Featured article in the Fall 2018 Issue of Nutrition Close-Up; written by Diana K. Rice, RD, LD
What infants eat in their first few months of life is critical.
Around six months old, breast milk and formula are no longer sufficient to meet an infant’s increasing nutritional needs. In particular, the nutrients needed for cognitive development including iron, zinc, choline and docosahexaenoic acid (DHA) must start to come from solid foods.1 We also now know that early exposure to common allergens including eggs and peanuts can actually help decrease the development of problematic food allergies.2
Although pediatricians once recommended starting with infant cereal at four months old, the World Health Organization and the American Academy of Pediatrics now recommend introducing complimentary foods around six months old. And that infant cereal has fallen out of fashion, too. A method of starting solids called baby-led weaning, in which infants are encouraged to self-feed pieces of whole foods, is rapidly rising in popularity.
The term “baby-led weaning” was coined by British author Gill Rapley, who published a book about letting infants self-feed titled “Baby-Led Weaning” in 2008. The feeding method quickly became popular in Europe and is now catching on in the United States. Parents are drawn to the approach because it prioritizes the consumption of freshly prepared, nutritious foods, encourages autonomy and is convenient.
Still, some worry that foregoing that iron-fortified infant cereal in favor of whole foods like scrambled eggs, avocados and sweet potatoes could result in nutrient deficiencies, or that allowing infants to self-feed could increase their risk of choking. A 2017 study, called The Baby-Led Introduction to SolidS (BLISS) trial, examined these concerns. It found that so long as parents were advised to frequently offer high-iron foods such as meat and egg yolks, the baby-led approach did not increase the risk of either iron or zinc deficiency.3,4 Reassuringly, the study also found that infants in the baby-led group consumed a similar amount of total energy and were no more likely to exhibit growth faltering or experience choking episodes.5
When the right foods are offered, the baby-led approach can easily lead to a more nutritious diet than the traditional spoon feeding method. Commercially prepared baby purees often contain produce and meat, but rarely feature eggs, fish and nuts. Another 2017 study showed that infants given eggs starting at six months old had higher blood concentrations of choline and DHA.6 Waiting to regularly incorporate eggs and other nutritious whole foods into a baby’s diet until he or she is beyond the puree stage could impact the child’s cognitive development and lead to missing a critical window for early allergen exposure. Certainly, parents can prepare their own purees featuring eggs and other nutritious foods, but as the growing popularity and demonstrated safety of baby-led weaning suggests, why bother?
The BLISS study also found that infants in the baby-led group exhibited less food fussiness at age two, which builds on past research demonstrating that regularly providing children with tactile food experiences helps them accept and enjoy new foods.5 So while a puree made with avocado, carrots and egg yolks may be nutritious, it is not a food that a baby is likely to encounter later in life. Offering babies recognizable, nutritious foods in their whole forms early on encourages food acceptance and, importantly, is also convenient for caregivers.
The current research on baby-led weaning shows that the method is indeed safe and effective, but parents and infants will benefit from expert guidance about the process. For instance, parents should be advised to minimize the amount of sodium in the foods they offer and that the first foods should be large and soft so they are easy for the infant to grasp and chew. Perfect examples are slices of a simply prepared omelet, cooked vegetables, ripe fruit and soft meat and fish. To promote iron absorption, parents should also know that iron-rich foods should be offered with a source of vitamin C, which can be as simple as meatballs served in tomato sauce or cooked egg yolks offered alongside kiwi slices.
With baby-led weaning only growing in popularity, healthcare practitioners need to be informed about the method so they can point interested parents toward credible resources, including Rapley’s pioneering book and “Born to Eat” by dietitians Leslie Shilling and Wendy Jo Peterson. Parents will also certainly benefit from a referral to a local practitioner trained in baby-led weaning instruction, such as a member of the International Network of Baby-Led Weaning Dietitians founded by dietitian Jessica Coll (jessicacoll.com/BLW_network.html).
And as for suggestions of the ideal food to start with? Look no further than the nutritious, convenient, soft and squishy little egg.
Diana K. Rice, RD, LD, is known as The Baby Steps Dietitian and is the founder of Diana K. Rice Nutrition, LLC, where she works with families to eat well and reduce the stress surrounding their food choices. She specializes in pre- and postnatal nutrition as well as feeding young children and is a strong advocate for cooking with kids, family meals, and body positivity.
- Prado E, et al. Nutrition and brain development in early life. Nutr Rev. 2016;267-284.
- Ierodiakonou D, et al. Timing of allergenic food introduction to the infant diet and risk of allergic or autoimmune disease: A systematic review and meta-analysis. JAMA. 2016;316(11).
- Daniels L, et al. Impact of a modified version of baby-led weaning on iron intake and status: a randomised controlled trial. BMJ Open. 2018;8(6).
- Daniels L, et al. Modified version of baby-led weaning does not result in lower zinc intake or status in infants: A randomized controlled trial. J Acad Nutr Diet. 2018;118(6).
- D’Auria E. et al. Baby-led weaning: what a systematic review of the literature adds on. Italian Journal of Pediatrics. 2018Mar;44(1).
- Iannotti LL, et al. Eggs early in complementary feeding increase choline pathway biomarkers and DHA: a randomized controlled trial in Ecuador. Am J Clin Nutr. 2017Jan;106(6):1482–9.