choking, baby, blw, baby led weaning, baby food

Choking and Baby Led Weaning

Choking and Baby Led Weaning (BLW): What does the most recent research say?

 

 

Last week during one of my webinars about BLW, a registered dietitian harshly interrupted me to voice her concerns about choking. She told me that what I’m saying is very scary and I should take my videos down. She said that my babies are cute and all but I should temper my enthusiasm about BLW. I’m sure this dietitian isn’t the only one to be scared about choking. That’s why I wrote up this blog post that addresses why babies who do BLW safely are not more at risk of choking compared to babies who eat jarred baby food, using the most recent research. I would like to thank Gill Rapley and dietetics intern Natalie Quathamer for their support and assistance in addressing this.

 

Choking: the main concern

When it comes to Baby Led Weaning, both parents and healthcare professionals find the risk of choking as a major concern. This is a very fair concern, as a baby’s first bite is a brand new experience of mastering chewing, swallowing and breathing all together for the first time, putting them at an overall higher risk of choking. To help quantify the current state of the issue, more than 12,000 children from age 0-14 have a non-fatal choking incident attributable to food in the US each year, as found by Chapin et al. in 2013 (1). No parent wants their child to choke, and as a professional it is your duty to protect the wellbeing of your clients. Unsurprisingly, choking is reported again and again as the #1 fear with regards to BLW in studies such as that by D’Andrea et al. in 2016 (2). That’s why I will spend a considerable amount of time addressing this very warranted concern.

 

What’s my objective with this post?

The goal here today is to focus on making you feel more comfortable with the fact that BLW babies are not more at risk of choking than babies fed with traditional spoon-fed approaches, using the most recent science.

 

What about baby’s motor skills?

First, let’s take a look at the average feeding timeline for a baby, to better understand the physiology of feeding. As many seminal studies, such as that by Woolridge in 1986 (3) have seen, at birth babies are able to feed themselves on their own. Physiologically, they have the innate reflex to suckle at the breast. Babies know when to feed, how to feed, when to stop and at what pace. Once they hit 1 ½ or 2 years old, we can again assume that most babies can feed themselves without help. This leaves a gap, starting at around six months, where we assume we have to feed babies with a spoon. However, babies do not lose their ability to self-regulate on when to feed, when to stop and at what pace, but are simply developing new physiological traits that change how and what they eat. These motor skill changes that develop around 6 months, like coordinating the grabbing and bringing of big objects like toys to their mouth and being able to sit upright with minimal help, make self-feeding a reasonable endeavour for most healthy infants at this time, as indicated in a literature review done by Cameron, Heath and Taylor in 2012 (4).

 

Traditionally speaking, we don’t tend to respect these new developmental milestones which can be a problem. Babies are then subject to being fed, at someone else’s pace and on someone else’s schedule, which has the power to lead to unexpected bites, overconsumption and a more stressful feeding environment.

 

What about oral motor skills?

So babies can maintain the correct position and bring food to their mouth, but what about oral motor skills? Well in their 2017 study, Cameron, Heath and Taylor (4) continue by noting that infants are able to handle foods that are soft in texture at 6 months by “munching” which is using up and down jaw movements to mash the food and eventually form a bolus. With this linear practice of munching, biting and chewing with age, babies get to apply and tweak their oral motor skills as they come in, rather than waiting in a spoon-feeding approach. This may have the power to prevent possible feeding difficulties in the future as well as choking episodes, since they have already developed, tested and fine-tuned their skills.

 

The gag reflex

I want to touch briefly on gagging, the protective reflex that helps prevent choking. Babies at six months of age have a gag reflex that is triggered at a much more frontal place in their mouth, as indicated by Rapley in 2011 (5). A possible benefit of BLW is that since only large pieces of food are offered at a time when the gag reflex is at the front of the mouth, this may help keep only well-masticated food to the back. It is important to note that BLW babies may gag more than their spoon-fed counterparts, as seen in the BLISS study by Taylor et.al in 2017 (6). However, by 8 months of age when these babies had a better grasp on self-feeding, they began to gag less than the control group.

 

Safety of jarred foods

Another consideration is the question of whether purees themselves are easy to eat, particularly once the ability to chew has developed. As noted in the thesis by Delaney in 2010 (7), for babies who can chew, purees are actually not that easy to manage, as the puree spreads throughout the mouth with chewing action and is very difficult to gather in a bolus.

 

What does the most recent science say?

Let’s finally get down to the nitty-gritty: what exactly does the newest science have to say specifically about BLW and choking risk? The best evidence to refute the idea that BLW leads to a higher choking risk is again the ongoing BLISS study by Taylor et.al in 2017 (6). This was a 2 year long Randomized Control Trial (RCT), where a control group of spoon fed babies were compared with a group of babies fed using the BLISS method, which is a combination of regular BLW techniques with extra instruction (such as choking prevention and offering high iron foods). Overall, the study found that that there was no difference in the number of babies who choked between the groups. Not only that, but it found no evidence of growth faltering or risk of iron deficiency in BLISS babies.

 

Another RCT by Fangupo et.al in 2016 (8) also showed that infants are not more at risk of choking following a BLW approach than spoon-fed. Better though still, is an editorial in the journal JAMA pediatrics, by Lakshman, Clifton and Ong in 2017 (9). This study pronounces BLW as a safe and effective intervention; no difference in energy intake, growth faltering or iron deficiency were noted, and no more choking incidents than in traditional spoon feeding. They even go so far as to suggest it may be recommended. It is important as purveyors of accurate science to look at all sides of the research. Another study from New Zealand by Morison et.al in 2016 (10), did indicate a possibly higher choking risk with a BLW-style approach. However, this study did not adequately define BLW; parents simply chose if they thought themselves to belong in the BLW group or the traditional feeding group, making the results difficult to state in a conclusive manner. An important take-away from this study was that education regarding inappropriate foods for infants, whether doing BLW or spoon-feeding, continues to be low. This further promotes the role of the dietitian during the infant feeding process, regardless of the approach.

 

What is the takeaway?

In summary, we need to remember that choking is a multifactorial issue; posture, chewing abilities, and distractions all need to be accounted for. However, with a dietitian-led BLW approach, babies are focused on their food, able to eat at their own pace, are under no pressure and most importantly, are not at a higher risk of choking than with purees.

 

How can we make sure BLW is being done safely?

  1. Make sure the baby is sitting upright while eating (none of those lying back bouncy chairs or high chairs that aren’t at 90˚).
  2. Limit distractions: no TV, IPad, cell phone or big crowds for the first few weeks so baby is not overwhelmed and can focus
  3. Make sure the baby is ready to feed him/herself on their own. Don’t start too early
  4. Do not feed the baby by putting foods into their mouth. You can lodge the food further down and actually cause choking by doing this
  5. Offer appropriate foods that they can easily grab and are soft enough to handle.
  6. Sign up for my BLW Online Course today or sign up to an in-person BLW workshop given by a member of my International Baby Led Weaning Network of Registered Dietitians.

References

  1. Chapin, M. M., et al. (2013). “Nonfatal Choking on Food Among Children 14 Years or Younger in the United States, 2001–2009.” Pediatrics 132(2): 275-281.
  2. D’Andrea, E, KIELYN JENKINS, MARIA MATHEWS, BARBARA ROEBOTHAN (2016). Baby-led Weaning: A Preliminary Investigation. Canadian Journal of Dietetic Practice and Research
  3. Woolridge, M. W. (1986). “The ‘anatomy’ of infant sucking.” Midwifery 2(4): 164-171.
  4. Cameron, S. L., Heath, A-L. M., & Taylor, R. W. (2012). Healthcare professionals’ and mothers’ knowledge of, attitudes to and experiences with, Baby-Led Weaning: a content analysis study. BMJ Open, 2 (6), 1-9. doi:10.1136/bmjopen-2012001542
  5. Rapley, G. (2011). Transitioning to solid foods at the baby’s own pace. Community Practitioner, Jun;84(6):20-3.
  6. Taylor, R.W., Williams, S.M., Fangupo, L.J., Wheeler, B.J., Daniels, L., Fleming, E.A., McArthur, J., Morison, B., Erickson, L.W., Davies, R.S., Bacchus, S., Cameron, S.L. and Heath, A-L. M. (2017) ‘Effect of a baby-led approach to complementary feeding on infant growth and overweight: A randomised clinical trial’, JAMA Pediatrics, 171(9): 838-846.
  7. Delaney, A.L. (2010) Oral-motor Movement Patterns in Feeding Development. Ph.D. (Communicative Disorders). University of Wisconsin-Madison.
  8. Fangupo, L. J., Heath, A-L. M., Williams, S. M., Erickson, L. W., Morison, B. J., Fleming, E. A.,…Taylor, R. W. (2016). A Baby-Led Approach to Eating Solids and Risk of Choking. Pediatrics, 138 (4), 1-8. doi:10.1542/peds.2016-0772
  9. Lakshman, R.; Clifton, E.A. and Ong, K.K. (2017) ‘Baby-led weaning – safe and effective but not preventive of obesity’, JAMA Pediatrics, 171(9): 832-833
  10. Morison, B. J., Taylor, R. W., Haszard, J. J., Schramm, C. J., Erickson, L. W., Fangupo L. J.,…Heath, A-L. M. (2016). How different are baby-led weaning and conventional complementary feeding? A cross-sectional study of infants aged 6–8 months. BMJ Open, 6 (5), 1-11. doi:10.1136/bmjopen-2015010665
asparagus, barbecue, babies, baby, blw, baby led weaning, whole foods, bbq

Can babies eat foods grilled on the barbecue?

Can babies eat foods grilled on the barbecue?

 

It’s getting hot outside and it’s time to light the barbecue. You might be wondering if babies can eat food grilled on the barbecue. The question is: are barbecuing and Baby Led Weaning (BLW) compatible?

 

The answer is yes, starting at around 6 months old. You do want to make sure you do it safely (as with everything else) because research shows that cooking meat, poultry and fish at high temperatures may increase you and your baby’s risk of cancer.

 

Here are a few tips from the cancer.ca website:

 

  • Marinate meat, poultry and fish before cooking. Studies have shown that marinating these foods can prevent the formation of cancer-causing chemicals.
  • When barbecuing, choose lean cuts of meat, poultry and seafood over higher-fat meats. Trim off visible fat. This will reduce the amount of harmful chemicals that develop from the smoke created by burning fat.
  • Barbecue slowly and keep the food away from the hot coals so that flames are less likely to engulf the food to prevent charring.
  • Try grilling vegetables, veggie burgers and fruit slices. Most experts agree that plant-based foods do not form the cancer-causing substances when cooked at high heat.

 

Foods grilled on the barbecue are great for babies because they maintain their shape yet babies can easily bite into them. Asparagus are delicious this time of year. Why not try barbecued asparagus? Here is a 6-month old enjoying asparagus on the barbecue:

 

asparagus, barbecue, babies, baby, blw, baby led weaning, whole foods, bbq

 

Even grilled mushrooms are totally appropriate for babies:

 

asparagus, barbecue, babies, baby, blw, baby led weaning, whole foods, bbq, whole foods for babies, whole foods, finger foods, summer foods, recipes, baby recipes, baby food

 

If your baby just sucks on a strip of meat without actually eating any, he or she is still getting some iron. It could also occupy a baby for quite some time!

 

Here are some free barbecue recipes that you can try for your baby:

 

Chicken satay with creamy peanut sauce (includes a cooking demo video)

 

gluten free, no bovine protein, dairy free, chicken, baby, blw, baby led weaning, barbecue recipes, summer recipes, paleo, soy free, egg free, no salt added, baby recipes, iron, real food

 

Simple burgers for babies (feel free to cook these on the barbecue)

 

blw, baby led weaning, veal, beef, beef recipe, beef recipe baby, burger recipe, iron baby, jessica coll, baby solids, choking baby

 

Grilled lamb chops for babies

 

lamb chops blw Baby led weaning

 

Minty Lamb Meatballs

 

The mouthwatering final product! BLW

 

For more Baby Led Weaning (BLW) recipes for babies, GET YOUR FREE COOKBOOK FOR BABIES HERE.

 

What will you grill on the barbecue this weekend?

sauerkraut, baby, fermented foods, tout cru, tout cru fermentation, fermented veggies, lacto-fermented foods, benefits, blw, baby led weaning, real foods, digestion

Why you should give sauerkraut to your baby

What’s with all the hype around lacto-fermented vegetables like sauerkraut? What are they, why should your baby eat them and where can you find them?

 

What are lacto-fermented vegetables?

 

Lacto-fermented vegetables (or simply “fermented veggies”) include foods like sauerkraut, pickles and pickled seasonal vegetables. They contain a healthy dose of gut-friendly bacteria, also known as probiotics. Regular consumption of these good bacteria is beneficial to your baby’s health.

 

Why are fermented vegetables good for babies?

 

Fermented vegetables help with digestion and provide a healthy boost to the immune system, improving all-around gut function [1]. Foods like sauerkraut and fermented vegetables have even been shown to reduce the risk of some cancers [1]. For babies in particular, fermented foods might be beneficial in helping with digestive issues like constipation, diarrhea, or gas [2].

 

Aren’t fermented vegetables too salty for babies?

 

While fermented veggies like sauerkraut offer a wide range of health benefits to your baby, it’s important to keep in mind that they’re quite salty. While sodium is a required nutrient for babies, too much of it is not a good thing. Keeping this in mind, if you’re offering small amounts of fermented foods to your baby – like 1 pickled carrot spear, or 1 tablespoon of sauerkraut – the benefits of including them in your baby’s diet is worth the extra salt.  

 

Here is a six-month old enjoying a fistful of sauerkraut:

 

sauerkraut, baby, fermented foods, tout cru, tout cru fermentation, fermented veggies, lacto-fermented foods, benefits, blw, baby led weaning, real foods, digestion

 

Here she is chomping down on a fermented carrot. It’s the perfect texture for her where she can easily grab it and it’s soft enough to take bites from:

 

sauerkraut, baby, fermented foods, tout cru, tout cru fermentation, fermented veggies, lacto-fermented foods, benefits, blw, baby led weaning, real foods, digestion

 

Here she is about to enjoy lacto-fermented turnips (right) and sauerkraut (left):

 

sauerkraut, baby, fermented foods, tout cru, tout cru fermentation, fermented veggies, lacto-fermented foods, benefits, blw, baby led weaning, real foods, digestion

 

Where can I find fermented vegetables?

 

One of my favorite store-bought brands of fermented foods is Tout Cru. They are a Montreal-based company that I absolutely love. I really believe in Pedro and Rachel’s mission. They make a wide range of fermented foods including kimchi, sauerkraut and seasonal fermented vegetables which are all so delicious. Check out their website to find out where you can purchase some near you! 

 

References:

  1. Parvez S, Malik KA, Ah Kang S, Kim HY. Probiotics and their fermented food products are beneficial for health. Journal of applied microbiology. 2006 Jun 1;100(6):1171-85.
  2. Marchand V. Using probiotics in the paediatric population. Paediatrics & child health. 2012 Dec;17(10):575.

 

Have you ever given sauerkraut to your baby?

 

 

time saving, kitchen, recipe, blw, baby led weaning, baby, babies, time saving tricks

5 best kitchen time-saving tricks

Especially with kids, we’re always looking for time-saving tricks in the kitchen. We want to spend more time with the children and less time cooking. Today I’m sharing my 5 favorite tricks to save time in the kitchen!

 

1- Plan 2 hours weekly in the kitchen without (any) distractions

 

Doesn’t it sounds like a dream to have 2 hours undisturbed in the kitchen? I know. The thing is, this is what can make the biggest difference. No kids, no babies, no phone, no screens, no social media. Just you and the food in your kitchen. When you’re focused on one task, you are much more productive and can get done faster than trying to cook for 10 minutes here and there. Don’t hesitate to ask your partner, friend or family member to have fun with your child(ren) so you can have your weekly two hours. For me, this made the biggest difference. It’s ma favourite time saving trick in the kitchen!

 

2) Plan meals that are appropriate for all family members

 

A meal for 3 year old Leo, homemade puree for baby Sara and a steak, rice and roasted veggies for the parents? That’s way too much work. If you plan appropriately, everyone can eat the same meals. This will save you lots of time. If you haven’t heard about Baby Led Weaning (BLW) yet (where babies skip the puree stage and eat finger foods from their first bite), check out my BLW Online Course. In the course, I share more than 30 recipes that are appropriate for your whole family, even babies! Tons more time saving tricks are included in the course.

 

blw, baby led weaning, jessica coll, baby, babies, baby food, time saving tricks

 

I also have a brand new Baby Led Weaning eBook with more than 45 recipes for babies 6 months and more. You’ll find spinach soufflés, mini lamb burgers, garlicky chicken drumsticks, coconut shrimp bites (to die for!) and salmon sliders. Check out my brand new BLW eBook HERE (only 10$).

 

recipe book, book, recipe, recipes, blw, time saving tricks, baby led weaning, ebook, ibook, jessica coll, baby

 

3) Batch cook

 

What’s batch cooking? Basically, it’s making large quantities of food at one time. You can either keep the leftovers for lunches over the next few days or freeze them to eat within the next 3 months. Meals cooked in a slow cooker like soups and spaghetti sauces can easily be doubled or tripled. Most meals taste better the next day anyway!

 

4) Have ready-to-eat foods ready

 

I’m talking about hard boiled eggs, cooked sweet potatoes, cooked ground meat, cooked rice and roasted vegetables always available and ready to go. This makes it easier to whip up a meal when you have less time. Also, it makes it easy to grab something healthy on the go!

 

5) Buy some minimal prep foods

 

Frozen vegetables, washed and packaged leafy greens, canned salmon, pre-made guacamole, marinated meats and cut up fruit and vegetables can be so practical. Don’t feel like you need to make everything from scratch. These can be huge time-savers!

 

I hope these kitchen time-saving tricks were helpful.

How do you save time in the kitchen?

best high chair, high chair

How to choose the best high chair?

How to choose the best high chair?

 

A high chair isn’t absolutely necessary when introducing complementary foods to babies but it can certainly be practical. I decided to ask Catherine Cusson, an occupational therapist to help guide us.

 

What are the top 3 criteria to look for when shopping for a high chair?

 

1) The high chair must place baby in a 90 degree angle in between his/her back and hips

 

Therefore we want to avoid all high chairs that slightly recline backwards like this one:

 

best high chair, high chair, baby, blw

 

A high chair with foot support is much more comfortable for babies and ensures a better position. We love the Trip Trap chair by Stokke which can be used from starting solids all the way throughout childhood.

 

best high chair, high chair, baby, jessica coll, blw

 

2) It must have good back support

 

We want to choose a high chair with a seatback that’s higher than the top of the baby’s head. We want to avoid choosing booster seats like this one with a low seatback:

 

bumbo, baby led weaning, best high chair, high chair

 

3) It must allow baby to have a 90 degree angle for his/her forearms

 

This way, your baby will have easier access to his/her foods on the tray. We want to avoid choosing high chairs with a tray that’s too high like this one:

 

 

best high chair, high chair, blw, baby

 

Our favourite high chair is The Trip Trap chair by Stokke.

 

Why we love it:

 

  • 90 angle in between your baby’s back and hips
  • Great back support with a high enough seatback
  • 90 angle for your baby’s forearms so easy access to food
  • Removable tray so you can bring your baby directly at the table to eat
  • Made in wood so easy to clean
  • It’s beautiful and available in a large variety of colors
  • Great for babies just starting out to eat until they are much older
  • Excellent foot support so ensures an optimal position and is comfortable for your baby

 

What’s the drawback?

 

  • It’s expensive at around 329$ without accessories

 

If you want to buy this chair, feel free to use the following link: The Trip Trap chair by Stokke.

What high chair do you have? Is your baby in the right position?

blw, kiwi, baby led weaning, jessica coll, dietitian

Why is BLW not for all babies?

Why is BLW not for all babies?  

 

To add to the information about BLW (Baby Led Weaning: what is it?) I share online, I decided to ask this question to Catherine Cusson, occupational therapist specializing in pediatrics from Clinique Pas à Pas. She is the newest collaborator to my BLW Network.

 

blw, baby led weaning, occupational therapist, registered dietitian, rd, baby, babies

 

Jessica Coll, registered dietitian: Welcome Catherine!

 

Catherine Cusson, occupational therapist: Thank you for having me!

 

Jessica Coll, registered dietitian: I often get the following question: Is Baby Led Weaning (BLW) appropriate for all babies?

 

Catherine Cusson, occupational therapist: The short answer is NO, it’s not appropriate for all babies. We know that we only recommend starting BLW around the age of 6 months, when your baby can maintain a sitting position on the floor and can bring food to his/her mouth. In order to proceed with BLW as an approach to introducing solids, your baby needs to have good motor and sensory development. Therefore, if there is a development delay or a particular condition, I recommend asking your doctor, occupational therapist or physical therapist beforehand.

 

Jessica Coll, registered dietitian: So what kinds of conditions prevent babies from starting BLW at around 6 months old?

 

Catherine Cusson, occupational therapist: Here is a list of conditions that might prevent babies from doing BLW at around 6 months of age:

 

  • Babies born at 36 weeks of gestation or less
  • Babies with developmental delays
  • Hypotonic babies (How do you recognize this? Your baby would constantly have his/her mouth open, stick his/her tongue out and would not be able to control his/her saliva)
  • Babies diagnosed with a genetic syndrome
  • Babies with a cleft lip or a tongue tie

 

Jessica Coll, registered dietitian: Why is it important for babies to maintain a sitting position before starting BLW?

 

Catherine Cusson, occupational therapist: The sitting position is necessary before starting solids for two reasons:

 

  • First, a good sitting position allows your baby to spit out a food after a gag reflex. This helps to prevent choking.
  • Also, the trunk stability is necessary for the development of your baby’s chewing skills.

 

Jessica Coll, registered dietitian: That’s great information. Thank you Catherine!

 

To find out more about Catherine Cusson and her services, feel free to visit her website.

 

blw, occupational therapist, dietitian, physical therapist

 

 

numnum, baby led weaning, blw, spoon

3 reasons to let baby feed him/herself

Starting at around 6 months old, your baby learns to feed him/herself. Learn more about baby led weaning (BLW).  Don’t expect your baby to ingest large amounts of food for the first few weeks (or even months for some) because babies need time to learn before they master BLW. Just like learning to walk, your baby needs to practice.

So how does it work? Your baby’s reflexes develop one after the other when starting out with BLW. Here’s the progression when introducing solid food to your baby:

  • Grab and bring to mouth: 6-month olds put everything in their mouth! When you offer a piece of food to your baby, he/she should be able to grab it and bring it to his/her mouth.
  • Bite: soon enough your baby will learn to bite off a piece of food.
  • Chew: your baby will chew the food. The ability to chew develops before he/she is able to bring food to the back of his/her mouth for swallowing. This is why you’ll notice food falling out of the baby’s mouth in the early stages. Leave them time.
  • Swallow: the final step is swallowing. Since birth your baby has been sucking to feed so it’s normal that they will try to suck the food first. Give them some time and he/she will figure out that food needs to be swallowed.

Here are the 3 reasons to let your baby feed him/herself:

Reason #1: To decrease his/her risk of choking.

If you decide to feed your baby because you’re worried he isn’t eating enough when doing BLW, you are interfering with the development of the reflexes listed above. This means that he/she might be more at risk of choking.

Reason #2: So your baby is in tune with his/her fullness cues.streaming xXx: Return of Xander Cage 2017 film

If you feed your baby, you’re in charge. You’re not allowing your baby to decide how much to eat. He/she is less in tune with his/her fullness cues so you may be feeding your baby too much.

How should you offer mashed foods like applesauce, liver pâté, yogurt and mashed potatoes to babies who do baby led weaning?  Make sure you choose a spoon that is a smaller version of an adult-sized spoon. You can pre-load it with the mashed food and give it to your baby.   Let them bring it to their mouth. Soon enough they will get the hang of BLW.

My neighbour’s 6-month old Sarah loved feeding herself with the GOOutensil:

numnum, baby led weaning, blw, spoon

 

Reason #3: It’s a more enjoyable experience for everyone. 

The last reason is quite straightforward 🙂  BLW is all about letting your baby feed him/herself.

Imagine being fed mashed foods with a similar texture at every meal. How boring! Compare that to being offered a variety of textures, shapes, exploring and taking bites when you are ready. Much more fun and stimulating. It’s also more enjoyable for YOU because you get to watch them explore AND savour a nice hot meal!

It’s just like walking: give your baby the time to practice. Soon enough he/she will become an expert eater.

Want BLW recipes?  Check out my 100% FREE mini cookbook including recipes with lots of iron by entering your email at jessicacoll.com.