Wednesday, 7 March 2012

Baby Led Weaning and It's Limitations

As you may have read yesterday, I read Gillian Rapley's Baby Led Weaning whilst pregnant, and again when Joseph was in special care. A lot of what I read made sense, until I came across a few paragraphs where Gillian advised she did not recommend it for extremely premature infants. I wanted to write a little about the limitations of baby-led weaning today.

What are the basic principles of baby led weaning? The first thing is, the baby decides when they start, not the parent. The parent offers opportunities to explore with food, but the baby always makes the first move. Babies use their hands to eat. It's more than just "offering finger foods", the baby might dip a fist into porridge, or even eat like a puppy! The baby decides what and how much they eat. There is not parent led spoon feeding. The baby might go on to use a preloaded spoon, but they decide what the do with it.

What are the problems with this style of weaning and premature babies? As I explained yesterday with premature babies, the general consensus in the UK is that the baby is weaned on their actual age, somewhere between 5-8 months. So with a baby born before 34 weeks especially, their motor skills, both find and gross are not going to be in line with the ability of their stomachs to process the food.

Babies who were born prematurely have specific dietary needs. They need iron rich foods, and calorie dense foods.  The Baby Led Weaning motto "food is fun until they are one" does not apply to the premature baby. In addition teeth can be late developing in preemies, Joseph didn't have a single tooth until he was one, where many term one year olds have 4 or more, which increases the range of foods you can offer. Iron rich foods, which are often meat based, are difficult to offer to a child under the age of one with no teeth and difficulty in manipulating food with their hands.

Is Baby Led Weaning really superior? There haven't been a lot of studies into baby led weaning. One study implied that babies who were baby led weaned as opposed to spoon food develop less of a liking for sweet foods. However, extremely interestingly for me, there is no difference in terms of fussy eating in toddler hood! Often baby led weaning is sold as the antidote to fussiness and that's simply not the case. If your going to have a picky toddler you are going to have a picky toddler!

What is the answer then? I think it's really important not to limit our premature babies, and to give up just because it's difficult for them to manipulate food in their hands and get it to their mouths, and masticate and consume that food. I came across this research from Glasgow which is exactly what I did. The researchers were concerned that in a minority of children (like mine) their nutritional needs would not be met by baby led weaning and they suggested a combined approach, offering finger foods at parents meal times and supplementing with spoon feeding.

Collaborative weaning I like to think I coined the term collaborative weaning to describe this half way house. Whenever I spoon fed Joseph I offered an equivalent finger food. So pureed mango was accompanied by slices. If we had apple porridge I offered slices of apple with extremely close supervision. I encouraged finger dipping and licking. I always adapted our meals for Joseph, so he could have what we were having.

In summary, for the vast majority of sub 34 weekers I think a pure Baby Led approach will be difficult if not impossible. I do think the pure spoon feeding method has limitations too and a combined approach is a good one.

Food is more than just about getting nutrition. It's a social activitiy. Food sharing, eating together and exploring are great fun, and important for future social development.  Manipulation of food aids fine motor skill development, and it also helps develop speech.  We need to get the balance right between nutritional intake and the other benefits of eating, and be willing to experiment.

Tomorrow I'll talk more about nutrition and calories and tips for enriching the food our babies eat.




8 comments:

  1. Not a fan of baby led weaning. I fed Katherine the same way I fed my older 3. It still worked.

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  2. I did exactly the same as you. Gave her her meals by spoon feeding but offered finger foods as "snacks" while we were eating :)

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  3. Hi. Thanks for posting this - it's great to see the introduction of solids for very prem babies being discussed because this is an area where there are still lots of opinions and not much solid research. I just wanted to clarify, though, that I don't 'not recommend' baby-led weaning for these babies. I think it's as important for them to be given the chance to make some of their own decisions about eating and to practise self-feeding skills as it is for term babies. However, I am aware that research into their nutritional and developmental needs is scarce and that individual babies' abilities can vary enormously. To treat them as if they were full term would be foolhardy, for exactly the reasons you've explained.

    Our book presented an approach that could work extremely well for the majority of babies but it never set out to cover all babies - nor could it have, for the very reason that babies born very early, and those with medical conditions or physical disabilities, each have very particular and individual needs. We therefore opted to alert readers to the fact that it may not be possible or safe for very premature babies to be weaned using ONLY a baby-led approach. We do stress, though, that there is no reason to assume that all of the principles of BLW (self-feeding, shared family meals etc.) need to be abandoned just because 'full' BLW isn't possible. A combination approach is a GREAT idea, and fully in line with what I recommend.

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  4. Hi Gill thanks so much for reading. One of the main reasons I wrote this post is that a lot of people think "baby led weaning" is purely offering finger foods, and sometimes throw the baby out with the bathwater when weaning there very early babies.We always ate together in early weaning (and now too), and I think that's so important. Babies learn by modelling behaviour, whether they are born at 24 weeks or 42. By the same token I know of parents who have steadfastly refused to accept that the ball game has changed with their extremely premature infant, and as a result the baby has suffered from being expected to manage finger foods, and not getting adequate nutrition.

    In amongst all this, unless you are very lucky, or your baby has complications, you are unlikely to get any help. My Health Visitor had no clue about weaning premature babies at all, referred me back to our consultant who happened to be on sabbatical!

    What concerns me, is that there isn't a book, aside from the Bliss guide, for special situations, that promotes weaning very ealry babies. Parents of very early premature babies have often had an extremely stressful time of feeding and then weaning is another stress. In our case breastfeeding failed and I had to give Joseph formula which was totally not in my plan at all, had a horrible time with bottlefeeding and then found I couldnt wean the way I initially wanted to.

    To clarify, I haven't read the book for ages, and gave it to a termie mum, but the gist I got on readng the bookwas that more research into premature babies nutritional needs is required, so that's why I have used the term "not recommended".

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  6. Just wanted to add, after weaning Daisy 24wker at three months corrected obviously I couldnt give her finger foods at this age. However, I did do finger foods from pretty early on, and I have always said that encouraging her to feed her self did wonders for her develeopement, coordination and fine motor skills. By the time she was 7 months corrected she was eating finger foods like any other baby, I just ensured that she had a wide range of foods including high calorie foods which she needed. Daisy has been on the 50th centile since 6 months corrected and is 21/2 and remains on the 50th centile. She came home on the 2nd. I think its important to taylor any weaning approach to the babies individual needs regardless of how early prem or not. Sorry for rambling xxx

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  7. Hi Kylie. Yes, that's the problem. Until some more research has been done no one can make recommendations for very prem babies without risking saying something that could be harmful to a particular baby. So, unless an author is prepared to be reckless, a book that deals satisfactorily with weaning prems just isn't feasible at the moment.

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