choking is the complete blockage of the airway. Choking is silent. Choking is panicked. I highly recommend that ANY parent (not just those doing BLW) learn infant/child CPR to learn what to do in the rare event that your child does choke.

It's been my experience that choking is less common with BLW, as the child becomes an expert at managing the food that goes in their mouth, and they are controlling the input. That said, it's not impossible that they might choke on something, particularly if the "whats" and "hows" were not followed (example: someone was complaining that BLW made their child choke, and we then found out that they were feeding the baby raw carrot slices - the discs, not the sticks).

Does it work?
Sometimes, you hear people say that BLW didn't work for them. In the vast majority of those cases, it's that BLW didn't work for the parents - that they weren't giving their child the chance to manage the food themselves, that they intervened when the child was gagging (and probably called it choking), that they were giving the wrong foods, etc. If your child is truly choking and not managing the food that you are giving them, or if they aren't showing any interest in the food, they are probably simply not ready for solids yet. Every child reaches readiness at a different time. Six months is merely the average.  If it doesn't work at the time you introduce it, try again a day later, or a week later, or a month later.  Or even beter, continue to offer them every day, even if the food is completely ignored!

That said, every child is different and, as the parent, you know your child best and should act accordingly.


Any questions? I'm sure I missed something, so please let me know if anyone wants more information!




Baby Led Weaning
Baby Led Weaning Cookbook
Baby Led Weaning, Step by Step (Note: I have not read this, only seen it recommended)
The Baby and Toddler Cookbook (BLW would suggest skipping the purees and using only the other recipes, or saving the purees for when they can spoon-feed themselves - or the purees could be great to put in pouches for on-the-go snacks, too)

Tomee Tipee Bibs (a favorite)
Baby Bjorn Bibs (another fave)
iPlay Green Sprouts sleeved Bibs (a favorite - if the sleeved bib isn't listed, contact the company and they'll send you pricing and pattern info - it just means that the store that the site feeds from is out of stock, not that the company is out of stock - but for real, this bib is A MUST, it makes clean up a huge snap!!!)
^^^^You'll note with all these bibs that the common factor is the pocket at the bottom - that is HUGE in making clean-up easy! The bigger and more, um, stick-outy the pocket, the better!
Boon Cutlery (all soft for when they are first learning)
Gerber Cutlery (with metal, like mom and dad!)
Disposable Placemats (for dining out)
Reusable Placemat (for home or dining out)