Measuring Baby-Led Weaning: Method development and pilot testing

Background: Baby-Led Weaning (BLW) is an alternative approach to complementary feeding in which infants are encouraged to self-feed using whole family foods from the start of solids introduction, rather than being spoon-fed purées by their parents. While research suggests that BLW may be feasible for the majority of families, health professionals remain concerned with the potential risks of choking, iron deficiency, and inadequate energy intake. Further research into the implications of BLW is needed to provide both health professionals and policy makers with sound scientific evidence on which to base their advice. However, in the limited research to date, there has been no agreement as to how to measure BLW. Therefore, for research to progress in this area, a standard measure of BLW needs to be developed to enable accurate and comparable results to be generated. Aim: To develop, pre-test and subsequently pilot test 2-4 methods to measure the extent of baby-led complementary infant feeding practices, in order to provide an effective tool for measuring and describing the level of adherence to BLW for future research studies. Methods: To capture the holistic nature of BLW, six components were identified from the literature. These components were then measured using four methods: Retrospective Questionnaire (RQ), Weighed Food Record (WFR), End of Day Questionnaire (EDQ) and Early Childhood Education Food Record (ECEFR). The RQ, WFR and EDQ were pretested in focus groups with mothers who had previously used BLW, and then pilot tested over a 24- hour period with mothers currently following either BLW or Traditional Weaning (TW) practices with their child. The ECEFR was pretested in interviews with Early Childhood Education (ECE) centre staff. Results: Participants identified key issues in the RQ such as the interpretation of various questions and issues with memory recall. In the WFR and ECEFR, participants suggested where layout, instruction and example changes were needed to improve clarity. Pilot testing identified the need for a more conveniently sized ‘Away From Home’ booklet for participants to use when out of the house and unable to weigh foods for the WFR. The EDQ needed both structural and wording revisions. The three pilot-tested methods, the RQ, WFR and EDQ, were able to clearly distinguish between the BLW and TW groups in the level of self-feeding, form of food offered, extent of family meal times, extent to which the same family foods were offered, level of exclusive and on demand breastfeeding, and the age of solids introduction. Conclusion: This pilot study describes four novel methods capable of measuring the six key components of BLW. These methods enable users to characterise BLW as a whole, thereby more closely reflecting its holistic nature. They also provide a range of measurements of BLW that future studies can use to assess adherence to BLW practices among participants, rather than relying on self-reported BLW status. This will ensure more robust and comparable results on the health outcomes of BLW practices in future studies