As you may have read yesterday, I read Gillian Rapley's Baby Led Weaning whilst pregnant, and again when Joseph was in special care. A lot of what I read made sense, until I came across a few paragraphs where Gillian advised she did not recommend it for extremely premature infants. I wanted to write a little about the limitations of baby-led weaning today.
What are the basic principles of baby led weaning? The first thing is, the baby decides when they start, not the parent. The parent offers opportunities to explore with food, but the baby always makes the first move. Babies use their hands to eat. It's more than just "offering finger foods", the baby might dip a fist into porridge, or even eat like a puppy! The baby decides what and how much they eat. There is not parent led spoon feeding. The baby might go on to use a preloaded spoon, but they decide what the do with it.
What are the problems with this style of weaning and premature babies? As I explained yesterday with premature babies, the general consensus in the UK is that the baby is weaned on their actual age, somewhere between 5-8 months. So with a baby born before 34 weeks especially, their motor skills, both find and gross are not going to be in line with the ability of their stomachs to process the food.
Babies who were born prematurely have specific dietary needs. They need iron rich foods, and calorie dense foods. The Baby Led Weaning motto "food is fun until they are one" does not apply to the premature baby. In addition teeth can be late developing in preemies, Joseph didn't have a single tooth until he was one, where many term one year olds have 4 or more, which increases the range of foods you can offer. Iron rich foods, which are often meat based, are difficult to offer to a child under the age of one with no teeth and difficulty in manipulating food with their hands.
Is Baby Led Weaning really superior? There haven't been a lot of studies into baby led weaning. One study implied that babies who were baby led weaned as opposed to spoon food develop less of a liking for sweet foods. However, extremely interestingly for me, there is no difference in terms of fussy eating in toddler hood! Often baby led weaning is sold as the antidote to fussiness and that's simply not the case. If your going to have a picky toddler you are going to have a picky toddler!
What is the answer then? I think it's really important not to limit our premature babies, and to give up just because it's difficult for them to manipulate food in their hands and get it to their mouths, and masticate and consume that food. I came across this research from Glasgow which is exactly what I did. The researchers were concerned that in a minority of children (like mine) their nutritional needs would not be met by baby led weaning and they suggested a combined approach, offering finger foods at parents meal times and supplementing with spoon feeding.
Collaborative weaning I like to think I coined the term collaborative weaning to describe this half way house. Whenever I spoon fed Joseph I offered an equivalent finger food. So pureed mango was accompanied by slices. If we had apple porridge I offered slices of apple with extremely close supervision. I encouraged finger dipping and licking. I always adapted our meals for Joseph, so he could have what we were having.
In summary, for the vast majority of sub 34 weekers I think a pure Baby Led approach will be difficult if not impossible. I do think the pure spoon feeding method has limitations too and a combined approach is a good one.
Food is more than just about getting nutrition. It's a social activitiy. Food sharing, eating together and exploring are great fun, and important for future social development. Manipulation of food aids fine motor skill development, and it also helps develop speech. We need to get the balance right between nutritional intake and the other benefits of eating, and be willing to experiment.
Tomorrow I'll talk more about nutrition and calories and tips for enriching the food our babies eat.
What are the basic principles of baby led weaning? The first thing is, the baby decides when they start, not the parent. The parent offers opportunities to explore with food, but the baby always makes the first move. Babies use their hands to eat. It's more than just "offering finger foods", the baby might dip a fist into porridge, or even eat like a puppy! The baby decides what and how much they eat. There is not parent led spoon feeding. The baby might go on to use a preloaded spoon, but they decide what the do with it.
What are the problems with this style of weaning and premature babies? As I explained yesterday with premature babies, the general consensus in the UK is that the baby is weaned on their actual age, somewhere between 5-8 months. So with a baby born before 34 weeks especially, their motor skills, both find and gross are not going to be in line with the ability of their stomachs to process the food.
Babies who were born prematurely have specific dietary needs. They need iron rich foods, and calorie dense foods. The Baby Led Weaning motto "food is fun until they are one" does not apply to the premature baby. In addition teeth can be late developing in preemies, Joseph didn't have a single tooth until he was one, where many term one year olds have 4 or more, which increases the range of foods you can offer. Iron rich foods, which are often meat based, are difficult to offer to a child under the age of one with no teeth and difficulty in manipulating food with their hands.
Is Baby Led Weaning really superior? There haven't been a lot of studies into baby led weaning. One study implied that babies who were baby led weaned as opposed to spoon food develop less of a liking for sweet foods. However, extremely interestingly for me, there is no difference in terms of fussy eating in toddler hood! Often baby led weaning is sold as the antidote to fussiness and that's simply not the case. If your going to have a picky toddler you are going to have a picky toddler!
What is the answer then? I think it's really important not to limit our premature babies, and to give up just because it's difficult for them to manipulate food in their hands and get it to their mouths, and masticate and consume that food. I came across this research from Glasgow which is exactly what I did. The researchers were concerned that in a minority of children (like mine) their nutritional needs would not be met by baby led weaning and they suggested a combined approach, offering finger foods at parents meal times and supplementing with spoon feeding.
Collaborative weaning I like to think I coined the term collaborative weaning to describe this half way house. Whenever I spoon fed Joseph I offered an equivalent finger food. So pureed mango was accompanied by slices. If we had apple porridge I offered slices of apple with extremely close supervision. I encouraged finger dipping and licking. I always adapted our meals for Joseph, so he could have what we were having.
In summary, for the vast majority of sub 34 weekers I think a pure Baby Led approach will be difficult if not impossible. I do think the pure spoon feeding method has limitations too and a combined approach is a good one.
Food is more than just about getting nutrition. It's a social activitiy. Food sharing, eating together and exploring are great fun, and important for future social development. Manipulation of food aids fine motor skill development, and it also helps develop speech. We need to get the balance right between nutritional intake and the other benefits of eating, and be willing to experiment.
Tomorrow I'll talk more about nutrition and calories and tips for enriching the food our babies eat.