Abstract
In Baby-Led Weaning (BLW), infants are offered foods that they are able to pick up and feed themselves from the start of the complementary feeding period. This means that infants who are fully BLW are not spoon fed by their parents, and instead feed themselves entirely. The Baby-Led Introduction to SolidS (BLISS) study was a randomised controlled trial of the effect of a modified version of Baby-Led Weaning on infant growth, iron status, and risk of choking, and provides an opportunity to investigate parents’ experiences of a baby-led approach to infant feeding. Cross-sectional studies have suggested that BLW may be associated with a wide range of possible benefits including better energy self-regulation and a lower risk of obesity, but randomised controlled trials of BLW are needed in order to determine whether these outcomes are truly the result of BLW, or due to other characteristics of families who choose to follow this method of infant feeding. Complementary feeding methods are usually chosen by parents, so it is important to ascertain whether parents find a baby-led method of introducing solids acceptable if they are assigned to follow it. This is both so that it can be determined whether it would be feasible to randomise them to follow such an approach in future randomised controlled trials, and because if beneficial effects of BLW are shown, policy makers need to know whether parents would find it acceptable to follow BLW instead of traditional spoon feeding.
The aim of this thesis was to determine the acceptability to parents of a baby-led approach to complementary feeding, specifically convenience, happiness, frustration, expense and mess, at 7 to 9, and 12 months of age, and age when parents considered that their infant was consuming enough food.
In total, 206 participants were randomised to Control (n=101) or BLISS (n=105) groups in the third trimester of pregnancy. When the infants were 7, 8, 9, and 12 months of age, questionnaires were administered that aimed to capture aspects of a baby-led approach to complementary feeding that might be considered acceptable or unacceptable by parents: specifically convenience, happiness, frustration, expense, mess, and how the method suits the parent, and the age of the infant when their parent considered that they were consuming enough food. The cost of foods consumed was estimated using supermarket prices linked to a 3-day weighed diet record completed by the participants on three non-consecutive days at 7 months of age.
When asked to report on their attitude to the method of complementary feeding they had been randomised to follow, both groups reported high levels of convenience and happiness, and found the method suited them very well. However, they also reported finding complementary feeding very frustrating. The only significant difference between the groups was in the perceived expense of the feeding method, where the BLISS group were more likely to perceive the method as expensive. In response to open ended questions on what it was that the parent liked about the method they followed, subthemes such as ‘improved autonomy’ and ‘fitting in with the family’ arose in the BLISS group. The Control group reported that ‘bonding’ and ‘monitoring the amount of food consumed’ were things that they liked.
Infants in the BLISS group were significantly more likely to drop their food, but the difference between the groups was small (3.80%; 95%CI 1.86% to 7.75%). Both groups found the mess associated with complementary feeding to be acceptable, and were relatively comfortable with it at home, although less so away from home. The only significant difference between the groups was in overall messiness, with the BLISS group reporting less messiness. However, there was no significant difference between groups in the number acting to make mess more manageable. Common strategies against mess in both groups were using a bib and a mat, the use of wipes, and restraining the child – usually in a highchair.
It cost the BLISS group $1.70 per day to feed their infant. The amount consumed was only $0.90 of this, leaving $0.60 in left overs. The Control group spent $1.90 per day to feed their infant, with the infants consuming $1.10 of this, leaving $0.50 in left overs – these values were not statistically significantly different.
The BLISS group felt that it took 5.5 weeks after beginning complementary feeding until their infant was eating enough, whereas the Control group felt it took 5.4 weeks.
In conclusion, parents did not find a baby-led approach to introducing solids any less acceptable than Control parents found standard infant feeding – even though they had been randomised to follow the approach rather than choosing it themselves. However parents did report high levels of frustration with complementary feeding no matter what method they were using. Each group had their own way of finding positives in the method they were following, with both groups reporting increased autonomy, improved fine motor skills, and benefits to their child’s health. Although the BLISS group was more likely to consider their method expensive, there was no difference in the actual cost as measured by the 3 day diet records. These results show that a baby-led approach to complementary feeding can be as acceptable for parents as a standard approach, and does not differ in cost. It also shows that while frustrations arise in each method, parents are resourceful in managing these and accept them as part of the process. This study shows that it is feasible to run studies where parents are randomised to follow a baby-led approach to complementary feeding, and that, should advantages to BLW be discovered, parents are likely to find it acceptable to follow BLW.