Abstract
Background: Although baby-led approaches to complementary feeding such as Baby-Led Weaning (BLW) are growing in popularity, research exploring the safety and efficacy of these approaches is sparse. Concerns have also been expressed regarding the potential for BLW to increase the risk of choking, growth faltering and iron deficiency. The Baby-Led Introduction to SolidS (BLISS) randomised controlled trial investigated whether a form of BLW, modified to address these concerns, was a suitable way to introduce solids to infants.
Aim: To investigate whether the BLISS approach to complementary feeding alters the risk of food-related choking and growth faltering among infants aged 0-12 months.
Methods: Dunedin families (n=206) were randomly allocated to a Control or intervention (BLISS) group. Control families (n=101) received the standard government funded ‘Well Child’ health service. BLISS families (n=105) received Well Child care plus at least 8 parent contacts for advice and support on following the BLISS approach.
Data on the frequency of choking and gagging, the characteristics of choking events, and the impact of adherence to a baby-led approach to infant feeding were collected by questionnaires when infants were 6, 7, 8, 9 and 12 months of age. Choking and gagging frequencies were also assessed by daily calendars at 6 and 8 months. Data on infant exposure to foods thought to pose a choking risk were obtained using three-day weighed diet records at 7 and 12 months. Parental feeding practices were evaluated by questionnaires at 7, 8, 9 and 12 months.
Infant growth was determined from repeated anthropometric measurements (infant weight at 6, 7, 8, 9 and 12 months, and length at 6 and 12 months). Growth was checked against five “growth triggers” to ensure the early identification of infants at potential risk. Growth faltering was defined as a weight deceleration of >1.34 of a weight-for-age z-score (using the World Health Organization Child Growth Standards) between 6 and 9 months.
Results: Overall, 35% of infants choked at least once between 6 and 8 months of age but there were no significant group differences in the number of choking events at any time point (all p>0.20). BLISS infants gagged more frequently than Controls at 6 months (RR 1.56, 95% CI 1.13 to 2.17), but less frequently than Controls at 8 months (RR 0.60, 95% CI 0.42 to 0.87). At 7 and 12 months of age, 52% and 94% of infants respectively were offered food thought to pose a choking risk during weighed diet recording, although no statistically significant group differences were observed at either age (all p>0.30). Consistently safe parental feeding practices were often lacking in both groups, particularly at 12 months when only 44% of Control and 65% of BLISS infants always had an adult sitting with them while they ate.
Although 32 infants (16 Control, 16 BLISS) met at least one growth trigger between 6 and 12 months, only 3 (2 BLISS, 1 Control) were potentially serious enough to be referred to the study paediatrician. However, growth improved in all three infants and no child met the criterion for growth faltering.
Conclusions: Infants following the BLISS approach to complementary feeding were no more likely to choke or experience growth faltering than Control infants, although it is acknowledged that this was a relatively small study.