Knowledge and attitudes towards baby-led-weaning by health professionals and parents: A

cross-sectional study.

Autores: Ismael San Mauro Martína Elena Garicano, Vilara Gema Porro, Guerrac María Alicia
Camina Martín

Abstract

Objective

Baby-led-weaning (BLW) is a novel model of complementary feeding. Although there is little

scientific evidence to support the suitability or superiority of this complementary feeding
model, BLW is followed by many families today. The aim was to evaluate the knowledge and
attitudes of a group of parents and health professionals regarding BLW in Spain.

Methods

This research was designed as a cross-sectional study in a sample of 502 parents and 364 health
professionals. Two questionnaires generated and disseminated through Google forms were
used. The differences between groups of professionals were analyzed using the Chi-Square
test.

Results

92.3% of professionals and 93.4% of parents knew about BLW. They recommend BLW “always”
in 39.8% and 69.3% of the cases, and “sometimes” in 49.7% and 24.9%, respectively. Of the
health professionals, 80.5% recommended starting complementary feeding as of six months,
36% of them using BLW, 24% followed traditional weaning, 3.3% bottle feeding and the
remaining 36% did not indicate. Eighty-three percent recommended chewing as soon as the
child showed interest.

Conclusion

Both health professionals and parents recommend BLW and consider it helps promote the
developmental milestones of the baby. Providing nurses with an adequate number of
resources to guide parents on complementary feeding will continue to improve childcare.
Resumen

Objetivo

El baby-led-weaning (BLW) es un modelo novedoso de alimentación complementaria. Aunque

hay poca evidencia científica que respalde la idoneidad o superioridad de este modelo de
alimentación complementaria, el BLW es seguido hoy por muchas familias. El objetivo fue
evaluar los conocimientos y actitudes de un grupo de padres y profesionales de la salud con
respecto al BLW en España.

Métodos

Esta investigación fue diseñada como un estudio transversal en una muestra de 502 padres y
364 profesionales de la salud. Se utilizaron 2 cuestionarios generados y difundidos a través de
Google Forms. Las diferencias entre grupos de profesionales se analizaron mediante la prueba
Chi-cuadrado.

Resultados

El 92,3% de los profesionales y el 93,4% de los padres conocían el BLW. Recomiendan BLW
«siempre» en el 39,8 y 69,3% de los casos, y «a veces» en el 49,7 y 24,9%, respectivamente. El
80,5% de los profesionales de la salud recomendó iniciar la alimentación complementaria a
partir de los 6 meses, el 36% de ellos con BLW, el 24% siguiendo la forma tradicional, el 3,3% con
biberón y el 36% restante no lo indicó. El 83% recomendó la masticación tan pronto como el niño
mostrara interés.

Conclusión

Tanto los profesionales de la salud como los padres recomiendan el BLW y consideran que
ayuda a promover los hitos madurativos del bebé. Proporcionar a las enfermeras los recursos
adecuados para orientar a los padres sobre la alimentación complementaria seguirá mejorando
el cuidado infantil.
Introduction

Food during the first year of human life is key to growth and development. It is essential to
ensure a sufficient supply of energy and nutrients. 1 During the first six months of life, breast
milk meets the infant's requirements, but from this moment onwards it is necessary to
introduce complementary foods,2 both for nutritional reasons, to continue progressing the
maturational, neuromuscular, renal, gastrointestinal, immune and psychomotor development
of the infant, as well as for family, social or educational reasons.3, 4
According to the Spanish Association of Paediatrics (Asociación Española de Pediatría, AEP),
complementary feeding (CF) is considered a process by which infants are offered solid or liquid
foods other than breast milk or infant formula as a complement to it. 4
The infant must show signs of maturity and psychomotor skills to begin CF. In any case, the age
at which it starts should be individualized.4, 5, 6 The European Society for Pediatric
Gastroenterology, Hepatology and Nutrition (ESPGHAN) establishes that CF should not be
introduced before 4 months (17 weeks) or after 6 months (26 weeks). 7 There are no firm rules
or scientific bases that establish why, what, how and when certain foods should be
introduced,4 but CF must cover the needs of iron and zinc.3, 7
Traditionally, the most commonly used method for CF in infants has been to offer food in the
form of puree/porridge, mixed and crushed until one year of age and administered with a
spoon by an adult.7, 8 Foods are progressively introduced by adapting their texture, starting
with the purees, going through flat foods, until finally offering chewy solid foods as they
develop oral motor skills.3, 4 However, an alternative approach known as Baby-Led Weaning
(BLW), which emerged in 2002 in United Kingdom and is also deeply rooted in New Zealand
and Canada, is currently becoming increasingly relevant.4, 8, 9, 10 This method proposes to
offer the baby whole foods with an elongated-narrow size and shape (finger foods) so that
they can grasp and take them to the mouth from the beginning of the food diversification
process. It is therefore a feeding strategy directed by the baby.4, 8

BLW offers a number of benefits, including the baby's participation in family meals, a longer
period of breastfeeding, greater autonomy for the baby, self-regulation of appetite and satiety,
better transition to a solid diet, saving time and cost of food, a greater acceptance of new
flavours and textures in the diet and a better development of fine and gross motor skills.3, 4, 6,
8, 9, 10, 11 On the contrary, the BLW approach has a series of disadvantages, among which are
the risk of energy and micronutrients deficit and the risk of choking.6, 9, 11 Therefore, BLW is
not indicated in children with developmental delay, with associated neuromuscular disease,
brain injury or any other primary and secondary medical conditions that affect the
neuromuscular coordination involved in the swallowing process. 4
In summary, the first year of life is a period in which feeding and nutrition will determine the
maturational, neuromuscular and psychomotor development of the baby. Specifically, the CF
period is considered a critical moment when other foods need to be introduced to ensure
adequate nutrition. The BLW is a novel model of CF, and despite little scientific evidence to
support its suitability or superiority as a CF model, BLW is followed by many families today.

The main objective of this study was to evaluate the knowledge and attitudes of a group of
parents and health professionals regarding BLW in Spain.

Section snippets

Design

An observational descriptive cross-sectional study was designed.

Subjects

A quota, non-probability sampling method was used to recruit participants for this study. The
study was carried out on a sample of 866 volunteers, 502 parents and 364 health professional
from different Autonomous Communities in Spain, who filled out a questionnaire anonymously
about the knowledge and attitudes towards BLW.

Data collection

The information necessary to carry out the study was collected between January and April 2020
using two
Sample characteristics

A total of 364 health professionals, 89% (n = 324) women and 11% (n = 40) men, participated in
the study. Health professionals from all of the Autonomous Communities of Spain, with the
exception of Ceuta and Melilla, participated in the survey. A 77.5% (n = 282) of the health
professionals carried out their activity in a public health centre or hospital, a 14.6% (n = 53)
worked in private centres and the remaining 8% (n = 29) worked in both, public and private
centres. The 47.8% (n = 174) of these

Discussion

The BLW, despite its great acceptance and follow-up by many families around the world, is a CF
method that had not been considered by the Spanish Association of Pediatrics (AEP, Asociación
Española de Pediatría) until 2018 in its recommendations on CF. 4 In fact, the study by Martínez-
Rubio et al.,12 published that same year but prior to the publication of the AEP
recommendations on CF, revealed limited knowledge of BLW by Spanish paediatricians. The
main reason why paediatricians did not

Source of funding

This research has not received specific funding from agencies of the public sector, commercial
sector or non-profit entities.

Conflicts of interest

None declared.

Acknowledgments

Thanks to the study subjects, without their collaboration the study could not have been
possible.
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