Exploring Baby-Led Weaning vs. Pureed Foods: What the Evidence Shows

Baby-Led Weaning (BLW) or Purees: Is there scientific evidence supporting one method over the other? Recently, we examined the scientific literature on BLW in relation to breastfeeding. Now, we focus on the evidence regarding the growth and food intake of infants following the BLW method compared to those who are traditionally spoon-fed.

One of the primary concerns among healthcare professionals and families regarding BLW is the fear that infants may consume less food, which could lead to stagnation or a decrease in weight gain. A common myth surrounding BLW suggests that babies grow in a non-linear fashion rather than steadily. Additionally, there are worries that infants might not receive adequate nutrients, particularly iron, potentially increasing the risk of iron-deficiency anemia.

Research has been published since 2011, with most studies investigating the relationship between BLW and infant growth and nutrition, often measuring weight, height, and BMI or tracking the infants' dietary intake.

Among the notable findings from studies comparing BLW and pureed foods regarding infant growth are:

• At 12 and 24 months, both weight, height, and BMI—whether adjusted for age (z-score) or not—are similar for infants fed using the BLW method and those fed using traditional spoon-feeding (1).
• Weight and height gain between 6 and 12 months is adequate for both BLW infants and those who are spoon-fed (2,3).
• In a study by Dogan et al. in 2018, it was observed that infants who were spoon-fed gained more weight between 6 and 12 months, resulting in 32.3% of these infants being classified as overweight or obese (3).

Regarding caloric intake and nutrient consumption, the following results stand out:

• Infants following the BLW approach consume the same daily energy as those fed traditionally with a spoon at both 6-12 months and 24 months (1,4,5,6).
• Those who start with BLW consume equivalent amounts of macronutrients (carbohydrates, fats, and proteins) and micronutrients (vitamins and minerals, including iron) as spoon-fed infants at 6-8 months and 9-12 months (6).
• At 12 months, both BLW and traditionally-fed infants have the same daily iron intake measured in mg/day (5,3).
• Hemoglobin and plasma ferritin levels are comparable between infants on the BLW diet and those on the traditional method at 12 months (5,3).

Despite only 11 years of research and observation on the BLW method, early indications suggest that this approach is nutritionally safe and that babies grow as well as those fed using traditional spoon-feeding methods.

The published studies vary widely and possess different levels of evidence. Most studies are observational, which typically indicates a lower level of evidence. In this article, we have highlighted clinical trial studies, which provide a higher level of evidence to minimize bias in results. Nonetheless, these studies may have limitations, such as accurately measuring infants' diets. Therefore, further clinical trials are necessary to establish high-evidence consensus on the nutritional safety of the BLW method.

References for BLW or Purees:

1. Taylor RW, Williams SM, Fangupo LJ, Wheeler BJ, Taylor BJ, Daniels L, et al. Effect of a baby-led approach to complementary feeding on infant growth and overweight: A randomized clinical trial. JAMA Pediatr [Internet]. 2017;171(9):838–46.
2. Jones SW, Lee M, Brown A. Spoonfeeding is associated with increased infant weight but only amongst formula-fed infants. Matern Child Nutr. 2020 Jul 1;16(3):1–8.
3. Dogan E, Yilmaz G, Caylan N, Turgut M, Gokcay G, Oguz MM. Baby-led complementary feeding: Randomized controlled study. Pediatr Int [Internet]. 2018;60(12):1073–80.
4. Kumar G. Baby-led weaning did not significantly impact body mass index when compared with traditional spoon-feeding. Arch Dis Child Educ Pract Ed [Internet]. 2018;103(4):222.
5. Daniels L, Taylor RW, Williams SM, Gibson RS, Fleming EA, Wheeler BJ, et al. Impact of a modified version of baby-led weaning on iron intake and status: A randomised controlled trial. BMJ Open [Internet]. 2018;8(6):1–10.
6. Pearce J, Langley-Evans SC. Comparison of food and nutrient intake in infants aged 6–12 months, following baby-led or traditional weaning: A cross-sectional study. J Hum Nutr Diet. 2021 Sep 2;jhn.12947.