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Baby Led Weaning, “starves children and leads to underweight!!”

Posted by on Feb 7, 2012 in Blog Posts | 9 comments

Did that headline get your attention? I had a little fun with that one. The real headlines? “BLW prevents obesity!”

Of course, because that seems to be the only way to get attention these days. What if the headline had said, “BLW starves babies and makes them underweight!” Equally as valid sensationalism given the conclusions of the actual study.

But, I digress…This article about Baby led weaning is intriguing, but leaves me with lots of questions! If you aren’t familiar with BLW, take a minute to read my post from last year which is a primer. It was my most commented on post ever!

Remember, my conclusion is that you can do either BLW or spoon-feed and have a healthy feeding relationship that supports healthy growth, if you follow your child’s lead!

“Researchers analysed two methods of weaning – baby-led weaning with finger foods, versus traditional spoon-feeding by parents. The sample included 92 children who had been weaned on finger foods and 63 who were traditionally spoon-fed. Parents filled in questionnaires on how their children had been weaned, including how often they ate certain foods.”

“Some 94% of youngsters in the baby-led group had never choked as a result of being given solid foods.”

 “Our results suggest that infants weaned through the baby-led approach learn to regulate their food intake in a manner which leads to a lower BMI (body mass index) and a preference for healthy foods like carbohydrates.

The actual article at least acknowledged: There was an increased incidence of (1) underweight in the baby-led group and (2) obesity in the spoon-fed group. No difference in picky eating was found between the two weaning groups. (surprising, since the book claims BLW means less picky eating, and I actually thought it might lead to greater variety as well…)

There is a major problem with these types of studies, with small numbers especially as they look at the children in one point of time, not at the growth patterns over time… Perhaps the “underweight” and “overweight” kids were healthy and growing at a steady rate… Perhaps kids in the “normal” group were dropping percentiles, or increasing…

So I did a little more digging, and found a few other things. The age of the groups of children at testing were very different. The BLW group was on average 32 months old, the spoon-fed group was 40 months. Big difference. BLW babies were breast fed for 23 months vs 9 months for spoon-fed. No report of choking in the spoon-fed. (A 6% incidence of true choking may be higher than acceptable, but the study is too small, 1 kid essentially…)

This chart was also interesting for several reasons. The increase in “underweight” was significant, but also look at how the NHS (National health service in England) and the CDC have chosen different arbitrary cut-offs for “underweight” and “overweight” and obese, and how different the conclusions might be based on that!

Baby-led group (n=63) Spoon-fed group (n=63)
WHO z-score
−3 1 (1.6%) 0 (0%)
−2 2 (3.2%) 0 (0%)
−1 5 (7.9%) 3 (4.8%)
0 39 (61.9%) 40 (63.5%)
1 15 (23.8%) 12 (19.0%)
2 1 (1.6%) 8 (12.7%)
3 0 (0%) 0 (0%)
NHS percentiles
 Underweight (<2) 3 (4.7%) 0 (0%)
 Healthy weight (2–90) 51 (81.0%) 53 (84.1%)
 Overweight (91–97) 9 (14.3%) 2 (3.2%)
 Obese (98+) 0 (0%) 8 (12.7%)
CDC percentiles
 Underweight (0–4) 6 (9.5%) 1 (1.6%)
 Healthy weight (5–85) 49 (77.8%) 47 (74.6%)
 Overweight (86–95) 7 (12.7%) 8 (12.7%)
 Obese (96+) 1 (1.6%) 7 (11.1%)

What I am getting at (not really sure  what that is as I rush to get  the first draft of my special needs chapter of my book done) is that these are complex issues, often not acknowledged in press releases or the headline-grabbing articles. We do need to be careful we aren’t causing more harm than good, and can’t just gloss over an increase in underweight without comment. Every child is different. Some children will thrive self-feeding, others may benefit from spoon-feeding, and often, a combination is the right approach. Supporting parents in being responsive, and not trying to get children to eat more or less than they might want is the way to go.

(Oh, and I love how they defined “carbohydrates” as “healthy” when I see carbs so often being blamed for the all nutritional ills…)

What do you think?

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  1. Regina T

    As a first time grandmother who has the fun job ( and I mean that, truly) of babysitting my 6 month old grandson four times a week, this post is very timely for me. My daughter is a surgical nurse and also a very “follow the docs recommendations to the letter” first time Mom. It has been difficult to watch my grandboy struggle with that natural curiosity for food and have to deny him the experience at 4 and 5 months because that was what my daughter wanted for her son. She still manages to pump and breastfeed while working full time, but when I ask her what is the reasoning behind her waiting until he’s six months, her response is that the research out there links early feeding with obesity, digestive problems, and breast refusal. Having raised my own two children—neither of which struggle with those issues today, it’s been hard to not just do what I know is right (feed him) and respect her decisions by following thrm.
    Now that he’s eating her organic, homemade blended baby food, I have been enjoying spoon feeding my grandson in a modified way. I give him a few spoonfuls, then let him hold the next spoonful and twist it into his mouth. It spills and drips, but he gets some of the food and at the same time controls part of his own feeding. I hope this helps him learn his own hunger cues, satiety, and tastes in a healthy way, while allowing his mother to feel like she is in charge. It’s funny how things change when it’s your grandchild instead of child.

    • katja

      Your daughter and grand-son are lucky to have you! It is hard to go against letting the children lead. Some kids are ready before six months, some not until seven or eight months. He won’t be harmed by being made to wait. Kids are resilient. There is more harm in pressuring a child who is not ready, say at 3 or 4 months. Sounds like you are doing perfect and following his lead! As a mom myself, whose mother and mother-in-law were both lobbying for solids at 2 weeks of age, and were not supportive of my breastfeeding and pumping, I know the intergenerational stuff can be hard. It sounds like you are being respectful of your daughter and your grandson! Has she read Child of Mine? Also, the DVDs are wonderful. Feeding with love and good sense 2. Maybe you could give her a copy for Christmas 🙂 Too pushy? I Love to hear from Grammas!

  2. unscrambled

    And now for the statistics grumbling. You can’t have all of those co-factors and that few patients and expect to prove diddly squat with regression analysis. Mmmmmmmmaybe if they had used a propensity score. In conclusion: bup-kis.

    I get really annoyed about how much people get torqued about the normal distribution of baby weight (well, weight in general–but there’s something particularly aggravating about getting wound up about freaking babies). As you said, the only thing that would be useful would be repeated measurements of weight, and then analysis of the trend. Aggravatingly, with an EMR it is dead easy to do, but people don’t want to think out the calculations. Or ((putting on my tinfoil hat)) they did it with repeated measures and it didn’t show anything.

    (I know you know this, but this turns my crank when people try to demonize one macronutrient or another–and I’ve seen every single one blamed for all manner of everything)

    • katja

      yes, the study is deeply, deeply flawed… and yes, the language around, “carbohydrates” vs “sweets” was funny since sugar is a simple carb…I think they were grasping at straws to find something else they could say was another benefit of BLW… Again, I think BLW is great, but so is responsive spoon feeding. 🙂

  3. jessidehl

    My youngest is 11 months old and we did a combination of BLW and spoonfeeding. This is the first baby we’ve done the DOR with so we tried to pick the approach that closely mirrored the way our two older kids (6 and 4)eat. I nursed her at the table when she was awake, and she started sitting in her high chair as soon as she could sit up. At first she played with the toys that snap over her tray, then she started getting some soft foods that she could scoop into her mouth with her hands. We did spoon feed her, but let her hold the spoon and suck the food off by herself. We gave her large hunks of meat to gnaw on and she never choked.

    She fully participates in our meals now, and eats most of the things we eat. Once in awhile she will let us put food into her mouth with a spoon but most of the time she insists on doing it herself. I think she has great self regulation. I’m really lucky that we found the DOR because she is consistently growing near the 75-85-90 percentile and I get a lot of comments about her size–I might just be more attuned to it because I am fat and a HAES advocate–and my first two weren’t big kids. My oldest daughter is tall and slim like my mom, and my son is average height and weight.

    Also–I hate how they label the middle range as “healthy” weight. Grrr!

    • katja

      yes, hate all the arbitrary cutoffs and labels. So harmful!

    • katja

      I too am grateful I found the DOR, and HAES in time. I have a larger than average daughter and it has helped me protect us from all the panic and counterproductive feeding advice!

  4. Erica Schaub, RN

    We spoon fed my first, and started spoon feeding my second and it just didn’t work. He wasn’t into the spoon, and really did want what we had. So I rented the BLW book, and tried to follow that and it worked great. My second boy can handle pretty much anything at 12 months now, and it sure made my life easier as I didn’t have to spend 15 minutes at each meal spoon feeding. I can just put the food on his tray and he goes to town. Then if he wants more, he signs for more or ‘all done’ if he is all done (ge just picked this up about 2 weeks ago). Also, definitely no issues with being underweight.

    • katja

      Sounds like you did a great job following what he was telling you and meeting his needs and supporting your family! Yay! I loved that little “more” sign. M also would say, “Ah-Dan” as some of her first words! It can be fun, fun times…