Baby Led Spoon Feeding

Babies are born learners and explorers. They find joy in exploring and mastering a skill. Babies are driven to do this and will learn and explore with food if we give them the opportunity to do so at their own pace. If we let this joy flourish and let them feel confident and successful, they will have a positive relationship with food that will last a lifetime. This is especially true for the more reticent feeder, who may never eat vigorously for the sheer love of it, but who will learn to eat what she or he needs and enjoy it. It holds true for all babies. Often the more we push them to eat or stop eating, the less likely they are to do so.

With this in mind, I'll offer my tips for baby led spoon feeding. Spoon feeding is primarily an adult let activity and can easily lead to a disconnect between patent and child's communication if we aren't  proactive about being "tuned-in". These tips are focused on making spoon feeding an interactive dance or a conversation. 

- Let your baby take the lead by giving him or her a spoon to hold from the very beginning. 

- Expect the activity to get messy and be ok with that. Mess is fun and it enriches the sensory experience. Your baby is learning a new skill and she can't do it perfectly from the start. If your baby isn't getting messy that means you're controlling the activity and doing it for them, which means your baby is not learning as much and probably not enjoying it as much. 

- Forget about quantity. Let the focus be on exploration and discovery, even if that means that zero amounts of food is actually swallowed or even tasted.

- Try loading the spoon for your baby at first, then just set it on the table, handle towards your baby. Let your baby pick it up and do whatever she or he wants with it!

- If your baby is struggling and appears interested, hold and offer the spoon directly to your baby. Keep the spoon near your baby's mouth and wait. Do not touch your baby's lips or try to put it in his or her mouth. Just wait until your baby opens his or her mouth or leans towards the food. If that never happens, eat the food yourself and let your baby just watch or touch the food if interested. 

- At all meals, try to have your own spoon and bowl of food to eat. Model eating and enjoy a meal with your baby. Babies and children learn best from watching you. They want to do what you're doing. If he is eating applesauce, you should eat applesauce. 

- If your baby is into the food and the activity, re-load the spoon and offer it again. 

- If not, let him or her enjoy time at the table, touching and playing with the food with his or her hands while you eat. Do not stress or worry. Offer a milk feed (breastmilk or formula) instead. 

Traditional Puree/Spoon-fed Approach VS Baby Led Weaning

"Why have an 'approach' at all?" you might ask.  This may seems silly to those who just "do it" and never even consider what their personal "approach" might be.  "We just fed you" my mother said when I asked her about what she did for me.  "We didn't stop to think about approaches." 

4 generations of daughters enjoying lunch together.  We all were fed in different ways and I'd say we all turned out fairly well!

I get this.  Many people are too busy to consider the intricacies of a feeding style or they inherently trust their parenting skills and would never second guess themselves or confuse things by reading about someone's feeding philosophy.  But, many parents don't have this same sense of self-confidence or experience, and because we are more isolated than ever these days, we also don't have family or friends we can easily turn to for guidance. Additionally, if we look around at the incredibly high rates of picky eating childhood and adult obesity as well as the unbelievably high rates of funky childhood diseases, like autism, type II diabetes, asthma, and allergies, and digestive disorders (like Crohn's or Celiac), I think it becomes clear that whatever we have been doing--even when we are confident about it--has not really be working all that well.  We need guidance to find a better way.  Yes, I know that it's a leap to blame these ailments on the style a parent uses to introduce solids.  Of course that's not the full story, but I believe the way we start, often gives way to how we continue to interact with food, mealtimes, feeding and our children over the course of their childhood.  We all learn and improve as we go but we also build habits and routines that can be difficult to change. And when picky eating sets in, so does poor nutrition and unhealthy eating, which does contribute in a very real way to childhood and adult illnesses.

So, that being said, looking at theory and approaches can be helpful in terms of understanding what part of each approach works well and what doesn't.  It also helps the next person to learn from our mistakes and do it better from the start so that she doesn't have to undo bad feeding habits.

So, in the interest of making things easier and more sucessful, here is a chart that compares the two primary approaches to feeding an infant solid foods: Baby Led Weaning and Traditional Purees.

Baby Led Weaning Introduction to Solids

Benefits

Drawbacks

Not focused on quantity and intake, so milk remains primary nutrition source No need to prepare or buy “baby food” Consistent exploration of solid food builds new oral motor patterns early on Early and consistent practicing of new oral motor patterns helps to create a well coordinated skill set Coordinated oral motor skills are important for eventual eating of resistive foods, such as vegetables and meats Coordinated oral motor skills decrease a person's risk for choking May decrease mealtime battles because baby is feeding him/herself and will either choose to eat or not Self-feeding builds eye-hand coordination and fine motor skills Uses a baby's inherent motivation to explore, discover, and self-feed Use of frequent modeling because parents eat the same thing as baby Less focus on just baby at meals increases the focus on socialization and family time Self-motivation is valued and practiced at each meal

Very messy Gagging happens and looks scary Over stuffing mouth is common at first Increased risk of choking at first if done wrong (though physiologic protection from 5-8 months decreases this risk, as does supervision, always sitting baby upright in a supported seat and never putting food in the baby's mouth for him/her) Possibly difficult for nanny, daycare, or unfamiliar feeder to do Baby often is less likely to accept spoon feeding because she enjoys feeding herself Many parents worry they can't also give purees

Traditional (Puree) Introduction to Solids

Benefits

Drawbacks

No choking risk at first Baby uses very familiar oral motor patterns Can be less messy if parent controls the spoon Builds spoon skills quickly Potentially faster/more efficient mealtimes Gets larger volume of food in baby from the start Parent controls activity but can still be fun and “baby led” with a tuned-in parent Some babies enjoy because there is less challenge initially Some babies prefer bland flavors and textures

Less exploration by baby if parent spoon feeds Easy to over ride inherent hunger/satiety cues by giving “1 more bite” or stopping before baby is done if not tuned-in Quantity can easily become a focus with implications for decreased milk intake and mealtime battles Delayed building of important oral motor patterns (I.e.- for chewing) Increased risk of choking later, after natural physiologic protection against choking is gone and textures are introduced Purees are often bland Less modeling because adults don't often eat purees for our meals Uncertainty about when to progress to textured and finger-foods

Rice cereal

There is generally very little research regarding best "first foods."  What guides first food recommendations are tradition and culture, a bit of science, as well as ideas that "sound good in theory." Here in the US, this has led to the recommendation of rice cereal as the doctor-recommended first food. The reasons behind the rice cereal:

1. Rice cereal is fortified with iron and iron stores from birth start to dwindle over time and may need food sources to be replenished by six-ish months.

2. Rice cereal has low risk of causing allergy. 

3. Rice cereal is easily mixed with breast milk (or formula) into a runny and easily accepted consistency which will taste sweet and familiar. 

4. Runny foods are not a choking risk (actually they can cause choking--aspiration is the better term-- and liquids and runny foods are the most commonly aspirated foods. However, they do not cause full airway obstruction choking which doctors are primarily concerned with because even though it is significantly more rare, it can be deadly.)

5. Although the AAP recommends starting solids "around 6 months" many people start solids even before 4 months. Rice cereal and other purée is easily ingested by a very immature baby. 

6. Rice cereal is manufactured on a large scale, readily available, and purchased in a standard box with simple mixing instructions, which makes it the same for just about everyone. This allows for consistency between doctors' recommendations. High and low income families alike educated or not, all will give pretty much the same thing with little concern of misinterpretation. This makes it an easy go-to recommendation for doctors. 

Liver from grass fed, well cared for cows is very high in iron and used to be a staple in babies' diets. 

While many of these reasons make sense, there are a few points to consider that might steer you away from rice cereal as a first food:
1. Rice cereal is a simple carbohydrate and as such it spikes your baby's blood sugar, without offering much by way of nutrition.

2. It is a processed food and in general, almost every doctor out there recommends NOT to give babies processed foods, especially at first. Processed foods are not as healthy as whole foods, like fruits, vegetables, and well sourced meats.

3. While babies will accept almost any food you give them at first, toddlers and school age children are significnatly more likely to be picky eaters.  If you have a picky eater on your hands, you can confirm that picky eating children almost across the board love carbohydrates (cookies, crackers, pasta, rice) but generally refuse veggies and protiens.  Since we don't really need to worry about kids learning to eat carb, why start with a simple carb as the very first solid food they ever eat? This may lay down a foundation for a lifetime love of simple, processed carbohydrates. 

4. Breast milk and formula are high in protein and fat so this is what your baby's stomach is used to processing. Some argue that your baby's body doesn't even produce the enzyme necessary to properly breakdown carbohydrates at 4-6 months. This causes foods like rice cereal to be hard on your baby's stomach. 

5. There are other foods besides rice cereal that naturally offer iron in higher amounts and in a more easily absorbable form.

6. Arsenic (a known carcinogen and poison) has been reportedly found in commercially available rice cereal in 2012. 

7.  If you follow the AAP recommendation to start solids at or around 6 months, your baby most likely has mature enough gross motor and oral motor skills to eat a wide variety of foods. 

8. Ask any pediatrician or infant feeding specialist: the whole point of those first few months of transitioning to solids is oral exploration and play with motor pattern learning. Rice cereal offers very little in terms of sensory input and doesn't challenge developing oral motor skills. It is so easily ingested it hijacks the focus from play and exploration and puts it on intake and quantity. 

9. Looking again towards toddlerhood- It takes very minimal oral motor coordination to eat things like crackers, cookies, and processed meats (I.E. chicken nuggets). It takes mature and strong oral motor skills to eat resistive foods such as raw and even partially cooked veggies and fruits, nuts, and baked or grilled meats. Building strong oral motor patterns in a safe way, from a young age (before food refusal sets in- around toddlerhood) is crucial to your child accepting these foods when he or she is older. Once he or she hits those toddler years, there is almost always less interest in exploring new foods and practicing how to eat them. If your child doesn't know how to safely eat resistive foods by toddlerhood, she or he will most likely refuse them completely for years to come- until they grow out of their resistant phase. I'm not suggesting you give choking hazards to your baby, but I am suggesting again that rice cereal does almost nothing to advance oral motor patterns.  There are other first food choices that do provide safe opportunities for oral motor skill advancement.  

If any of these points ring true to you or concern you, I suggest doing your own research and discussing with your baby's pediatrician before deciding what to give your baby for his/her first solid foods.