Dr. Homan's blog

As a physician, we have the motto, “first do no harm,” so sometimes it is a little difficult accepting new ideas–because we are fearful of the harm that they may do. And it took me a while to accept and recommend infant-led feeding. I had some reservations.

No, I’m not nervous about babies choking, which most parents seem to worry about, that was not my top concern. Ever since the idea of baby-led feeding came out, I have been very nervous that it will cause babies to be low on iron when I check their blood at the one-year check-up. And this is no small matter, as we know (and I’ve seen) that iron is important for brain development, growth, and adequate red blood cell production, among other things. In fact, my first patient who really pushed the idea of baby-led feeding, did not grow well and was iron-deficient at one-year of age. I do not think that mother understood how serious I was about giving her infant iron-rich foods.

The general idea behind infant-led feeding was good, that babies can to listen to their appetite and eat “whole” foods if they aren’t just spoon-fed purées. Know how to listening to our appetite, our fullness and hunger cues, is very important in our current culture’s obesity epidemic.

So when Sarah Ward invited me to come visit her breastfeeding support group at Capital Regional Medical Center, I decided to see what new research had been published about infant-led feeding. And body did I find some meat! The research that has put my mind at ease is called BLISS, which stands for Baby Led Introduction to SolidS,” and it started in 2015 and finished in 2018. The BLISS researchers were fully aware of the risks of choking, developing iron-deficiency, and inadequate weight gain, so they gave families principles to follow. I have summarized these here:

Choking Precautions

• Test foods before they are offered to ensure they are soft enough to mash with the tongue on the roof of the mouth (or are large and fibrous enough that small pieces do not break off when sucked and chewed, e.g., strips of meat).
• Avoid offering foods that form a crumb in the mouth.
• Make sure that the foods offered are at least as long as the child’s fist, on at least one side of the food.
• Make sure the infant is always sitting upright when they are eating – never leaning backwards.
• Always have an adult with the child when they are eating.
• Never put whole foods into the infant’s mouth – the infant must do this at their own pace and under their own control.

Iron-rich and Energy Recommendations

• Offer the child 3 different foods at each meal:
  • iron-rich food, such as meat, beans, or lentils
  • an energy rich food like cheese, eggs, or nuts
  • a food like a fruit or vegetable
• Avoid hurrying your baby (she may not eat enough, of sense your urgency and eat too fast herself and choke!)
• Always include your baby at meal times just as you would other family members (we know that families that eat together have better mental illness and eat healthier)
• Avoid offering “fast” foods or foods that have added sugar or salt

The researchers followed these babies for 2 years, and they found that when families were properly educated, babies who were infant-led, did not choke any more and grew just as well as infant spoon-fed. They were also not more likely to be iron-deficient at one-year of age. They also found that some of the spoon-feed babies were sometimes allowed to self-feed and that some of the infant-led babies were occasionally spoon-fed.

Summary of Findings

• Infant-led babies were not more likely to choke, be iron-deficient, or be underweight at one-year of age
• Infant-led babies breastfed longer
• Infant-led babies did consume a little more salt between 6-12 months of age. The researchers think this was due to their recommendation to try things on toast.
• Infant-led babies ate more often with their families and had better appetite control

But, no everything was roses. They found that both infant-led and spoon-fed babies and toddlers had excessive amounts of sugar and salt intake! This is the culture that we live in, and it is very hard to change our habits, I know. My three kids would live off candy if I let them, and they sneak sugar and hoard it like it’s on national shortage. We struggle at my house too, but we keep fighting. We limit juice, soda, and candies and try to feed our kids whole foods.

So, in closing, now I fully recommend infant-led feeding as the best way to introduce solids to your baby. In reality, a mix of baby-led feeding and spoon feeding is probably the most realistic way to go.