Abstract
Baby-Led Weaning (BLW) is an alternative approach to complementary feeding. Parents offer ‘whole’ (baby-fist size) pieces of food, allow infants to feed themselves, include infants at family meal times and offer family foods when practical. There is virtually no information on BLW infants’ food and nutrient intakes, and there have been no randomised studies with participants who were not self-motivated to choose a Baby-Led approach. The aim of this thesis was to investigate the extent to which families are able to adhere to a Baby-Led approach to complementary feeding, and the impact a Baby-Led approach has on infant food group and nutrient intakes at seven months of age.
The Baby-Led Introduction to SolidS (BLISS) study was a two-arm randomised controlled trial. Women from Dunedin, New Zealand, were recruited during pregnancy and randomised to the Usual Care (n=101) or the BLISS Intervention (n=101) group. The Intervention group used a modified Baby-Led approach to complementary feeding which focused on inclusion of high-iron and high-energy foods at each meal, and reduction of infants’ choking risk. The BLISS group received five intervention contacts before seven months: an antenatal education session, three Lactation Consultant contacts, and a BLISS advice visit.
This thesis used the BLISS study Maternal Baseline Questionnaire, Feeding Questionnaires collected at two, four, six, seven and eight months postpartum and a three-day Weighed Food Record, modified to collect adherence data for the Baby-Led approach to infant feeding, completed at seven months. Parents reported who fed the infant each food (parent-fed only, infant and parent-fed together, infant self-fed only) as well as the foods and amounts offered and consumed. Participants were classified as adherent to a Baby-Led approach if ≤ 10% of foods were solely parent-fed, ≤ 15% of foods were infant and parent-fed together, and at least 75% of foods were infant self-fed only. This meant that the infant contributed to feeding ≥ 90% of their food.
Weighed Food Records were returned by 80% of participants (n=162). Two-thirds of the BLISS group (n=48) were classified as adherent, as were eight Usual Care infants. A significantly greater proportion of the energy intake of infants in the Usual Care group was supplied by ‘Fruit’ (median: 30.7% vs. 18.3% (p=0.001)) and ‘Vegetables’ (median: 10.8% vs. 6.3% (p<0.001)) compared to the BLISS group. BLISS infants were more likely to have eaten ‘Sweet foods’ (Odds Ratio (OR): 4.08; 95% Confidence Interval (95%CI): 2.05, 10.52 (p<0.001)) and ‘Powdered infant cereal’ (OR: 2.69; 95%CI: 1.32, 5.50 (p=0.006)). However, the Usual Care group were more likely to have consumed ‘Ready-to-eat commercial infant foods’ (OR: 2.78; 95%CI: 1.41, 5.56 (p=0.003)), and they also had a higher energy intake from these foods (median: 15.8% vs. 0% (p<0.001)). There was no difference between the study groups in terms of mean energy intakes, or percentage of energy contributed by fat, protein or carbohydrate. Infants in the BLISS group had a significantly lower intake of vitamin A (-12%, 95%CI: -20%, -3% (p=0.0013)), and significantly higher intakes of selenium (11%, 95%CI: 4%, 8% (p=0.002)) and sodium (38%, 95%CI: 20%, 59 (p<0.001)) than the Usual Care group.
These results indicate that, with support, families are able to adhere to the principles of a Baby-Led approach, as presented by BLISS, including infant self-feeding of complementary foods. The food group and nutrient intakes of infants following a modified Baby-Led approach showed some differences compared to infants being introduced to complementary foods conventionally. Intake of ‘Fruit’ and ‘Vegetables’ was lower for BLISS infants and consumption of sodium was higher. Longitudinal follow-up is needed to determine whether these differences will dissipate, or become more pronounced, as Usual Care group infants are introduced to family-foods later in infancy.