New Research Says Baby Led Weaning Does NOT Increase Risk of Choking

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Baby-led weaning, increasingly acclaimed as a healthier weaning approach, is a method that allows babies to feed themselves from the very moment solids are introduced.

According to World Health Organization guidelines, most babies are developmentally ready to start solid foods at around 6 months. There are several physical signs, such as grabbing for the parent’s food and the loss of the tongue-thrust reflex, that signal food readiness in an infant.

Traditionally, parents were advised to follow a rather rigid solids-introduction schedule: starting with rice cereal then moving up to various types of pureed fruits, vegetables, and meats. Eventually, they would be allowed to try foods in other consistencies besides but only if they were no bigger than the tip of the baby’s pinky finger — to prevent choking.

Baby-led weaning bypasses the pureed steps and allows parents to offer appropriately sized pieces of fruits, vegetables, grains, and meats from the start. If the baby likes it, he eats it. If not, he doesn’t eat it. And best of all: no more spoon-feeding.

Another benefit, which goes deeper than easing the mealtimes hassle of spoon-feeding, is that baby-led weaning helps teach babies how to self-regulate their food intake. They learn their hunger and fullness cues more keenly, and therefore are lower risk of developing a pattern of overeating. There is also evidence that baby-led weaning supports proper jaw development, hand-eye coordination and dexterity, and healthy food choice habits.

However, the American Academy of Pediatrics raised concerns about the safety of baby-led weaning (which was developed by a health home visitor who practiced baby-led weaning on her own children and then advocated it in her practice) saying that this approach to weaning might increase the risk of choking among infants — particularly after a New Zealand study published in November 2015 touted baby-led weaning as an obesity prevention initiative.
But new guidelines, published in September in the journal Pediatrics, say otherwise — concluding that baby-led weaning does not, in fact, cause more choking risk than spoon-feeding.

However, this does not mean that using this method eliminates the risk of choking. Researchers did find that both approaches, baby-led weaning and spoon-feeding, have led to choking and they encourage all parents to be trained in how to deal with choking incidents.
Researchers also suggest that parents ensure that foods being served to baby:

• Are soft enough for baby to mash with the tongue
• Don’t form a crumb in the mouth
• Are at least as long as baby’s fist on one side
• Are being offered while baby is sitting up
• Are given when baby is being monitored
• Are offered so baby is only one at a time
• Are eaten at the baby’s own pace and under the baby’s control.

Age also appears to make a difference. A third of all infants in the study — whether baby-led or spoon-fed — gagged at least once, but gagging at 6 months was more likely among baby-led weaning infants. On the other hand, gagging at 8 months was more likely among spoon-fed infants.

The real problem found here is not that weaning carries an inherent gagging risk (though it may), but rather that parents practicing baby-led weaning tend to make more mistakes in what foods they offer.
So, if parents can stick to the guidelines above, baby-led weaning can be considered just as safe as other methods – and perhaps even safer than has been described in this study.

-Rita Brhel
Rita Brhel, BS, CLC, is the Executive Editor for Attachment Parenting International, a WIC Breastfeeding Peer Counselor, and a domestic violence survivors advocate.

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