Devlin Erin NURS 595 Baby Led SPAR 2021

BABY-LED WEANING: A SCOPING REVIEW 1
BABY-LED WEANING: A SCOPING REVIEW
By:
ERIN ELIZABETH DEVLIN
BHK, The University of British Columbia, 2011
BSN, The University of British Columbia, 2013
A SCHOLARLY PRACTICE ADVANCEMENT RESEARCH (SPAR) PROJECT
SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE
OF
MASTER OF SCIENCE IN NURSING
in
THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES
THE UNIVERSITY OF BRITISH COLUMBIA
Vancouver
© September 2021
Acknowledgements
I acknowledge that I am a settler who is grateful to live, work, and study on the
traditional, ancestral, and unceded territories of the Musqueam, Squamish, and Tsleil-Waututh
peoples.
I would like to extend my gratitude and appreciation to my supervisor Dr. Maura
MacPhee and committee member Ranjit Dhari. Dr. MacPhee, thank you for supporting me along
every step of this journey and providing me with encouragement when I needed it most. Ranjit
Dhari, thank you for providing your support and expertise. I would also like to thank Ursula
Ellis, reference librarian and subject specialist, for assisting me with my search strategy.
Thank you to my family, friends, and colleagues who have supported me throughout my
journey to achieving this degree. Pearce, thank you for your endless support and for encouraging
me to pursue my dreams.
Dedication
This work is dedicated to my sweet and adventurous son, Beau. Thank you for inspiring
me to explore the world of baby-led weaning and for showing me how much fun eating can be. I
love you, Beau.

Abstract
Background: Baby-led weaning is an approach to the complementary feeding of infants
that is quickly becoming popular among parents and caregivers around the world. Baby-led
weaning is advertised as an approach that has many benefits for both infants and their families.
However, health care professionals seem hesitant to recommend a baby-led weaning approach
due to a lack of knowledge and concerns of choking and inadequate intake.
Objectives: The objectives of this scoping review were to determine if baby-led weaning
is a safe and effective approach to the complementary feeding of infants and to increase the
knowledge of baby-led weaning among health care professionals.
Methods: A systematic search for evidence published between January 2010 and June
2021 was completed in three databases: Cumulative Index to Nursing and Allied Health
Literature (CINAHL), Ovid EMBASE, and Ovid MEDLINE.
Results: Fifteen studies (three qualitative, nine quantitative, three systematic reviews)
were included in this scoping review. Three themes were developed to provide a synthesis of the
main findings from the included studies: child experience and outcomes, parent experience, and
health care professional experience.
Conclusion: The evidence included within this review suggests that baby-led weaning is a
safe and effective approach to the complementary feeding of infants. The evidence provides
support for many of the perceived benefits of a baby-led weaning approach while suggesting
there is no reason for concern regarding an increased risk of choking or inadequate intake. This
review outlines implications for health care professionals, education, and research.
Table of Contents
Acknowledgements ……………………………………………………………………………… 2
Dedication ………………………………………………………………………………………. 3
Abstract …………………………………………………………………………………………. 4
Introduction ……………………………………………………………………………………… 7
Background ……………………………………………………………………………… 7
Rationale ………………………………………………………………………………… 9
Objectives ……………………………………………………………………………… 11
Methods ………………………………………………………………………………………… 12
Protocol ………………………………………………………………………………… 12
Eligibility Criteria ……………………………………………………………………… 12
Information Sources & Search …………………………………………………………. 13
Selection of Sources of Evidence ……………………………………………………… 14
Data Charting Process …………………………………………………………………. 15
Synthesis of Results……………………………………………………………………. 15
Results ………………………………………………………………………………………….. 16
Selection of Sources of Evidence ……………………………………………………… 16
Characteristics and Results of Sources of Evidence …………………………………… 18
Synthesis of Results…………………………………………………………………….. 29
Child Experience and Outcomes………………………………………………………... 31
Parent Experience ……………………………………………………………………… 36
Health Care Professional Experience ………………………………………………….. 42

Discussion ……………………………………………………………………………………… 44
Summary of Evidence …………………………………………………………………. 44
Implications ……………………………………………………………………………. 49
Limitations …………………………………………………………………………….. 52
Conclusion ……………………………………………………………………………... 52
Introduction
When you imagine an infant’s first introduction to solid foods, do you visualize a parent
spoon-feeding their infant an iron-fortified infant cereal or the infant self-feeding themselves
thick strips of well-cooked steak? These visualizations represent the two most prevalent
approaches to the complementary feeding of infants, conventional weaning and baby-led
weaning. Baby-led weaning has steadily been gaining popularity over the past two decades and
is very prevalent among the internet and social media, with over 6.8 million search results on
Google (n.d.) and 1.4 million hashtags on Instagram (n.d.).
Background
In order to understand the concept of baby-led weaning, the terms weaning and
complementary feeding must be defined. According to D’Auria et al. (2018), “the term weaning
describes the time period in which a progressive reduction of breastfeeding or the feeding of
infant-formula takes place while the infant is gradually introduced to solid foods” (p. 1). Further,
Rapley (2011) explained that weaning is a gradual process that can span several months to a few
years, and “the introduction of solid foods marks the initiation of weaning and the final feed of
breastmilk or formula its completion” (p. 20). The introduction of solid foods during this period
is referred to as complementary feeding, as an infant’s need for energy and nutrients begins to
exceed what is provided by breast milk and complementary foods are necessary to meet those
needs (World Health Organization [WHO], 2020). The WHO (2009, 2020) and Health Canada,
Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada
(2014) agree that complementary feeding should begin around 6 months of age.
Baby-led weaning is “an approach to weaning in which the baby is allowed to direct and
control the process from the very beginning … the parents decide what to offer but it is the baby
who decides what they will eat, how much and how quickly” (Rapley, 2011, p. 20). Baby-led
weaning has a few unique characteristics: the infant sits with the family at mealtimes; they are
encouraged to explore food with their hands as soon as they are interested; they are offered the
same healthy food as the rest of the family - served in developmentally appropriate sizes and
shapes; they feed themselves from the beginning, rather than being spoon-fed by someone else;
they decide how much to eat; and they continue to have breast milk or formula on demand
(Rapley, 2011; Rapley & Murkett, 2019). Baby-led weaning is very different from the
conventional approach to weaning where infants are traditionally spoon-fed by their parents,
beginning with pureed foods and gradually progressing food consistency and variety with age
(WHO, 2009).
The term baby-led weaning was first coined by public health nurse Gill Rapley in
2001/2002 while completing a Master of Science degree at the Canterbury Christ Church
University in the United Kingdom (Rapley, 2018). Although Rapley is credited with coining the
term baby-led weaning, she has clearly stated that baby-led weaning is not a new phenomenon
and that it has been implemented by parents and caregivers for generations - long before it had a
name (Rapley, 2015; Rapley, 2018; Rapley & Murkett, 2019). In a popular baby-led weaning
book written by Rapley and Murkett (2019), they shared testimonials of parents with multiple
children who discovered baby-led weaning on their own with their youngest children as it was
simply easier and made sense. Many of these parents shared that as a result, their youngest
children were the best eaters in the family as they were less fussy and more adventurous.
Improved eating patterns - decreased picky eating and mealtime battles, are only one of the many
believed benefits of using a baby-led weaning approach to introduce complementary foods
(Anderson et al., 2020; Rapley & Murkett, 2019).

Baby-led weaning has quickly been gaining popularity among parents and caregivers,
largely in part to the advertised benefits that this approach has for both infants and their families.
Rapley and Murkett (2019) promoted a multitude of benefits for infants who are introduced to
complementary foods using a baby-led weaning approach: it’s enjoyable, being a part of family
mealtimes, learning about real food, learning to trust food, learning to eat safely, better nutrition,
appetite control, making scientific discoveries, improving dexterity and coordination, gaining
confidence, easier and cheaper meals, less pickiness and fewer battles, and eating out is easier.
Understandably, these benefits are very appealing to parents and caregivers. At the same time,
there can be hesitation due to the common concerns about using a baby-led weaning approach.
The most common concerns about a baby-led weaning approach are that infants may have an
increased risk of choking, have insufficient food intake, and low iron intake in comparison to
infants who are introduced to complementary foods using a conventional weaning approach
(Anderson et al., 2020; Rapley, 2011).
Rationale
Although baby-led weaning has quickly become popular among parents and caregivers, it
seems that the approach to complementary feeding has yet to become widely accepted by health
care professionals. According to a study by D’Andrea et al. (2016) that investigated baby-led
weaning knowledge and perceptions among mothers and health care professionals in
Newfoundland and Labrador, Canada, mothers relied on social media and other mothers for
baby-led weaning information and support over health care professionals. This practice was
“likely because many HCPs [health care professionals] were not supportive or sufficiently
knowledgeable about the practice” (D’Andrea et al., 2016, p. 76). It is concerning that parents
are consulting social media and their peers rather than health care professionals regarding the
complementary feeding of infants, given that health care professionals have historically played a
critically important role in the education of parents surrounding infant feeding.
A perceived lack of knowledge among health care professionals regarding the baby-led
weaning approach to the complementary feeding of infants is of further concern considering that
multiple Canadian infant feeding resources for both health care professionals and parents support
and recommend key features of a baby-led weaning approach. These resources include the
Health Canada, Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee
for Canada (2014) Nutrition for Healthy Term Infants: Recommendations from Six to 24 Months;
Provincial Health Services Authority (2016) Pediatric Nutrition Guidelines (Six Months to Six
Years): For Health Professionals; and Provincial Health Services Authority (2019) Baby’s Best
Chance: Parents’ Handbook of Pregnancy and Baby Care. It is clear that baby-led weaning is an
approach to complementary feeding that is quickly becoming popular among parents and
caregivers, yet despite national and provincial recommendations and guidelines including key
features of baby-led weaning, health care professionals appear to be hesitant and lack sufficient
knowledge regarding the approach.
Given how popular and widespread the baby-led weaning approach to complementary
feeding has become among parents and caregivers and the apparent hesitancy and knowledge
gap among health care professionals, it is critical to examine the literature surrounding this
approach and explore if the advertised benefits and common concerns are supported by evidence.
A scoping review was determined to be the most appropriate tool for the knowledge synthesis of
emerging evidence surrounding a baby-led weaning approach. According to Munn et al. (2018),
scoping reviews are “an ideal tool to determine the scope or coverage of a body of literature on a
given topic and give clear indication of the volume of literature and studies available as well as
an overview (broad or detailed) of its focus” (p. 2). Importantly, a scoping review allows for a
broad scope and more expansive inclusion criteria that may include data from any source of
evidence and research methodology, not restrictive to quantitative studies alone (Peters et al.,
2020). Provided how little is known about the extent, range, and nature of the emerging literature
surrounding baby-led weaning, a scoping review was conducted to systematically map the
research done in this area, as well as to identify any existing gaps in knowledge.
Objectives
The objectives of this scoping review were to determine if baby-led weaning is a safe and
effective approach to the complementary feeding of infants and to increase the knowledge of
baby-led weaning among health care professionals. The following research question was
formulated: Is baby-led weaning a safe and effective approach to the complementary feeding of
infants from 6 months of age?

Methods
Protocol
This scoping review was completed in accordance with the Preferred Reporting Items for
Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) Checklist
(Tricco et al., 2018) and the Joanna Briggs Institute [JBI] Manual for Evidence Synthesis (Peters
et al., 2020). A review protocol was developed a priori by the author and submitted as part of the
Scholarly Practice Advancement Research (SPAR) project proposal that was approved by Dr.
Maura MacPhee and Ranjit Dhari on April 30, 2021. The protocol is not publicly available
however access requests can be made through communication with the author.
Eligibility Criteria
In order to be included in the scoping review, articles had to be primary studies,
secondary studies, or systematic reviews with clearly stated methodology explained in their
abstracts and demonstrated relevance to the research question: Is baby-led weaning a safe and
effective approach to the complementary feeding of infants from six months of age? The study
population included healthy infants greater than 6 months of age, parents and caregivers, or
health care professionals who had experience with baby-led weaning. The definition of baby-led
weaning associated with the study must have demonstrated some consistency with the definition
of baby-led weaning provided in this review. Articles with a quantitative, qualitative, or mixed
methods study design that were published between January 2010 and June 24, 2021, available in
full-text, and written in the English language were included. Articles that were grey literature or
feasibility studies were excluded as they do not contribute to achieving the objectives of this
scoping review.
Information Sources & Search
A systematic search for evidence was completed in these three databases on June 24,
2021: Cumulative Index to Nursing and Allied Health Literature (CINAHL), Ovid EMBASE,
and Ovid MEDLINE. The search strategies were drafted by the author and refined through
collaboration with University of British Columbia (UBC) reference librarian and subject
specialist Ursula Ellis. Within CINAHL, there were no appropriate Subject Headings for the
search. The final search strategy for CINAHL is outlined in Table 1. The final searches within
Ovid EMBASE and Ovid MEDLINE were completed simultaneously on the advice of the
reference librarian as there were no appropriate Medical Subject Headings (MeSH) for the search
strategies within either database. When deduplicating the results within the Ovid EMBASE and
Ovid MEDLINE databases, preference was given to results with an abstract and Ovid MEDLINE
over Ovid EMBASE on the advice of the reference librarian for better quality. The final search
strategy for Ovid EMBASE and Ovid MEDLINE is outlined in Table 2. The final searches were
executed by the author and subsequently approved by the reference librarian.
Table 1
CINAHL Search (June 24, 2021 at 1200)
Search ID Search terms Limitations Results

S1 baby led wean* OR baby led feed* OR infant 89
led wean* OR infant led feed*
S2 S1 English Language 87
S3 S2 Publication Date: 78
2010 - 2021
Table 2
Ovid EMBASE & Ovid MEDLINE Search (June 24, 2021 at 1300)
Search ID Search terms Limitations Results

S1 baby led wean* OR baby led feed* OR infant 181
led wean* OR infant led feed*
S2 S1 Remove Duplicates 109
(Preference: Has
Abstract & Ovid
MEDLINE)
S3 S2 English Language 98
S4 S3 Publication Date: 96
2010 – 2021
Selection of Sources of Evidence
After the final searches were executed, the results were exported from the respective
databases and imported into Covidence. Covidence is a web-based software platform that
supports citation screening, full text review, and data extraction for the production of systematic
and other comprehensive literature reviews, including scoping reviews. Upon importing the
results into Covidence, the software automatically completed duplicate screening and removed
duplicate results. The author then sequentially completed title and abstract screening and full text
review evaluating the eligibility of the results based on the previously stated inclusion and
exclusion criteria. When the author experienced uncertainty at any point during the title and
abstract screening or full text review, Dr. Maura MacPhee was consulted and assisted in the final
decision-making regarding eligibility. As this scoping review includes systematic reviews, the
final step in the selection of evidence was to exclude the individual articles that satisfied
eligibility criteria yet were already incorporated in an included systematic review.

Data Charting Process
Data charting was an iterative process completed independently by the author using
Garrard’s (2017) matrix method to create a structured way of organizing, extracting, and
summarizing the main characteristics and relevant findings from all included sources of evidence
within the scoping review. Following the steps outlined by Garrard (2017), the author created a
spreadsheet in Microsoft Excel consisting of rows and columns. The rows list the articles
included in the scoping review in chronological order based on the date of publication. The
columns were used to represent headings describing the data items that were extracted from each
article. The column headings include year of publication, authors, citation, title, location, study
type, methodology, objective, population, baby-led weaning definition, comparison, intervention,
discussion, outcomes, results, recommendations, conclusions, and limitations. The final version
of the data charting spreadsheet was approved by Dr. Maura MacPhee and is available as a
supplementary file upon request to the author.
Synthesis of Results
Following the completion of the data charting process, the author followed an inductive
approach to summarizing and synthesizing the range of evidence included in the scoping review.
The author reviewed the data charting spreadsheet in detail and completed a basic descriptive
content analysis to categorize and code the main findings of the evidence into themes and
subthemes to effectively address the research question. The synthesis of the evidence will be
presented in the form of tables, figures, and narratives to enhance the understanding of the
evidence and to effectively address the research question and achieve the objectives of this
scoping review.
Results
Selection of Sources of Evidence
The PRISMA-ScR Flow Diagram in Figure 1 provides an overview of the flow of
evidence through the identification and screening process and outlines the number of results
identified, included, and excluded while providing the reasons for exclusions. A systematic
search of three databases produced 174 results which were exported from their respective
databases and imported into Covidence to begin evidence screening and assessment of eligibility.
The Covidence software automatically removed 48 duplicate records and the remaining 126
records underwent title and abstract screening. Based on the title and abstract screening, 60
records were excluded as they were irrelevant to the research question and did not satisfy
eligibility criteria. The remaining 66 full text articles were retrieved, downloaded, and assessed
for eligibility. Of these, 51 articles were excluded for the following reasons: 22 were grey
literature, 17 were already included in eligible systematic reviews, 5 did not have an appropriate
study design, 3 did not measure outcomes that were relevant to the research question, 2 were
duplicates not previously removed by the software, and 2 did not have a study population who
had experience with baby-led weaning as defined in this review. The remaining 15 studies were
considered eligible for inclusion within this scoping review.

Figure 1
PRISMA-ScR Flow Diagram
Identification of Studies via Databases
Records identified through

Identification
database searching
Records removed before screening:
(n = 174)
Duplicate records removed
• CINAHL (n = 78)
(n = 48)
• Ovid EMBASE & Ovid
MEDLINE (n = 96)
Records screened
Records excluded (n = 60)
(n = 126)
Full text reports assessed for Full text reports excluded

eligibility (n = 51)
Screening
(n = 66) • Grey literature (n = 22)

• Included in systematic
review (n = 17)
• Wrong study design (n = 5)
• Wrong outcome (n = 3)
• Duplicate report (n = 2)
• Wrong population (n = 2)
Studies included in the scoping

review
Included
(n = 15)
• Qualitative (n = 3)
• Quantitative (n = 9)
• Systematic review (n = 3)
Characteristics and Results of Sources of Evidence
Table 3 outlines the main characteristics of the 15 studies included in this scoping review,
including the location, study design, data collection methods, population, comparison, and
definition of baby-led weaning. The included studies have publication dates between 2018 and
2021 and consist of three qualitative studies, nine quantitative studies, and three systematic
reviews. Of the quantitative studies, four are secondary analyses of a randomized controlled trial
and five are observational cross-sectional. The majority of the studies were located in the United
Kingdom and New Zealand, with others located in Australia, Canada, Indonesia, Italy, Spain,
Turkey, and the United States of America. The population of all 15 studies included parents of
infants and children, the vast majority of them being mothers, and two of the studies included
health care professionals. The 15 included studies measured a wide variety of outcomes related
to the safety and effectiveness of a baby-lead weaning approach to complementary feeding and
the main findings and conclusions that are relevant to the research question are presented in
Table 4.
Table 3
Characteristics of Sources of Evidence
Reference/ Study design/ Data Population Comparison Definition of BLW

Location collection
Daniels, Taylor, Quantitative: Randomized 206 women in BLISS BLISS: General principles
Williams, controlled trial (secondary third trimester (intervention) of BLW followed (infants
Gibson, analysis) of pregnancy vs. TSF feed themselves handheld
Fleming et al. (n = 105 (control) foods and are involved in
(2018) Weighted 3-day diet records intervention, n family mealtimes)
at 7 & 12 months, blood = 101 control) Adherence defined as the
New Zealand sample at 12 months, infant feeding themselves
feeding questionnaires at 2, most or all of their food in
4, 6, 7, 8, 9 & 12 months the past week
D'Auria et al. Systematic Review: 12 Parents of BLW vs. Not specified, most studies
(2018) quantitative studies (10 children 0-78 traditional included participants who
observational cross- months old weaning self-identified as following
Not specified sectional, 2 randomized BLW
controlled trials)
Systematic search of
Cochrane Library, DARE,
EMBASE & MEDLINE
from 2000 to March 1, 2018
Daniels, Taylor, Quantitative: Randomized 206 women in BLISS BLISS: General principles
Williams, controlled trial (secondary third trimester (intervention) of BLW followed (infants
Gibson, analysis) of pregnancy vs. TSF feed themselves handheld
Samman et al. (n = 105 (control) foods and are involved in
(2018) Weighted 3-day diet records intervention, n family mealtimes)
at 7 & 12 months, blood = 101 control) Adherence defined as the
New Zealand sample at 12 months, infant feeding themselves
feeding questionnaires at 2, most or all of their food in
4, 6, 7, 8, 9 & 12 months the past week
Williams Quantitative: Randomized 206 women in BLISS BLISS: General principles

Erickson et al. controlled trial (secondary third trimester (intervention) of BLW followed (infants
(2018) analysis) of pregnancy vs. TSF feed themselves handheld
(n = 105 (control) foods and are involved in
New Zealand Weighted 3-day diet records intervention, n family mealtimes)
at 7, 12 & 24 months, = 101 control) Adherence defined as the
feeding questionnaires at 2, infant feeding themselves
4, 6, 7, 8, 9, 12 & 24 months most or all of their food in
the past week
Arantes et al. Systematic Review: 13 Mothers of BLW vs. Not specified

(2018) studies (10 quantitative, 3 children 6-78 traditional
qualitative) months old & weaning
United health
Kingdom, New Systematic search of professionals
Zealand, MEDLINE & PubMed in
Canada & USA August 2016, no date
limitations

Location collection
Morison et al. Quantitative: Randomized 206 women in BLISS BLISS: General principles
(2018) controlled trial (secondary third trimester (intervention) of BLW followed (infants
analysis) of pregnancy vs. TSF feed themselves handheld
New Zealand (n = 105 (control) foods and are involved in
Weighted 3-day diet records intervention, n family mealtimes)
at 7, 12 & 24 months, infant = 101 control) Adherence defined as the
food preference infant feeding themselves
questionnaires at 12 & 24 most or all of their food in
months, feeding the past week
questionnaires at 2, 4, 6, 7,
8, 9, 12 & 24 months
Rowan et al. Quantitative: Observational 180 parents of Strict BLW Strict BLW: never or rarely
(2019) (cross-sectional) infants 6-12 vs. loose fed by an adult
months old BLW vs. TSF TSF: always or mostly
United Online survey consisting of always fed by an adult
Kingdom 24-hour diet recall and Loose BLW: middle of the
feeding method questions scale
Komninou et al. Quantitative: Observational 565 parents of Strict BLW Strict BLW: self-feeding
(2019) (cross-sectional) children 12-36 vs. 90% of the time
months old predominant Predominant BLW: self-
United Online questionnaire BLW vs. feeding 51-89% of the time
Kingdom consisting of PFSQ, The predominant Predominant PLW: self-
Child Eating Behaviour PLW vs. feeding 10-50% of the time
Questionnaire, and questions strict PLW Strict PLW: self-feeding
about feeding practices, 10% of the time
environment, and sources of
information
Alpers et al. Quantitative: Observational 134 parents of BLW vs. BLW: spoon-fed 10% of
(2019) (cross-sectional) infants 6-12 standard the time
months old weaning Standard weaning: spoon-
United Online questionnaire fed 10% of the time
Kingdom consisting of 28-day FFQ,
24-hour diet recall, and
feeding questions
Swanepoel et al. Qualitative: Descriptive 13 mothers BLW vs. BLW: introducing family
(2020) phenomenology about to conventional foods, emphasis on infant
introduce solid weaning exploration of finger foods
Australia Photovoice (submitted food to their rather than feeding from a
photographs once a week for infant spoon
the month solids first Researchers assigned to
introduced) and focus groups BLW vs. conventional
weaning based on the type
and texture of foods first
offered according to
photographs

Location collection
McNally et al. Qualitative: Descriptive 11 mothers of BLW vs. Mothers self-identified as
(2020) children 7-24 traditional using BLW, majority
Video-elicited semi- months old weaning reported using only
United structured interviews (short independent feeding or use
Kingdom videos of participants of loaded spoons for infant
feeding their infants which to self-feed
were obtained in a prior
study)
Utami et al. Qualitative: Descriptive 13 mothers of Not specified, women self-

(2020) children 12 identified as following
Semi-structured interviews months to 5 BLW
Indonesia years old who
had introduced
complementa-
ry feeding
using BLW
Martinon-Torres Systematic Review: 8 Parents of BLW vs. TSF Included studies regardless
et al. (2021) quantitative studies (6 children from of BLW definition, BLW
observational, 2 randomized 0-78 months definition varied between
United controlled trials) old the included studies
Kingdom, New
Zealand & Systematic search of
Turkey PubMed, Web of Science,
EMBASE & Cochrane
Library from 2000 to March
2021
Addessi et al. Quantitative: Observational 1245 mothers BLW vs. BLW: spoon-fed or offered
(2021) (cross-sectional) of infants 6-12 non-BLW pureed foods 10% of the
months old time or offered the same
Italy Online questionnaire food eaten by the rest of the
consisting of questions about family 90% of the time
approach to complementary
feeding and developmental
milestones
San Mauro Quantitative: Observational 502 parents & Not specified

Martin et al. descriptive (cross-sectional) 364 health
(2021) professionals
Online questionnaires
Spain assessing knowledge and
attitudes towards BLW
Note. BLW = baby-led weaning; BLISS = Baby-Led Introduction to SolidS; TSF = traditional spoon-feeding; USA
= United States of America; PFSQ = Parental Feeding Styles Questionnaire; PLW = parent-led weaning; FFQ =
Food Frequency Questionnaire.
Table 4
Main Findings and Conclusions of Sources of Evidence
Reference Main findings/Conclusions

Daniels, - No significant difference in median dietary iron intake at 7 (95% CI [-1.0, 2.3]) or 12 (95% CI [-
Taylor, 1.6, 1.4]) months between the control and BLISS groups.
Williams, - No significant differences in plasma ferritin concentration (95% CI [-10.9, 5.8]), body iron (95%
Gibson, CI [-1.1, 1.2]) or the prevalence of depleted iron stores, early functional iron deficiency, or iron
Fleming et deficiency anemia (all p  .65) at 12 months.
al. (2018) - BLISS infants obtained significantly more iron from ‘breads and cereals’, ‘red meat’, ‘dairy’, and
‘legumes, nuts, seeds and eggs’ than control infants at 7 months. None of these differences
remained at 12 months. At 12 months, BLISS infants received significantly less iron from
‘vegetables’ than control infants.
- Prevalence of inadequate iron intake was high at 74% for both groups at 7 months, but
considerably lower by 12 months (23% control, 26% BLISS).
- The majority of infants in both groups were iron sufficient at 12 months (83% for both groups),
although 5% of control and 7% of BLISS infants presented with iron-deficiency anemia.
- No difference in the number of infants who were fed breastmilk, formula, or both, between groups
at either 7 or 12 months.
- No evidence of a difference in iron intakes and status between spoon-fed infants and infants
following a modified version of BLW in which parents were advised to offer ‘high-iron’ foods with
each meal.
- Results suggest that a baby-led approach can be used without having a negative impact on iron
status.
D'Auria et - Due to the low quality of the evidence, there is insufficient evidence to draw conclusions about the
al. (2018) baby-led weaning approach in regard to adequacy of energy and nutrient intake.
- Evidence from recent randomized studies suggests that a modified baby-led weaning approach
(BLISS) may have positive preventative effects for the risk of choking and nutrient deficiency.
- No significant difference in choking between baby-led and traditional weaning approaches among
the included studies.
- Mothers following a baby-led weaning approach were more likely to begin complementary
feeding at 6 months.
- There are still unresolved questions about baby-led weaning that require further research and
health professionals should consider this when providing complementary feeding advice.
- Parents following a BLW approach need education on how to provide and prepare safe, healthy,
and nutritious food.
Daniels, - No significant difference in zinc intakes between the control and BLISS groups at 7 (p = .42) or 12
Taylor, (p = .86) months.
Williams, - No significant difference in plasma zinc concentration between control and BLISS groups at 12
Gibson, months (p = .75).
Samman - Prevalence of inadequate zinc intake was low at 7 months (9% control, 5% BLISS) and 12 months
et al. (1% for both groups).
(2018) - A high percentage of infants had low plasma zinc concentrations in both groups (63% control,
57% BLISS) at 12 months, with no significant difference between groups.
- No difference in the number of infants who were fed breastmilk, formula, or both, between groups
at either 7 or 12 months.
- No evidence of a difference in zinc intakes and status between spoon-fed infants and infants
following a modified version of BLW.
- Results suggest that infants following a modified version of BLW can achieve similar zinc intake
and status to infants following TSF.

Williams - At 7 months, BLISS group consumed significantly more total fat and sodium than the control
Erickson group, but all other nutrients were similar.
et al. - At 12 months, BLISS group consumed significantly less saturated fat than the control group, but
(2018) all other nutrients were similar.
- At 24 months, there were no significant differences in nutrient intakes between groups.
- No significant difference in nutrient adequacy between groups at 7 months, intake appeared to be
adequate for both groups for all nutrients measured.
- At 12 months, 19% of infants had inadequate vitamin B12 intakes, 15% had inadequate calcium
intakes – at 24 months the same were 4% and 6% respectively.
- At 12 months, 9% of infants had sodium intakes greater than recommended (3% control, 15%
BLISS, p = .018). At 24 months, 68% of children had excessive sodium intakes (66% control, 70%
BLISS, p = .458).
- At 7 months, 7% of infants were consuming 5% or more of their energy as added sugars (12%
control, 2% BLISS, p = .013). At 12 months, 31% of children (39% control, 24% BLISS, p = .068)
had intakes of added sugars higher than recommended. At 24 months, 75% of children (80%
control, 70% BLISS, p = .229) had intakes of added sugars higher than recommended.
- Overall, there were very few differences in nutrient intake between groups and there is evidence
that a modified version of BLW is as nutritionally adequate as TSF. However, both groups had high
intakes of sodium and added sugars at 24 months that are of concern.
Arantes et - Compared to the traditional weaning group, the BLW group of infants were less prone to being
al. (2018) overweight, less demanding of food, and more likely to eat the same foods as the family and to
share the same mealtimes.
- No difference in the number of choking episodes between groups.
- BLW group was more likely to have been breastfed until 6 months.
- Health professionals were hesitant to recommend BLW.
- Most parents had been introduced to BLW by fellow parents, friends, or online sources.
- Mothers who followed BLW with their children recommended the approach to complementary
feeding. However, they did report concerns about the messes made at mealtimes, the wasting of
food, and the possibility of choking.
- The concerns of mothers combined with health professionals’ fears that infants are unable to self-
feed reflect the lack of knowledge and scarcity of recommendations about BLW.
- BLW was associated with a longer duration of exclusive breastfeeding, child participation in
family meals, greater self-regulation of being full, and less work for parents who were feeding the
infants.
Morison et - BLISS infants consumed a greater proportion of their foods as ‘whole’ foods at each age compared
al. (2018) to the control group, particularly at 7 months (p < .001).
- At 7 months, BLISS group had a significantly greater total food variety. At 24 months, BLISS
group had significantly greater ‘fruit and vegetable’ variety only.
- At 12 months, BLISS group had an increased preference for ‘savoury-non-meat high-protein
foods’ and were more likely to be offered and slightly more likely to consume ‘lumpy’ foods
compared to the control group. No significant differences in food preference between groups at 24
months.
- Results suggest that a modified BLW approach leads to increased dietary variety and greater
exposure to more textured foods at 7 months, with some increased variety present at 24 months.
- Overall, any impact of a modified BLW approach on perceived food preferences appeared to be
only transitory.
Rowan et - Significant association (p = .000) between weaning groups and breastfeeding. Mothers who
al. (2019) followed a strict BLW approach were more likely to be breastfeeding (p = .000).
- Infants 6-8 months: Significant differences between weaning groups found in exposure to
vegetables (strict BLW had higher exposure than TSF [p = .000], loose BLW had higher exposure
than TSF [p = .016]), protein (strict BLW had higher exposure than TSF [p = .002], loose BLW had

Rowan et higher exposure than TSF [p = .001]), and composite meals (strict BLW had lower exposure than
al. (2019) TSF [p = .002], loose BLW had lower exposure than TSF [p = .000]).
cont. - Infants 9-10 months: Significant differences in exposure to milk feeds (strict BLW had more milk
feeds than loose BLW [p = .006]) and dairy consumption.
- Infants 11-12 months: Significant differences in exposure to savoury snacks (loose BLW had
higher exposure than strict BLW [p = .015]), dairy products (loose BLW had higher exposure than
strict BLW [p = .009]), and composite meals (TSF had higher exposure than strict BLW [p = .045]).
- No significant differences were reported in exposure to iron-containing foods between weaning
groups at any age.
- Authors suggest the findings add to a growing body of evidence that suggests a BLW approach
may be safe and sufficient.
Komninou - Moderate effect sizes were observed in comparisons regarding breastfeeding duration, maternal
et al. feeding practices, sources of information, and types of first foods given to infants.
(2019) - Small effect sizes were observed in comparisons regarding toddlers’ eating behaviour and the
family food environment.
- Strict BLW infants were breastfed for longer in comparison to the other three groups (predominant
BLW, predominant PLW, strict PLW) with medium effect size (p < .001)
- There were significant differences in parental feeding styles measured with PFSQ between the
four groups (p < .001), effect size ranged from small to medium. Parents in the strict and
predominant BLW groups were using less instrumental feeding practices than parents in the PLW
groups. Parents in the strict BLW group were exerting significantly less control over their toddler’s
eating and use significantly less encouragement to increase food consumption than the other three
groups (p < .001).
- Significant difference was observed between the groups for both shared mealtimes (p < .001) and
common meals (p < .001) with a small effect size. Parents in the strict BLW group were found to
share their mealtimes (strict BLW vs. predominant BLW [p = .006], strict BLW vs. predominant
PLW [p = .001], strict BLW vs. strict PLW [p < .001]) and eat the same meals with their children
(strict BLW vs. predominant BLW [p = .024], strict BLW vs. predominant PLW [p = .003], strict
BLW vs. strict PLW [p < .001]) significantly more often than all other groups. Parents in the strict
PLW group ate the same meal as their child significantly less frequently than the rest of the groups.
- 39.3% of all parents identified the internet as their primary source of information, 22.3% health
professional advice, 14.4% books, 12.3% friends, and 8% family. Parents in strict (p = .03) or
predominant (p = .01) PLW group demonstrated a preference for sourcing advice from health
professionals significantly higher frequency than statistically expected. Strict BLW parents follow
health professional advice significantly lower frequency than statistically expected (p < .001).
Parents in strict and predominant BLW groups demonstrated a preference for independent research,
with the internet found to be a significantly more popular source of advice for parents in the
predominant BLW group (p = .05) and a preference for literature in books significantly more
popular for strict BLW (p = .04).
- Significant difference in the age of introduction to solids between groups with a small effect size.
Parents in strict BLW groups introduced solids later than the other groups.
- Significant difference between toddlers’ eating behaviour between the four groups (p = .002). A
significantly lower level of food fussiness (strict PLW vs. strict BLW [p = .03]) and higher food
enjoyment (strict PLW vs. strict BLW [p = .004]) was reported for the toddlers who were allowed to
self-feed most of the time in comparison to mainly spoon-fed toddlers.
- Results suggest that parents following strict BLW are less controlling over feeding issues, less
likely to use encouragement as a technique to increase their child’s food consumption, more likely
to offer vegetables and finger foods from the beginning of complementary feeding, more likely to
rely on independent research for information relating to the introduction of solid foods, more likely
to share mealtimes, and more likely to eat the same food as their child than the other groups.
- Toddlers in the strict BLW group were less food fussy and enjoyed food more.
- Parents following BLW are utilizing social media more than parents following PLW.

Alpers et - No difference between weaning methods for the intake of food groups ‘fruits’, ‘vegetables’, ‘all
al. (2019) fish’, ‘meat and fish’, ‘sugary’ or ‘starchy’ foods.
- SW group offered more ‘fortified infant cereals’ at all ages (p < .001), ‘salty snacks’ at 6-8 months
(p = .03), ‘dairy and dairy based deserts’ at 9-12 months (p = .04), and ‘pre-prepared baby foods’ at
all ages (p < .001) than the BLCF group.
- BLCF group offered more ‘oily fish’ (p < .001) and processed meats (p = .001) at all ages than the
SW group.
- No significant difference in nutrient intake between SW and BLCF groups for energy,
carbohydrate, protein, saturated fat, or zinc.
- BLCF group had significantly greater intake of sodium (p = .028) and fat from food (p = .035) and
significantly lower intake of iron from milk (p = .012) and free sugar (p = .03) at 6-8 months
compared to SW group.
- Free sugars in the SW group accounted for 9% of total energy intake, considerably higher than the
1% for the BLCF group.
- Iron intake was below recommended for both groups. Sodium intake was above recommended for
BLCF group.
- BLCF group commenced weaning significantly later than the SW group (p < .001).
- Significantly more BLCF infants were breastfed exclusively for 6 months (p < .001) than the SW
group.
- Compared to the SW group, BLCF group was offered foods higher in sodium and lower in iron,
however, the foods offered contained less free sugar.
- BLCF was associated with a longer duration of breastfeeding and later introduction of
complementary foods.
- Authors suggest that BLCF can have both positive and negative implications for the diet of infants.
Swanepoel - Three themes emerged from the data, women’s approaches to complementary feeding were
et al. mediated by ‘trust’, ‘convenience’, and making decisions that were ‘value based vs. practical
(2020) based’.
- Trust: trusting the infant, trusting women’s own instincts, and the tension between social pressures
and trust of self. Women identified as BLW avoided purees as a starting food, trusting their infants
to choose foods they could manage. All women discussed concerns related to choking. BLW
women appeared to trust their infant’s ability to eat or handle non-pureed foods safely, and as
women observed their infant over time their trust in their abilities increased. All women spoke about
trusting their instincts, self-trust was used before taking advice from friends, family, and health
professionals. All women spoke of perceived pressures from society, media, and family regarding
the timing of introduction and the type of food offered to infants. BLW group used their own
research to overcome perceived challenges, knowledge and confidence stemmed from research in
books, videos, and the internet. The majority of conventional weaning mothers trusted the advice of
health professionals. Both groups experienced pressure and disapproval from health professionals
regarding complementary feeding.
- Convenience: Desire for ease and time efficiency appeared to underpin many feeding decisions for
women following conventional weaning. Women felt the feeding process was easier once infant
was able to independently feed themselves.
- Value based vs. practical based: Utilizing a BLW approach allowed women to fulfill their ideals
and uphold their feeding values. Conventional weaning women expressed an increase in infant
enjoyment and independence once complementary feeding progressed to finger foods.
- Most women who used BLW introduced solids at 6 months, while conventional weaning mothers
introduced solids between 4.5 to 5.5 months.
- BLW women described key concepts of BLW as including the use of family foods and an
emphasis on infant exploration of finger foods rather than feeding from a spoon.
- For BLW women, trusting the infant and allowing them to drive the feeding process was common,
emphasis on the infant was more pronounced such as infant focused ideals and beliefs and trusting
the infant. BLW women wanted to build a healthy relationship with food in the future. BLW women
perceived it to be more time efficient to integrate the use of family foods already being prepared.

Swanepoel - Women following BLW were more value-driven as opposed to conventional women who were
et al. more pragmatic in decision-making.
(2020) - Differences between women following a conventional approach and BLW approach were seen in
cont. perceptions of convenience and the decision-making process.
- This study provides insight into how and why women choose certain feeding practices and can be
used to better equip health professionals to work with new mothers in providing realistic and
nuanced feeding support.
McNally - Findings from this analysis provide some support for reports that BLW is a more responsive
et al. feeding approach than TW in relation to infant satiation.
(2020) - Findings indicate that TW mothers, while recognizing infant cues, may have been less inclined to
follow them. Further indications of satiation cues being missed or misinterpreted by some TW
mothers.
- Authors suggest that it may be productive for HCP to encourage awareness that boredom may
represent developing satiation and to encourage mothers to pause in feeding rather than encouraging
further intake.
- Findings suggest that mothers may benefit from advice regarding responses to infant behaviour
which differs from expectations and advice about managing sleep in older infants without resorting
to feeding.
- Feeding cues: BLW and TW mothers reported noticing many similar hunger and satiation cues,
but there were differences in the range of satiation cues reported with TW mothers reporting a more
extensive range than BLW.
- Three main themes were generated to capture maternal perceptions of infant hunger and satiation
and how mothers determined when to end the meal: deciphering, enough, and strategies.
- Deciphering: Both groups reported some difficulty in interpreting both hunger and satiation cues.
Several mothers, mostly TW, reported difficulty differentiating between boredom and satiation.
Generally, BLW mothers associated boredom with satiation and TW mothers saw boredom as
affecting their infant’s eating behaviour.
- Enough: BLW mothers expressed concern about offering the right amount, while TW mothers
tended to focus on infants consuming enough and wanting them to eat a ‘good amount’ or a ‘good
meal’. For TW mothers, ‘enough’ was equated with eating everything. Concerns about the
sufficiency of intake were largely expressed by TW mothers. Some TW mothers reported finding it
easier to accept infant autonomy in determining ‘enough’ as infants started to self-feed and
increasing feeding independence appeared to be associated with greater maternal acceptance of
infant autonomy in determining intake. While watching the video of them feeding their infants,
many TW mothers commented that they realized they gave more than the infant needed/wanted,
while most BLW mothers did not comment on themselves or their infant’s intake on video.
- Strategies: BLW mothers emphasized the importance of gaining an overview of their infant’s
intake through general signs of the infant being well nourished and assessing intake over several
days. Concerns about intake and strategies to ensure infants ate enough were generally reported by
TW mothers.
Utami et - Three themes were identified: avoiding being a ‘picky’ eater, infants gagging and choking, and
al. (2020) becoming independent feeders.
- Avoiding being a ‘picky’ eater: trying and accepting different foods (given time, children would
learn to eat foods that were once refused) and learning to accept different food textures (mothers
identified that using BLW helped the infants increase or elevate the type of food textures they
accept).
- Gagging and choking: infants gagging and choking (most mothers talked about gagging as a
normal part of the process and had done prior reading about gagging and were prepared on how to
manage it) and gagging as part of the learning process (gagging was identified by some as part of
the learning process needed to learn to eat complementary foods, one mother reported her child did
have a choking episode and related it to the preparation of the food)
- Becoming an independent feeder: learning to be independent, all women identified that their
infants were becoming independent feeders as an outcome of BLW, through BLW they developed

Utami et skills that enabled their increasing ability to eat complementary foods, giving them the opportunity
al. (2020) to self-feed has assisted in the development of gross and fine motor skills, one mother directly
cont. attributes her infant’s increasing willingness to trying new foods and developing mealtime
independence to BLW.
- Women spoke of several BLW positive outcomes: independence, involvement, socialization. One
mother commented that cooking preparation became simpler. Mothers commented that the focus on
family meals motivated them to eat together as a family which exposed infants to social and
learning aspects of eating with a family.
- Women valued BLW as it provided a focus on eating rather than the need to distract the child to
get them to eat. One mother emphasized her infant being socialized into acceptable mealtime
behaviour. Mothers show that they are respectful of infant’s decisions that they are no longer
hungry.
- Findings show that infants who were weaned using BLW showed certain responses of increased
independence and eating without fuss. Infants eat with the family and share the same foods. Infant’s
increasing independence arose due to the opportunities they were provided to regulate the amount of
food eaten and the overall feeding process. The infants became confident and eventually
independent eaters. Infants at times did experience gagging and choking, but responses to such were
enhanced due to women learning about how to properly handle choking episodes.
Martinon- - The results of this systematic review about the effect of BLW on infant weight gain and
Torres et overweight prevalence were inconclusive.
al. (2021) - More clinical trials and prospective studies should be done before providing a general
recommendation about the best method of weaning to reduce the risk of obesity.
- Importantly, regardless of the disparity of results in the included studies, children’s weight and
nutritional indexes showed normal values for their gender and age in most cases.
- Results were indecisive, while some studies seem to demonstrate lower weight gain in infants that
apply BLW, others show inconclusive results. The risk of bias in all included studies was moderate
or high.
Addessi et - Data suggested that BLW may be a multifaceted approach simultaneously defined by low spoon
al. (2021) and puree feeding and high family food feeding, but these might not happen at the same time.
- BLW was positively related to breastfeeding, later exposure to complementary foods, earlier
exposure to both finger and family foods, and a higher interest in family food and shared meals.
- Family food feeding was associated with sitting unsupported at an earlier age (p = .019). Low
spoon feeding was associated with crawling at an earlier age (p = .037).
- Mothers belonging to all BLW groups breastfed significantly longer than mothers belonging to the
corresponding non-BLW groups. Mothers who were still breastfeeding engaged in less spoon
feeding (p < .001), less puree feeding (p < .001), and more family-food feeding (p < .001) than
mothers who were no longer breastfeeding.
- Mothers belonging to all BLW groups reported significantly later introduction of complementary
foods, compared to mothers belonging to the corresponding non-BLW groups.
- Infants belonging to all the BLW groups started eating family food significantly earlier than
infants belonging to the corresponding non-BLW groups.
- Significant positive associations between the degrees of family food feeding and the frequency of
both infant’s interest in family food (p < .001) and sharing family meals (p < .001).
San - Both HCP and parents recommend BLW and consider it helps promote the development of
Mauro milestones.
Martin et - HCP and parents believed BLW facilitates the transition to family feeding, eases adaptation to new
al. (2021) flavours and consistencies, enhances chewing, and may promote fine motor skills development and
maturational development of infants.
- Neither HCP nor parents believed BLW leads to nutrient deficiencies or lower weight gain for
infants.
- Authors suggest BLW could be considered as an alternative and beneficial system of
complementary feeding for babies.

San - 92.3% of HCP and 93.4% of parents knew about BLW.
Mauro - They recommended BLW ‘always’ in 39.8% (professionals) and 69.3% (parents), ‘sometimes’ in
Martin et 49.7% (professionals) and 24.9% (parents).
al. (2021) - Of HCP: 36% recommended using BLW, 24% recommended TSF. 97.9% indicated that they
cont. knew about the benefits of BLW. 81.8% had families who followed BLW.
- Most HCP agreed that BLW facilities the transition to family feeding, makes it easier for the baby
to adapt to new flavours and consistencies, enhances chewing against sucking, and can promote
maturational development of the baby. All HCP, except for non-pediatric doctors, considered that
BLW favours the development of fine motor skills.
- All HCP disagreed with babies not gaining enough weight or having a deficiency in some nutrients
as a result of BLW.
- HCP source of information for BLW: 41.5% courses/conferences/professional events, 27.6%
Internet (webpage, social media, etc.) 15.3% personal learning (books, scientific articles, etc.)
- Parent source of information for BLW: 38.8% Internet (webpage, social media, etc.), 25.8%
workshops for parents, 15.9% mothers/relatives/friends
- HCP: Of the pediatric doctors – 61.4% ‘sometimes’, 32.9% ‘always’, 5.7% ‘never’ recommended
BLW. Of the pediatric nurses – 55% ‘sometimes’, 45% ‘always’ recommended BLW. Of the
dieticians, 79.3% ‘always’, 13.8% ‘sometimes’, 6.9% ‘never’ recommended BLW.
- 91.8% of parents indicated that they knew about the benefits to BLW, 78.5% practiced BLW with
one of their children, 69.3% would recommend BLW to other families.
- Parents were informed about complementary feeding by nurses 43.6% of the time, pediatricians by
42.6% of the time, and dieticians 1.6% of the time.
- Parents were recommended to start complementary feeding with BLW 11%, 44.4% TSF.
Note. BLISS = Baby-Led Introduction to SolidS; BLW = baby-led weaning; TSF = traditional spoon-feeding; PLW
= parent-led weaning; PFSQ = Parental Feeding Styles Questionnaire; BLCF = baby-led complementary feeding;
SW = standard weaning; TW = traditional weaning; HCP = health care professionals.
Synthesis of Results
In order to provide a synthesis of the main findings from the 15 studies included in this
scoping review, three themes were developed: child experience and outcomes, parent experience,
and health care professional experience. These themes, and their respective subthemes, are
presented in Figure 2. Child experience and outcomes was the dominant theme throughout the
sources of evidence, with both parent experience and health care professional experience serving
as complimentary themes. Table 5 presents the 15 studies and three themes, indicating which
themes are represented within each study and whether or not they are a major or minor focus.
Figure 2
Themes in Baby-Led Weaning Research
Child Experience and Outcomes
Nutrient Intake
Growth and Weight
Choking
Age of Introduction
Breastfeeding
Motor Development
Eating Habits
Parent Experience
Health Care
Values and Beliefs
Professional
Choking
Experience
Feeding Style
Source of Information
Table 5
Sources of Evidence and Relevant Themes
Reference Child experience Parent Health care professional

and outcomes experience experience
Daniels, Taylor, Williams, X
Gibson, Fleming et al. (2018)
D'Auria et al. (2018) X
Daniels, Taylor, Williams, X

Gibson, Samman et al. (2018)
Williams Erickson et al. X

(2018)
Arantes et al. (2018) X * *
Morison et al. (2018) X
Rowan et al. (2019) X
Komninou et al. (2019) X X
Alpers et al. (2019) X
Swanepoel et al. (2020) * X
McNally et al. (2020) * X
Utami et al. (2020) X X
Martinon-Torres et al. (2021) X
Addessi et al. (2021) X
San Mauro Martin et al. X X

(2021)
Note. X = major theme; * = minor theme.

Child Experience and Outcomes
The dominant theme of child experience and outcomes represents the wide variety of
infant and child focused outcomes measured throughout the sources of evidence. The subthemes
include nutrient intake, growth and weight, choking, age of introduction, breastfeeding, motor
development, and eating habits.
Nutrient Intake
Alpers et al. (2019), Daniels, Taylor, Williams, Gibson, Fleming et al. (2018), and
Rowan et al. (2019) compared the intake and exposure to iron within an infant’s first year of life
between those who followed baby-led and conventional weaning approaches. Daniels, Taylor,
Williams, Gibson, Fleming et al. (2018) reported no significant difference in median dietary iron
intakes between groups at 7 or 12 months, but they did report differences in the source of iron.
At 7 months, baby-led weaning infants obtained significantly more iron from bread, cereal, red
meat, dairy, legumes, nuts, seeds, and eggs. However, these differences appeared transitory as
they were no longer present at 12 months. Meanwhile, Alpers et al. (2019) reported that baby-led
weaning infants had a significantly lower intake of iron from milk between 6 and 12 months.
Further, Rowan et al. (2019) reported no significant difference in the exposure to iron-containing
foods between groups between 6 and 12 months. Additionally, Daniels, Taylor, Williams,
Gibson, Fleming et al. (2018) reported no significant difference in plasma ferritin concentration
or the prevalence of depleted iron stores, early functional iron deficiency, or iron deficiency
anemia between groups at 12 months. Although these studies reported no significant differences
in iron intake, exposure to iron-containing foods, or iron deficiency between groups, Daniels,
Taylor, Williams, Gibson, Fleming et al. (2018) and Alpers et al. (2019) raised concerns
regarding the prevalence of inadequate iron intakes among both baby-led and conventional
weaning infants.
Alpers et al. (2019), Daniels, Taylor, Williams, Gibson, Samman et al. (2018), D'Auria et
al. (2018), and Williams Erickson et al. (2018) compared additional nutrients between infants
who followed baby-led and conventional weaning approaches. Overall, Alpers et al. (2019),
Daniels, Taylor, Williams, Gibson, Samman et al. (2018), and Williams Erickson et al. (2018)
reported very few significant differences in nutrient intakes between groups. However, the
systematic review by D'Auria et al. (2018) concluded there was insufficient evidence to draw
conclusions on any differences in the adequacy of nutrient intakes between groups due to the low
quality of evidence. There were concerns raised in the evidence regarding progressively
excessive intakes of both sodium and sugar among both groups of infants with age. Both Alpers
et al. (2019) and Williams Erickson et al. (2018) reported that baby-led weaning groups had a
significantly greater intake of sodium between the age of 6 and 8 months. Additionally, Williams
Erickson et al. (2018) reported excessive sodium intakes for both groups at 12 and 24 months. At
12 months the prevalence was 9% of all infants, with a significantly higher percentage of those
infants being from the baby-led weaning group, and at 24 months the prevalence was 68% with
no significant difference between groups. In regard to sugar intakes, Alpers et al. (2019) and
Williams Erickson et al. (2018) reported that baby-led weaning groups had a significantly lower
intake of sugar between the age of 6 and 8 months. However, at 12 and 24 months there was a
concerning prevalence of excessive sugar intakes, 31% and 75% respectively, with no significant
differences between baby-led and conventional weaning groups (Williams Erickson et al., 2018).
Growth and Weight
Two systematic reviews examined the growth and weight of infants in the first few years
of life, comparing baby-led and conventional weaning groups. Arantes et al. (2018) reported that
baby-led weaning infants were less prone to being overweight compared to conventional
weaning infants. Martinon-Torres et al. (2021) reported that the results of their systematic review
regarding the effect of baby-led weaning on infant weight gain and overweight prevalence were
inconclusive and recommended more clinical trials and prospective studies be completed before
providing recommendations about the best method of weaning to reduce the risk of obesity.
However, despite an inconclusive result, Martinon-Torres et al. (2021) reported the studies
included in their review demonstrated that children’s weight showed normal values for their
gender and age in the majority of cases.
Choking
An increased risk of choking is one of the most commonly perceived concerns regarding
the use of a baby-led weaning approach to complementary feeding. Two systematic reviews
(Arantes et al., 2018; D’Auria et al., 2018), including a total of 25 individual studies, reported no
significant difference in the number of choking episodes between baby-led and conventional
weaning groups of infants.
Age of Introduction
Four studies included in this review (Addessi et al., 2021; Alpers et al., 2019; D’Auria et
al., 2018; Komninou et al., 2019) reported a significant difference in the age of introduction to
complementary feeding between baby-led and conventional weaning groups of infants, with the
baby-led group having a later introduction than the conventional group. Baby-led weaning
infants were more likely to be introduced to complementary feeding at 6 months of age (D’Auria
et al., 2018; Swanepoel et al., 2020), while conventional weaning infants were more likely to be
introduced between 4.5 and 5.5 months of age (Swanepoel et al., 2020).
Breastfeeding
Addessi et al. (2021), Alpers et al. (2019), Arantes et al. (2018), Komninou et al. (2019),
and Rowan et al. (2019) were all in agreement that a baby-led weaning approach to
complementary feeding is positively associated with a longer duration of breastfeeding in
comparison to a conventional weaning approach. Komninou et al. (2019) reported that this
association has a medium effect size. Additionally, Addessi et al. (2021) reported that mothers
who are still breastfeeding were significantly less likely to engage in spoon-feeding and puree
feeding while being significantly more likely to engage in family-food feeding than mothers who
were no longer breastfeeding. In contrast, Daniels, Taylor, Williams, Gibson, Fleming et al.
(2018) and Daniels, Taylor, Williams, Gibson, Samman et al. (2018) reported no significant
difference in the number of infants who were fed breastmilk, formula, or both, between baby-led
and conventional weaning groups at 7 or 12 months of age.
Motor Development
San Mauro Martin et al. (2021) reported that the majority of parents and health care
professionals included in their study believed that a baby-led weaning approach to
complementary feeding helped in promoting infant fine motor skill development. Utami et al.
(2020) shared that mothers who had engaged in baby-led weaning with their infants believed that
self-feeding had assisted in their development of gross and fine motor skills. Finally, Addessi et
al. (2021) examined specific components of complementary feeding and found that family-food
feeding was significantly associated with sitting unsupported at an earlier age and that low
spoon-feeding was significantly associated with crawling at an earlier age.

Eating Habits
The eating habits of infants and children were discussed within the majority of the studies
included within this review. Food variety and preference, food fussiness and enjoyment, and
family food and mealtimes were the common expressions of eating habits addressed. According
to Morison et al. (2018), baby-led weaning infants had a significantly increased total dietary
variety and greater exposure to more textured foods at 7 months of age compared to
conventionally weaning infants, with some increasing variety remaining amongst fruit and
vegetables at 24 months of age. Additional studies indicated that baby-led weaning infants had
greater exposure to vegetables and protein and less exposure to composite meals (Rowan et al.,
2019), fortified infant cereals, and pre-prepared baby foods (Alpers et al., 2019) than
conventionally weaning infants between 6 and 12 months of age. The only study that examined
infant and toddler food preferences between weaning groups was Morison et al. (2018) and they
concluded that any impact of baby-led weaning on food preferences appeared to only be
transitory. In respect to food fussiness and enjoyment, the evidence reported that baby-led
weaning infants were less demanding of food (Arantes et al., 2018), had lower levels of food
fussiness (Komninou et al., 2019; Utami et al., 2020), and higher food enjoyment (Komninou et
al., 2019) than conventional weaning infants during infancy and toddlerhood. Additionally,
mothers who followed a conventional weaning approach reported their infants expressed greater
enjoyment in feeding once they progressed to eating finger foods (Swanepoel et al., 2020).
Finally, infants fed using a baby-led weaning approach were more likely to eat the same foods as
the family and to share mealtimes with the family than conventionally weaned infants (Addessi
et al., 2021; Arantes et al., 2018; Komninou et al., 2019; Utami et al., 2020).
Overall, the evidence suggests that both baby-led and conventional weaning approaches
to complementary feeding provide nutritionally adequate diets with no increased risk of choking
episodes associated with either approach. However, there is evidence for concern regarding the
prevalence of inadequate iron intakes and excessive sodium and sugar intakes among all infants
and children regardless of the weaning approach used. Currently, there is not enough available
evidence to determine if either weaning approach is associated with obesity prevention. The
majority of evidence suggests that a baby-led weaning approach is associated with a later
introduction of complementary feeding at around 6 months of age and a longer duration of
breastfeeding, both of which are recommended by the WHO (2009, 2020) and Health Canada,
Canadian Paediatric Society, Dietitians of Canada, and Breastfeeding Committee for Canada
(2014). Finally, the evidence suggests that parents and health care professionals believe a baby-
led weaning approach promotes infant gross and fine motor development, decreases their food
fussiness, increases their food enjoyment, and leads to more shared food and mealtimes with the
family. Further explorations of the parent and health care professional experience with a baby-
led weaning approach to complementary feeding are detailed throughout the subsequent themes.
Parent Experience
The theme of parent experience encompasses the parental experience during a baby-led
weaning approach to complementary feeding. The subthemes include values and beliefs,
choking, feeding style, and sources of information.
Values and Beliefs
Two qualitative studies included in this review explored the complementary feeding
experiences of mothers. One of these studies included mothers who had used either a baby-led or
conventional weaning approach (Swanepoel et al., 2020), and the other included mothers who
had used a baby-led weaning approach for a minimum of 6 months (Utami et al., 2020).
Swanepoel et al. (2020) identified three themes that mediated mothers’ approaches to
complementary feeding – trust, convenience, and making decisions that were value based versus
practical based. For baby-led weaning mothers, trusting their infant was central to their feeding
experience and doing so allowed their infants to drive the feeding process. These women
believed it was convenient and time efficient to feed their infants the same food that was being
prepared for the rest of the family. This is contradictory to mothers who engaged in conventional
weaning who perceived the use of commercial baby food as more convenient. The mothers who
identified as using a baby-led weaning approach were more value-driven and valued infant
enjoyment, independence, and exploration during the complementary feeding experience.
Meanwhile, conventional weaning mothers were more pragmatic in their decision making.
Swanepoel et al. (2020) determined that “it appeared that utilising a baby-led approach allowed
women to fulfill their ideals and uphold their feeding values” (p. 378). Unfortunately, women
from both feeding groups reported experiencing pressure and disapproval from health care
professionals regarding their complementary feeding practices.
Utami et al. (2020) determined that a baby-led weaning approach to complementary
feeding had been accepted by mothers as having positive outcomes for their children. These
positive outcomes included avoiding picky eating, becoming an independent feeder, and the
involvement and socialization of their children. The mothers identified that using a baby-led
weaning approach helped their children avoid being picky eaters as it encouraged them to try and
accept different foods and allowed them to learn to accept different food textures. No concerns
were raised about children not eating an adequate diet. All of the women in this study attributed
their children’s developing mealtime independence and ability to become independent feeders to
the use of a baby-led weaning approach. The women believed that baby-led weaning allowed
their children to develop the skills necessary to increase their ability to eat complementary foods,
including the ability to sense when they are hungry or full and to control their eating. The
emphasis on serving family meals provided the women with the motivation to eat together as a
family and allowed the children to be exposed to the social and learning aspects of eating with
the family from the beginning of their complementary feeding journey. The women believed this
experience allowed their children to become socialized into acceptable mealtime behaviour and
“provided a focus on eating rather than the need to distract the child to get them to eat” (Utami et
al., 2020, p. 5). Overall, the women in this study believed that using a baby-led weaning
approach to complementary feeding allowed their children to enjoy the eating process while
becoming confident and independent eaters.
In addition to these two qualitative studies, one systematic review and one quantitative
study included in this review each addressed parental experiences with a baby-led weaning
approach to complementary feeding. Arantes et al. (2018) reported that baby-led weaning was
recommended by mothers who followed the approach with their children and San Mauro Martin
et al. (2021) reported that 94.2% of parents recommended baby-led weaning ‘always’ or
‘sometimes’. San Mauro Martin et al. (2021) reported that parents believed that baby-led
weaning “facilitates the transition to family feeding, makes it easier for the baby to adapt to new
flavours and consistencies, enhances chewing versus sucking, and may promote the development
of fine motor skills and the maturational development of the baby” (p. 8), without leading to any
nutrient deficiencies or lower weight gain for infants. However, Arantes et al. (2018) indicated
that women who engaged in baby-led weaning with their children reported concerns regarding
the messes made at mealtimes, the wasting of food, and the possibility of choking.
Choking
Three studies included within this review addressed parental concerns of choking when
using a baby-led weaning approach to complementary feeding (Arantes et al., 2018; Swanepoel
et al., 2020; Utami et al., 2020). Swanepoel et al. (2020) identified that both baby-led weaning
and conventional weaning mothers discussed concerns related to choking, however, the baby-led
weaning mothers “appeared to trust their infant’s ability to eat or handle non-pureed foods
safely” (p. 376). All the mothers in this study expressed that over time as they observed their
infants, their trust in their abilities to consume food safely increased. Utami et al. (2020)
identified that at times some infants did experience gagging and choking while using a baby-led
weaning approach. Most of the mothers reported that they had engaged in preparative reading or
educational courses regarding safe foods for infants, the differences between gagging and
choking, and the management of gagging and choking (Utami et al., 2020). Generally, the
mothers believed gagging to be a normal “part of the learning process needed to learn to eat
complementary foods” (Utami et al., 2020, p. 4) and felt prepared to manage it. Utami et al.
(2020) concluded that although some infants did experience gagging and choking, prior learning
and education helped to prepare mothers and enhanced their responses allowing them to properly
handle gagging and choking episodes.
Feeding Style
Two studies outlined the differences in parental feeding styles between those who
engaged in baby-led weaning and conventional weaning approaches to complementary feeding.
Komninou et al. (2019) completed a quantitative study and concluded that parents who used a
baby-led weaning approach used significantly less instrumental feeding practices than those
using a conventional weaning approach. These instrumental feeding practices included exerting
control over the child’s eating, using encouragement and prompting to increase their child’s food
consumption, and using food as a reward. McNally et al. (2020) completed a qualitative study
and concluded that their findings support baby-led weaning as a more responsive approach to
infant feeding than conventional weaning in relation to infant satiation. Although both baby-led
and conventional weaning mothers recognized infant satiation cues, conventional weaning
mothers were less inclined to follow these cues and were more likely to acknowledge that they
encouraged their infant to consume more food than they needed or wanted. While baby-led
weaning mothers expressed concern about offering enough food to their infants, conventional
weaning mothers expressed concerns about their infants consuming enough food and were more
likely to equate eating enough with eating everything. Although conventional weaning mothers
were more likely to express concerns about the sufficiency of their infant’s intake, this concern
started to ease as their infants began to self-feed. Therefore, McNally et al. (2020) concluded that
“increasing feeding independence appeared to be associated with greater maternal acceptance of
infant autonomy in determining intake” (p. 5).
Source of Information
The evidence demonstrated that regardless of whether parents are using a baby-led or
conventional weaning approach, the internet is a primary source of information for
complementary feeding (Komninou et al., 2019; San Mauro Martin et al., 2021; Swanepoel et al.,
2020). According to Komninou et al. (2019), 39.3% of all parents identified the internet as their
primary source of information for complementary feeding compared to 22.3% who identified
health professional advice as their primary source. Similarly, San Mauro Martin et al. (2021)
reported that 38.8% of parents following a baby-led weaning approach identified the internet as
their primary source of information compared to 9.3% who identified health professionals as
their primary source. Parents following a baby-led approach demonstrated a preference for
completing their own research regarding complementary feeding (Komninou et al., 2019; San
Mauro Martin et al., 2021; Swanepoel et al., 2020), while conventional weaning parents were
more likely to rely on health professional advice (Komninou et al., 2019; Swanepoel et al.,
2020). Parents following a baby-led weaning approach used the internet, social media, books,
and videos to complete their research (Komninou et al., 2019; San Mauro Martin et al., 2021;
Swanepoel et al., 2020). San Mauro Martin et al. (2021) reported that when parents were
informed about complementary feeding by health professionals, 43.6% of the time they were
informed by nurses and 42.6% of the time by pediatricians. Further, only 11% of parents
reported being recommended to begin complementary feeding with a baby-led weaning approach
in comparison to 44% who were recommended to use a conventional approach. Despite this
recommendation, 78.5% of parents within this study followed a baby-led weaning approach with
at least one of their children.
Overall, the evidence suggests that parents who engage in a baby-led weaning approach
with their children believe it has many benefits for their child and family and the majority of
them would recommend the approach to others. These benefits include infant enjoyment,
independence, socialization, avoiding picky eating, and the convenience of serving family foods.
Although parents using both baby-led weaning and conventional weaning approaches have
concerns regarding the possibility of choking, the evidence suggests that many of those using a
baby-led weaning approach had engaged in prior learning and education about gagging and
choking and were better prepared to manage and respond to these events. Further, the evidence
suggests that baby-led weaning is a more responsive complementary feeding approach that
encourages parents to use less instrumental feeding practices. Finally, the evidence suggests that
the internet is a primary source of complementary feeding information for parents regardless of
the weaning approach used. The evidence suggesting that health care professionals may not be
the primary source of complementary feeding information for parents raises questions regarding
the involvement of health care professionals in the complementary feeding experience.
Health Care Professional Experience
The theme of health care professional experience encompasses the perspectives of health
care professionals regarding a baby-led weaning approach to complementary feeding. Two
studies included in this review explored the experiences of health care professionals (Arantes et
al., 2018; San Mauro Martin et al., 2021).
Arantes et al. (2018) completed a systematic review and concluded that health care
professionals were hesitant to recommend a baby-led weaning approach to parents due to
concerns regarding choking, caloric intake, iron intake, and infants lacking the ability to self-
feed. However, health care professionals acknowledged there were some advantages to a baby-
led weaning approach including sharing meals as a family, promoting healthy eating habits,
stimulating oral development, and decreasing caregiver stress during mealtimes. Overall, Arantes
et al. (2018) acknowledged that the apprehension towards baby-led weaning by health care
professionals resulted from the lack of theoretical-practical evidence available and has impacted
the lack of educational resources and recommendations available for parents.
In contrast, San Mauro Martin et al. (2021) reported that 92.3% of health care
professionals were aware of baby-led weaning, 81.8% of health care professionals had patients
who followed baby-led weaning, and 89.5% of health care professionals recommended baby-led
weaning to parents ‘always’ or ‘sometimes’. According to San Mauro Martin et al. (2021), most
health care professionals believed that baby-led weaning “facilitates the transition to family
feeding, makes it easier for the baby to adapt to new flavours and consistencies, enhances
chewing against sucking and can promote the maturational development of the baby” (p. 4). All
health care professionals disagreed with the idea of infants not gaining enough weight or having
nutrient deficiencies as a result of baby-led weaning. The primary sources of information
regarding baby-led weaning reported by health care professionals were 41.5% courses,
conferences, and professional events; 27.6% the internet; and 15.3% personal learning through
books or scientific articles.
Overall, the evidence suggests that the majority of health care professionals believe there
are benefits to a baby-led weaning approach to complementary feeding. These benefits include
promoting family mealtimes, healthy eating habits, and infant development. However, the
evidence is inconclusive regarding health care professional recommendations regarding a baby-
led weaning approach. Some health care professionals have concerns regarding choking,
inadequate nutrient intake, and infants not having the ability to self-feed. Meanwhile, others who
care for patients and families who engage in a baby-led weaning approach disagree with
concerns about infants not gaining enough weight and having nutrient deficiencies. The
experiences and recommendations of health care professionals have implications on parent and
caregiver education regarding complementary feeding and a baby-led weaning approach that will
be explored further.
Discussion
Summary of Evidence
This scoping review was conducted to provide a knowledge synthesis and systematically
map the emerging evidence surrounding the increasingly popular baby-led weaning approach to
complementary feeding. While adhering to the rigorous methodological standards outlined by the
PRISMA-ScR Checklist (Tricco et al., 2018) and the JBI Manual for Evidence Synthesis (Peters
et al., 2020), this scoping review identified 15 studies that addressed the safety and effectiveness
of a baby-led weaning approach to complementary feeding for infants published between 2010
and 2021. The three qualitative studies, nine quantitative studies, and three systematic reviews
identified in this review demonstrated an emerging worldwide interest in the popular baby-led
weaning approach. Three themes were developed to synthesize the main findings from the
studies included in this review: child experience and outcomes, parent experience, and health
care professional experience. The main findings within these three themes provided sufficient
evidence to address the safety and effectiveness of a baby-led weaning approach to
complementary feeding by addressing the perceived benefits and common concerns relating to
the approach.
Rapley and Murkett (2019) promoted baby-led weaning as an approach to
complementary feeding that has a wide variety of benefits for infants and their families. While
the evidence included in this scoping review addressed many of the perceived benefits advertised
by Rapley and Murkett (2019), the perceived benefits of learning about real food, learning to
trust food, learning to eat safely, making scientific discoveries, and it being easier to eat out were
not addressed. The perceived benefits that have been addressed include infant enjoyment,
improved eating patterns, family mealtimes, better nutrition, improved appetite control,
improved dexterity and coordination, increased confidence, decreased pickiness and mealtime
battles, and easier meal preparation.
The evidence suggests that infants following a baby-led weaning approach are less
demanding of food (Arantes et al., 2018), have lower levels of food fussiness (Komninou et al.,
2019; Utami et al., 2020), have higher food enjoyment (Komninou et al., 2019), and are more
likely to eat the same foods as the family and share family mealtimes (Addessi et al., 2021;
Arantes et al., 2018; Komninou et al., 2019; Utami et al., 2020) than conventional weaning
children during infancy and toddlerhood. Evidence exploring the perspectives of parents who
have engaged in baby-led weaning with their children suggests that the approach allows their
children to avoid picky eating by encouraging them to try and accept different foods and
textures, to develop the ability to sense when they are hungry or full and control their eating, to
become confident and independent feeders, and to socialize into acceptable mealtime behaviours
(Utami et al., 2020). Meanwhile, parents believe that it is more convenient and time efficient to
feed infants the same foods as the family (Swanepoel et al., 2020). Further, both parents (San
Mauro Martin et al., 2021; Utami et al., 2020) and health care professionals (San Mauro Martin
et al., 2021) believe that baby-led weaning promotes the development of infant gross and fine
motor skills, while family-food feeding is significantly associated with sitting unsupported at an
earlier age and low spoon-feeding is significantly associated with crawling at an earlier age
(Addessi et al., 2021).
The most common concerns regarding a baby-led weaning approach are that infants may
have insufficient food intake, low iron intake, and an increased risk of choking (Anderson et al.,
2020; Rapley, 2011). All three of these concerns have been addressed by the evidence included
within this scoping review. Overall, the evidence suggests there is no association between a
baby-led weaning approach to complementary feeding and an insufficient food intake, lower iron
intake, or increased risk of choking. The evidence suggests that both a baby-led weaning
approach and a conventional weaning approach to complementary feeding provide nutritionally
adequate diets (Alpers et al., 2019; Daniels, Taylor, Williams, Gibson, Fleming et al., 2018;
Daniels, Taylor, Williams, Gibson, Samman et al., 2018; Rowan et al., 2019; Williams Erickson
et al., 2018). Notably, evidence suggests there is no significant difference in median dietary iron
intakes (Daniels, Taylor, Williams, Gibson, Fleming et al., 2018), no significant difference in
exposure to iron-containing foods (Rowan et al., 2019), and no significant difference in plasma
ferritin concentration or the prevalence of depleted iron stores, early functional iron deficiency,
or iron deficiency anemia (Daniels, Taylor, Williams, Gibson, Fleming et al., 2018) between
baby-led and conventional weaning groups of infants. However, the evidence does indicate
concern regarding the prevalence of inadequate iron intakes (Alpers et al., 2019; Daniels, Taylor,
Williams, Gibson, Fleming et al., 2018) and excessive sodium and sugar intakes (Alpers et al.,
2019; Williams Erickson et al., 2018) among both baby-led and conventional weaning groups of
infants.
In addition, the evidence explored both parent and health care professional beliefs
regarding the nutritional adequacy of a baby-led weaning approach. While parents did not
believe in nor have any concerns regarding nutritional inadequacy (San Mauro Martin et al.,
2021; Utami et al., 2020) or lower weight gain (San Mauro Martin et al., 2021) as a result of
baby-led weaning, there was conflicting evidence among health care professionals. While some
health care professionals were hesitant to recommend baby-led weaning due to concerns
regarding inadequate caloric intake (Arantes et al., 2018), others disagreed with the idea of
infants having nutrient deficiencies or not gaining enough weight as a result of baby-led weaning
(San Mauro Martin et al., 2021).
The evidence within this scoping review suggests that there is no increased risk of
choking associated with a baby-led weaning approach to complementary feeding as there is no
significant difference in the number of choking episodes between baby-led and conventional
weaning groups of infants (Arantes et al., 2018; D’Auria et al., 2018). Although parents using
both baby-led weaning and conventional weaning approaches express concerns relating to
choking (Arantes et al., 2018; Swanepoel et al., 2020; Utami et al., 2020), both groups of parents
report an increase in trust in their infant’s ability to consume food safely over time (Swanepoel et
al., 2020). Importantly, evidence suggests that parents who have engaged in prior learning and
education regarding gagging and choking feel better prepared to manage, and have enhanced
responses to, gagging and choking episodes (Utami et al., 2020).
In addition to addressing the perceived benefits and common concerns of a baby-led
weaning approach to complementary feeding, the evidence included in this scoping review
explores parental sources of information and health care professional recommendations for
complementary feeding. The most significant finding in this regard is that regardless of whether
parents are using a baby-led or conventional weaning approach, the internet is a primary source
of information for complementary feeding (Komninou et al., 2019; San Mauro Martin et al.,
2021; Swanepoel et al., 2020). Further, parents using a baby-led weaning approach have
demonstrated a preference for conducting their own research (Komninou et al., 2019; San Mauro
Martin et al., 2021; Swanepoel et al., 2020), while parents using conventional weaning are more
likely to seek health care professional advice regarding complementary feeding (Komninou et
al., 2019; Swanepoel et al., 2020). San Mauro Martin et al. (2021) provided further evidence of a
disconnect between parents using a baby-led weaning approach and health care professionals.
Despite only 11% of the parents in their study being recommended by health care professionals
to begin complementary feeding with a baby-led weaning approach, 78.5% of them used a baby-
led weaning approach with at least one of their children.
Interestingly, the only two sources of evidence included in this review that addressed
health care professional recommendations regarding a baby-led weaning approach to
complementary feeding present polarizing findings. While Arantes et al. (2018) completed a
systematic review and concluded that health care professionals were hesitant to recommend a
baby-led weaning approach due to concerns regarding caloric intake, iron intake, and infants
lacking the ability to self-feed, San Mauro Martin et al. (2021) reported that 89.5% of health care
professionals within their study recommended a baby-led weaning approach to parents. The
rationale behind these polarizing recommendations is unclear and could be the result of
numerous factors. However, Arantes et al. (2018) acknowledged that health care professionals’
hesitation was the result of a lack of available evidence. Therefore, the emergence of evidence
regarding a baby-led weaning approach between the data collection for Arantes et al. (2018) in
2016 and San Mauro Martin et al. (2021) in 2020 may provide an explanation for these
polarizing recommendations from health care professionals. Additionally, Arantes et al. (2018)
acknowledged that the lack of available evidence regarding a baby-led weaning approach has
impacted the lack of educational resources and recommendations developed by health care
professionals for parents. This is an important consideration when reflecting on the implications
that this scoping review has for health care professionals, education, and research.
Implications
This scoping review and the resulting knowledge synthesis of the emerging evidence
regarding a baby-led weaning approach to complementary feeding has implications for health
care professionals, education, and research.
Implications for Health Care Professionals
The findings of this scoping review support baby-led weaning as a safe and effective
approach to the complementary feeding of infants that is prevalent with parents around the
world. Therefore, health care professionals must develop sufficient awareness and gain adequate
knowledge regarding this approach to complementary feeding to provide evidence-based
support, guidance, and education to parents and caregivers. In addition to reviewing the main
findings of this scoping review, health care professionals are encouraged to explore the key
resources for baby-led weaning included in Table 6. Specifically, health care professionals
should be sure to review the following infant feeding recommendations and guidelines designed
for health care professionals that integrate principles of a baby-led weaning approach to
complementary feeding: Nutrition for Healthy Term Infants: Recommendations from Six to 24
Months (Health Canada, Canadian Paediatric Society, Dietitians of Canada, & Breastfeeding
Committee for Canada, 2014) and Pediatric Nutrition Guidelines (Six Months to Six Years): For
Health Professionals (Provincial Health Services Authority, 2016). Health care professionals are
encouraged to have an understanding that regardless of whether or not they recommend it, many
parents and caregivers are likely to continue to use a baby-led weaning approach. Therefore,
health care professionals are encouraged to develop evidence-based baby-led weaning resources
that are designed for and accessible to parents and caregivers.

Table 6
Baby-Led Weaning Key Resources
Reference Title Link

HealthLinkBC Finger Foods for Babies 6-12 Months https://www.healthlinkbc.ca/health
(2014) y-eating/finger-foods-baby-6-12-
month
Health Canada et al. Nutrition for healthy term infants: https://www.canada.ca/en/health-

(2014) Recommendations from six to 24 canada/services/canada-food-
months guide/resources/infant-
feeding/nutrition-healthy-term-
infants-recommendations-birth-six-
months/6-24-months.html
Provincial Health Pediatric nutrition guidelines (six https://www.health.gov.bc.ca/librar

Services Authority months to six years): For health y/publications/year/ 2017/pediatric-
(2016) professionals nutrition-guidelines.pdf
Provincial Health Baby’s best chance: Parents’ handbook https://www.health.gov.bc.ca/librar

Services Authority of pregnancy and baby care (7th ed.) y/publications/year/2019/BBC-7th-
(2019) edition-FINAL-Nov2019.pdf
Rapley (2008) Baby-Led Weaning: The fuss-free way http://www.rapleyweaning.com/ind

to introduce solid foods ex.php
Rapley (2011) Baby-led weaning: Transitioning to https://www.proquest.com/docview

solid foods at the baby’s own pace /871227994?pq-
origsite=gscholar&fromopenview=t
rue
Rapley (2015) Baby-led weaning: The theory and https://www.magonlinelibrary.com/

evidence behind the approach doi/abs/10.12968/johv.2015.3.3.14
4
Rapley (2018) Baby-led weaning: Where are we now? https://onlinelibrary.wiley.com/doi/

10.1111/nbu.12338
Rapley & Murkett Baby-led weaning: The essential guide -

(2019) how to introduce solid foods and help
your baby to grow up a happy and
confident eater (10th ed.)
Solid Starts (2021) Solid Starts https://solidstarts.com/

Implications for Education
The findings of this scoping review suggest that health care professional advice is no
longer the primary source of information for many parents regarding the complementary feeding
of infants. Parents, especially those who engage in a baby-led weaning approach with their
children, are more likely to source information from the internet than they are from health care
professionals (Komninou et al., 2019; San Mauro Martin et al., 2021; Swanepoel et al., 2020).
While the evidence has not yet identified why parents are more likely to source information from
the internet rather than health care professionals, potential reasoning includes a lack of health
care professional advice and resources, a lack of health care professional knowledge regarding
current complementary feeding practices, and parental experiences of disapproval from health
care professionals regarding their complementary feeding practices. Regardless, if health care
professionals strive to continue providing current and evidence-based complementary feeding
education to parents and caregivers then they must develop resources that include a baby-led
weaning approach that are made easily accessible. Considering the preference for internet-based
sources of information demonstrated by parents, it is recommended that educational resources
developed by health care professionals be made accessible online. Further, evidence suggests
that complementary feeding education should promote a high-iron diet and include information
regarding the management of gagging and choking. Health care professionals are encouraged to
share the key resources for baby-led weaning included in Table 6 with parents and caregivers
who may be interested in the approach.
Implications for Research
This scoping review identified and synthesized the emerging evidence base regarding the
safety and effectiveness of a baby-led weaning approach to complementary feeding. The 15

studies included in this review demonstrated a variety of research designs, populations, and
outcomes among baby-led weaning research. However, the conduction of further high-quality
research including prospective cohort studies, longitudinal studies, and randomized control trials
is recommended for strengthening the evidence base surrounding a baby-led weaning approach.
Further research exploring additional outcomes such as obesity prevention, parental anxiety, and
food allergies is recommended. Finally, a consistent, comprehensive, and realistic definition for a
baby-led weaning approach to complementary feeding must be standardized in future research.
Limitations
Although this scoping review was conducted in adherence with the rigorous
methodological standards outlined by the PRISMA-ScR Checklist (Tricco et al., 2018) and the
JBI Manual for Evidence Synthesis (Peters et al., 2020), a few key limitations require disclosure.
Due to the time and resource constraints associated with a Scholarly Practice Advancement
Research (SPAR) project, this scoping review was limited to a systematic search in three
databases, limited to publication dates between January 2010 and June 2021, and did not include
the critical appraisal of individual sources of evidence.
Conclusion
This scoping review was conducted to provide a knowledge synthesis of the emerging
evidence surrounding the popular baby-led weaning approach to complementary feeding. The
evidence included within this review suggests that a baby-led weaning approach to
complementary feeding is a safe and effective method for introducing solid foods to infants.
While providing support for many of the perceived benefits of a baby-led weaning approach, the
evidence does not provide support for the most common concerns regarding the approach. Three
themes were developed to synthesize and present the main findings of the review: child
experience and outcomes, parent experience, and health care professional experience. The
findings of this scoping review have important implications for health care professionals,
education, and research.

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Anderson, L. N., Van den Heuvel, M., Omand, J. A., & Wong, P. D. (2020). Practical tips for
paediatricians: Baby-led weaning. Paediatrics & Child Health, 25(2), 77-78.
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Arantes, A. L. A., Neves, F. S., Campos, A. A. L., & Netto, M. P. (2018). The baby-led weaning
method (BLW) in the context of complementary feeding: A review. Revista Paulista de
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Taylor, B. J., Haszard, J. J., & Heath, A. M. (2018). Impact of a modified version of
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BABY-LED WEANING: A SCOPING REVIEW 1

BABY-LED WEANING: A SCOPING REVIEW

ERIN ELIZABETH DEVLIN

BHK, The University of British Columbia, 2011

BSN, The University of British Columbia, 2013

A SCHOLARLY PRACTICE ADVANCEMENT RESEARCH (SPAR) PROJECT

SUBMITTED IN PARTIAL FULFILLMENT OF THE REQUIREMENTS FOR THE DEGREE

MASTER OF SCIENCE IN NURSING

THE FACULTY OF GRADUATE AND POSTDOCTORAL STUDIES

THE UNIVERSITY OF BRITISH COLUMBIA

I would like to extend my gratitude and appreciation to my supervisor Dr. Maura

love you, Beau.

Background: Baby-led weaning is an approach to the complementary feeding of infants

due to a lack of knowledge and concerns of choking and inadequate intake.

knowledge of baby-led weaning among health care professionals.

Literature (CINAHL), Ovid EMBASE, and Ovid MEDLINE.

health care professional experience.

Eligibility Criteria ……………………………………………………………………… 12

Information Sources & Search …………………………………………………………. 13

Selection of Sources of Evidence ……………………………………………………… 14

Data Charting Process …………………………………………………………………. 15

Selection of Sources of Evidence ……………………………………………………… 16

Characteristics and Results of Sources of Evidence …………………………………… 18

Child Experience and Outcomes………………………………………………………... 31

Parent Experience ……………………………………………………………………… 36

Health Care Professional Experience ………………………………………………….. 42

Summary of Evidence …………………………………………………………………. 44

approaches to the complementary feeding of infants, conventional weaning and baby-led

Google (n.d.) and 1.4 million hashtags on Instagram (n.d.).

believed benefits of using a baby-led weaning approach to introduce complementary foods

(Anderson et al., 2020; Rapley & Murkett, 2019).

(Anderson et al., 2020; Rapley, 2011).

critically important role in the education of parents surrounding infant feeding.

knowledge regarding the approach.

infants from 6 months of age?

In order to be included in the scoping review, articles had to be primary studies,

Information Sources & Search

executed by the author and subsequently approved by the reference librarian.

CINAHL Search (June 24, 2021 at 1200)

Search ID Search terms Limitations Results

Search ID Search terms Limitations Results

Selection of Sources of Evidence

eligibility criteria yet were already incorporated in an included systematic review.

Data Charting Process

type, methodology, objective, population, baby-led weaning definition, comparison, intervention,

supplementary file upon request to the author.

Selection of Sources of Evidence

The PRISMA-ScR Flow Diagram in Figure 1 provides an overview of the flow of

considered eligible for inclusion within this scoping review.

PRISMA-ScR Flow Diagram

Identification of Studies via Databases

Records identified through

Full text reports assessed for Full text reports excluded

(n = 66) • Grey literature (n = 22)

Studies included in the scoping

Characteristics and Results of Sources of Evidence

Characteristics of Sources of Evidence

Reference/ Study design/ Data Population Comparison Definition of BLW

Williams Quantitative: Randomized 206 women in BLISS BLISS: General principles

Arantes et al. Systematic Review: 13 Mothers of BLW vs. Not specified

Reference/ Study design/ Data Population Comparison Definition of BLW

Reference/ Study design/ Data Population Comparison Definition of BLW

Utami et al. Qualitative: Descriptive 13 mothers of Not specified, women self-