IMPORTANCE Baby-led approaches to complementary feeding, which promote self-feeding of all nonliquid foods are proposed to improve energy self-regulation and lower obesity risk. However, to date, no randomized clinical trials have studied this proposition.OBJECTIVE To determine whether a baby-led approach to complementary feeding results in a lower body mass index (BMI) than traditional spoon-feeding. DESIGN, SETTING, AND PARTICIPANTS The 2-year Baby-Led Introduction to Solids (BLISS) randomized clinical trial recruited 206 women (168 [81.6%] of European ancestry; 85 [41.3%] primiparous) in late pregnancy from December 19, 2012, through March 17, 2014, as part of a community intervention in Dunedin, New Zealand. Women were randomized to a control condition (n = 101) or the BLISS intervention (n = 105) after stratification for parity and education. All outcomes were collected by staff blinded to group randomization, and no participants withdrew because of an adverse event. Data were analyzed based on intention to treat.INTERVENTIONS Mothers in the BLISS group received lactation consultant support (Ն5 contacts) to extend exclusive breastfeeding and delay introduction of complementary foods until 6 months of age and 3 personalized face-to-face contacts (at 5.5, 7.0, and 9.0 months). MAIN OUTCOMES AND MEASURESThe primary outcome was BMI z score (at 12 and 24 months). Secondary outcomes included energy self-regulation and eating behaviors assessed with questionnaires at 6, 12, and 24 months and energy intake assessed with 3-day weighed diet records at 7, 12, and 24 months. RESULTS Among the 206 participants (mean [SD] age, 31.3 [5.6] years), 166 were available for analysis at 24 months (retention, 80.5%). The mean (SD) BMI z score was not significantly different at 12 months (control group, 0.20 [0.89]; BLISS group, 0.44 [1.13]; adjusted difference, 0.21; 95% CI, −0.07 to 0.48) or at 24 months (control group, 0.24 [1.01]; BLISS group, 0.39 [1.04]; adjusted difference, 0.16; 95% CI, −0.13 to 0.45). At 24 months, 5 of 78 infants (6.4%) were overweight (BMIՆ95th percentile) in the control group compared with 9 of 87 (10.3%) in the BLISS group (relative risk, 1.8; 95% CI, 0.6-5.7). Lower satiety responsiveness was observed in BLISS infants at 24 months (adjusted difference, −0.24; 95% CI, −0.41 to −0.07). Parents also reported less food fussiness (adjusted difference, −0.33; 95% CI, −0.51 to −0.14) and greater enjoyment of food (adjusted difference, 0.25; 95% CI, 0.07 to 0.43) at 12 months in BLISS infants. Estimated differences in energy intake were 55 kJ (95% CI, −284 to 395 kJ) at 12 months and 143 kJ (95% CI, −241 to 526 kJ) at 24 months. CONCLUSIONS AND RELEVANCEA baby-led approach to complementary feeding did not result in more appropriate BMI than traditional spoon-feeding, although children were reported to have less food fussiness. Further research should determine whether these findings apply to individuals using unmodified baby-led weaning.

ObjectivesTo compare the food, nutrient and ‘family meal’ intakes of infants following baby-led weaning (BLW) with those of infants following a more traditional spoon-feeding (TSF) approach to complementary feeding.Study design and participantsCross-sectional study of dietary intake and feeding behaviours in 51 age-matched and sex-matched infants (n=25 BLW, 26 TSF) 6–8 months of age.MethodsParents completed a questionnaire, and weighed diet records (WDRs) on 1–3 non-consecutive days, to investigate food and nutrient intakes, the extent to which infants were self-fed or parent-fed, and infant involvement in ‘family meals’.ResultsBLW infants were more likely than TSF infants to have fed themselves all or most of their food when starting complementary feeding (67% vs 8%, p<0.001). Although there was no statistically significant difference in the large number of infants consuming foods thought to pose a choking risk during the WDR (78% vs 58%, p=0.172), the CI was wide, so we cannot rule out increased odds with BLW (OR, 95% CI: 2.57, 0.63 to 10.44). No difference was observed in energy intake, but BLW infants appeared to consume more total (48% vs 42% energy, p<0.001) and saturated (22% vs 18% energy, p<0.001) fat, and less iron (1.6 vs 3.6 mg, p<0.001), zinc (3.0 vs 3.7 mg, p=0.001) and vitamin B12 (0.2 vs 0.5 μg, p<0.001) than TSF infants. BLW infants were more likely to eat with their family at lunch and at the evening meal (both p≤0.020).ConclusionsInfants following BLW had similar energy intakes to those following TSF and were eating family meals more regularly, but appeared to have higher intakes of fat and saturated fat, and lower intakes of iron, zinc and vitamin B12. A high proportion of both groups were offered foods thought to pose a choking risk.

Infants following a baby-led approach to feeding that includes advice on minimizing choking risk do not appear more likely to choke than infants following more traditional feeding practices. However, the large number of children in both groups offered foods that pose a choking risk is concerning.

Despite growing international interest in Baby-Led Weaning (BLW), we know almost nothing about food and nutrient intake in infants following baby-led approaches to infant feeding. The aim of this paper was to determine the impact of modified BLW (i.e., Baby-Led Introduction to SolidS; BLISS) on food and nutrient intake at 7–24 months of age. Two hundred and six women recruited in late pregnancy were randomized to Control (n = 101) or BLISS (n = 105) groups. All participants received standard well-child care. BLISS participants also received lactation consultant support to six months, and educational sessions about BLISS (5.5, 7, and 9 months). Three-day weighed diet records were collected for the infants (7, 12, and 24 months). Compared to the Control group, BLISS infants consumed more sodium (percent difference, 95% CI: 35%, 19% to 54%) and fat (6%, 1% to 11%) at 7 months, and less saturated fat (−7%, −14% to −0.4%) at 12 months. No differences were apparent at 24 months of age but the majority of infants from both groups had excessive intakes of sodium (68% of children) and added sugars (75% of children). Overall, BLISS appears to result in a diet that is as nutritionally adequate as traditional spoon-feeding, and may address some concerns about the nutritional adequacy of unmodified BLW. However, BLISS and Control infants both had high intakes of sodium and added sugars by 24 months that are concerning.

The aim of this study was to determine whether food variety and perceived food preferences differ in infants following baby-led instead of traditional spoon-feeding approaches to introducing solids. A total of 206 women (41.3% primiparous) were recruited in late pregnancy from a single maternity hospital (response rate 23.4%) and randomized to Control (n = 101) or BLISS (n = 105) groups. All participants received government-funded Well Child care. BLISS participants also received support to exclusively breastfeed to 6 months and three educational sessions on BLISS (Baby-Led Weaning, modified to reduce the risk of iron deficiency, growth faltering, and choking) at 5.5, 7, and 9 months. Food variety was calculated from three-day weighed diet records at 7, 12, and 24 months. Questionnaires assessed infant preference for different tastes and textures at 12 months, and for ‘vegetables’, ‘fruit’, ‘meat and fish’, or ‘desserts’ at 24 months. At 24 months, 50.5% of participants provided diet record data, and 78.2% provided food preference data. BLISS participants had greater variety in ‘core’ (difference in counts over three days, 95% CI: 1.3, 0.4 to 2.2), ‘non-core’ (0.6, 0.2 to 0.9), and ‘meat and other protein’ (1.3, 0.8 to 1.9) foods at 7 months, and in ‘fruit and vegetable’ foods at 24 months (2, 0.4 to 3.6). The only differences in perceived food preferences observed were very small (i.e., <5% difference in score, at 12 months only). Infants following the modified Baby-Led Weaning were exposed to more varied and textured foods from an early age, but only an increased variety in ‘fruit and vegetable’ intake was apparent by two years of age.