Book Club! Baby-Led Weaning

Book Review: Baby-Led Weaning by Gill Rapley and Tracey Murkett

It seems like everywhere I go over the past couple months, I hear parents of young children talking about this book. The cover of the book has many claims “No purees, no stress, no fuss!” and the subtitle “The Essential Guide to Introducing Solid Foods and Helping Your Baby to Grow Up a Happy and Confident Eater.” Well, who would not want to read this book?

The basis is that spoon-feeding purees is outdated and can actually lead to many of the problems that we are currently seeing in our children from obesity and picky eating to texture and sensory sensitivities. The author’s simple solution is to wait until your baby is at least 6 months old and then allow them to explore solid foods with their hands and eat what you are eating.  The drawbacks being that it is very messy the first few months but in the end you are saving loads of time and money on baby food and you will have a child who has a broad palate and is able to feed themselves what they need and want. There is a strong emphasis that the majority of their nutrition will be breast milk or formula until they are effectively taking solids 10-11 months old. In the meantime, the meal times are a developmental exercise of exploring, working on eye hand coordination, and fine motor skills and social interaction.  Sounds great, right?

So, what is the current standard in the United States with introduction of solid foods? If you talk with 5 different pediatricians, you will get 5 different ways to approach introducing solid foods. The American Academy of Pediatrics (AAP) is frustratingly vague with the section on breastfeeding recommending exclusive breastfeeding until 6 months and the section on nutrition stating that solids should not be introduced before 4 months, but not delayed after 6 months. So, parents have been figuring this out for themselves with the advice of grandparents, friends, and their pediatricians to come up with how and what to feed to their infants. Parents start solids for many reasons: they are hopeful that their child will sleep longer, they think it will be an enjoyable experience for their baby, they think that their baby must need additional nutrition to continue to thrive and grow.

While parents used to rely on commercially prepared baby foods, there has been a shift in the way we think about food in America and that can be seen in the baby food industry as well. Many parents are concerned about where their food comes from and what it contains in relation to preservatives and additives. This can be seen on any baby aisle with hundreds of baby foods labeled as organic, whole grains, added omega-3 s, etc.  There has been a huge movement towards making your own baby food with cleverly marketed products available like the Baby Beaba and Baby Bullet so that you can make your own baby food from what you have at home.

There is a lot for parents to think about, and even more if food allergies run in your family! Should you start with rice cereal (no, too constipating and aren’t carbs bad?), or fruits (no, then they will develop a sweet tooth, is there arsenic in my applesauce?), or vegetables (but not anything that will make them gassy, and not spinach because of phytates?), or fish (but what about mercury?), tofu (what about estrogens?), meat? For every step you might take there are several questions! Eating seems more complicated than ever. But back to the book…

There were a few things that I did raise my eyebrows at and did not agree with. I am most concerned with the choking possibilities with this method of solid food introduction. Choking is a leading cause of morbidity and mortality in children under 3 years old. The most common things that children choke on are food, coins, and toys. Because, in my training at a large children’s hospital, I have witnessed normal healthy children die or be left brain dead after choking on a piece of apple, a grape, and a piece of popcorn, I cannot take the risk of choking lightly or suggest that letting your 6 month old gnaw on a piece of meat is okay.  The book does go over minimizing the risk factors for choking such as never letting the baby eat alone, having them sitting upright, and avoiding high risk foods like hard candies and nuts and cutting spherical foods like grapes, cherry tomatoes, and pieces of hotdog. But I would go further to suggest that most foods should be pureed until primary tooth eruption and incredibly soft or mashed until molar eruption when you child can actually masticate their food.  I would also suggest that all parents take a first aid course for choking and CPR if they have not done so before their child starts to eat solids.

The second issue that struck me with the book was the amount of effort involved in this “no fuss” feeding method. One suggestion in the book is that you cut your fruits and veggies with a crinkle cutter to make the pieces easier to hold and that you keep extra veggies on hand in the freezer. The preparation methods are roasting, boiling, and steaming and not adding salt.  So, it seems to me that the only step you are saving is the actually pureeing, which in my experience is the easiest part!

And finally, my third problem with this book is the woefully inadequate references. I eagerly flipped to the back to see all the wonderful developmental pediatric articles to support this book only to be hugely disappointed. She has one very small research study cited, two dictionaries (dead serious), and a few websites. She also references herself, which I find to be a little obnoxious.

So, in summary, I loved it at first but then was disappointed. I think that this method might work really well for some families. If you can be a parent that is laid back about mess, wasted food, and not going to be fixated on being able to quantify how much your child is eating, then this might really work for you. And all I would suggest is a choking CPR course and keeping the foods on the softer, mushier, smaller side of things.

My two cents is that all babies are individuals and that some may be ready before 6 months and some after. I have told my families that a good time to introduce solids is when the child is trying to grab food off your plate and in general, is very interested in what you are eating. With most children who have no family history of food allergies, I suggest introducing eggs, dairy, and fish around 9 months, and even nut butters.  I think that spoon-feeding is fine so long as it is never forced and that you respect your child’s cues. An open mouth meaning “more please” and a turned head meaning, “I am done with that”.  I think that letting your child start with finger foods early is great and having them eat what you eat is wonderful but I would keep the pieces small and soft (think peas and rice) and watch them closely. I also love and support the early introduction of cups (shot glasses work really well) and utensils to encourage independence and confidence as well as fine motor development.

So, Baby-Led Weaning was a good read and has some interesting ideas, but not for everyone and maybe not as simple as the cover would have you believe.

 

References:

Rapley, Gill, and Tracey Murkett. Baby-led Weaning: The Essential Guide to Introducing Solid Foods and Helping Your Baby to Grow up a Happy and Confident Eater. New York: Experiment, 2010. Print.

AMERICAN ACADEMY OF PEDIATRICS: Policy Statement—Prevention of Choking Among Children COMMITTEE ON INJURY, VIOLENCE, AND POISON PREVENTION Pediatrics .2009-2862

AMERICAN ACADEMY OF PEDIATRICS: Policy Statement: Breastfeeding and the Use of Human Milk SECTION ON BREASTFEEDING Pediatrics 2012; 129:3 e827-e841

Effects of Early Nutritional Interventions on the Development of Atopic Disease in Infants and Children: The Role of Maternal Dietary Restriction, Breastfeeding, Timing of Introduction of Complementary Foods, and Hydrolyzed Formulas Frank R. Greer, Scott H. Sicherer, A. Wesley Burks, and and the Committee on Nutrition and Section on Allergy and Immunology Pediatrics January 2008; 121:1 183-191

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