Baby-Led Introduction to SolidS (BLISS) study: a randomised controlled trial of a baby-led approach to complementary feeding

Abstract

BackgroundIn 2002, the World Health Organization recommended that the age for starting complementary feeding should be changed from 4 to 6 months of age to 6 months. Although this change in age has generated substantial debate, surprisingly little attention has been paid to whether advice on how to introduce complementary foods should also be changed. It has been proposed that by 6 months of age most infants will have developed sufficient motor skills to be able to feed themselves rather than needing to be spoon-fed by an adult. This has the potential to predispose infants to better growth by fostering better energy self-regulation, however no randomised controlled trials have been conducted to determine the benefits and risks of such a “baby-led” approach to complementary feeding. This is of particular interest given the widespread use of “Baby-Led Weaning” by parents internationally.Methods/DesignThe Baby-Led Introduction to SolidS (BLISS) study aims to assess the efficacy and acceptability of a modified version of Baby-Led Weaning that has been altered to address potential concerns with iron status, choking and growth faltering. The BLISS study will recruit 200 families from Dunedin, New Zealand, who book into the region’s only maternity hospital. Parents will be randomised into an intervention (BLISS) or control group for a 12-month intervention with further follow-up at 24 months of age. Both groups will receive the standard Well Child care provided to all parents in New Zealand. The intervention group will receive additional parent contacts (n = 8) for support and education on BLISS from before birth to 12 months of age. Outcomes of interest include body mass index at 12 months of age (primary outcome), energy self-regulation, iron and zinc intake and status, diet quality, choking, growth faltering and acceptability to parents.DiscussionThis study is expected to provide insight into the feasibility of a baby-led approach to complementary feeding and the extent to which this method of feeding affects infant body weight, diet quality and iron and zinc status. Results of this study will provide important information for health care professionals, parents and health policy makers.Trial registrationAustralian New Zealand Clinical Trials Registry ACTRN12612001133820.

Baby‐led complementary feeding: Randomized controlled study

“…Baby‐led weaning is an alternative method for introducing complementary foods to infants. By 6–7 months of age, most infants are able to chew, sit unsupported and bring foods to their mouth, suggesting that a gradual transition from purees to finger foods may now not be necessary …”

“…Participants in the BLW group attended four additional group training meetings and received six home visits for support and education in this type of complementary feeding, when the infant was 5.5, 6.5, 7, 8, 9 and 11 months of age. Trained research staff supervised by a multidisciplinary team (dietitian, pediatrician, lactation consultant, pediatric nurse) provided a range of recipe books and food lists to the BLW participants, explaining how to follow the baby‐led approach, and provided information about the study, age‐appropriate family recipes, food lists and safety information …”

“…We used a modified form of BLW to address the primary concerns (choking, increased risk of low iron status, increased risk of growth impairment) of health‐care professionals and parents (baby‐led introduction to solids, BLISS) …”

“…The BLW parents were encouraged to offer a variety of foods, including at least one high‐energy food at each meal, and were provided with food ideas and recipes that were high in energy and could be easily self‐fed by the infant …”

Complementary Feeding in Developed Countries: The 3 Ws (When, What, and Why?)

“…Recent studies show no differences in frequency of choking [29], body mass index [30], and energy intake [31] between BLW and traditional feeding practices. Another similar approach, the "baby-led introduction to solids" (BLISS), has been developed to address potential concerns with iron status, choking, and growth faltering [32]. BLISS infants showed less food fussiness and better enjoyment of food compared to infants who were spoon-fed, but it did not result in a more appropriate body weight than the traditional feeding method [33].…”