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Baby-Led Weaning First Foods & Iron

More and more babies use baby led weaning. First foods, especially those containing iron, become a critical part of the diet. Learn why iron rich foods are important for baby, especially with a baby led feeding approach.

Baby eating broccolini in baby led weaning first foods and iron

What is Baby Led Weaning?

Baby led weaning (BLW) originated in the UK by Gill Rapley, and is popular worldwide, including in the United States.

It’s a feeding method based in using whole foods, instead of spoon-feeding. Babies are offered table food in graspable shapes and dissolvable forms (sticks of soft-cooked veggies, ripe fruit or soft bread) that she can manage to eat on her own.

Research on BLW has been afoot. Mostly to look at choking incidences, nutrient adequacy, weight differences, pickiness and overall health.

In the earlier studies, the research focused on a baby’s ability to self-feed and self-regulate his intake. More recently, studies are looking at choking risk and nutrient adequacy. Particularly, iron adequacy in the diet and calorie content, which makes me happy to see.

Feeding My Babies

As you probably know already, I have four kids. They were all breastfed. Each one started solids with a spoon, at around 4-5 months of age (back then we started at 4 months; current recommendations are to begin at 6 months).

They transitioned quickly over to chopped and finger foods at about 7 or 8 months.

I distinctly remember offering my first born a soft, buttery cracker to gnaw on when she was around 6 months of age. (What I remember most was the fear that she would choke.)

She didn’t have any teeth, so she gummed that cracker until it was a mess.

Looking back, I consider that falling within the guidelines of BLW, with the exception of eating off the spoon as well.

Personally, I’ve always been a responsive feeder, probably because I was trained in the ’80s on Ellyn Satter’s Division of Responsibility.

From my professional vantage, one of the best things I see with BLW is the encouragement of babies to regulate their own eating.

In other words, they’re encouraged to start and stop their eating according to their appetite.

However, I’ve always wondered if BLW would be adequate in nutrition, particularly for the breastfed baby.

And, especially with regard to iron.

Iron-Rich Foods for Babies

The question of iron adequacy is one that keeps coming up for me. The present research doesn’t completely quiet my concerns, however, the word is getting out and I believe more and more parents are feeding with consideration to iron and other nutrients.

I’m hoping for more studies, and will continue to support families who want to take a BLW approach with the nutrition information they need to optimize both brain and body growth and development.

[Similarly, I had my reservations about early introduction of peanuts before there was enough substantiated (and well-conducted) research on the topic.]

A Tour of the Research on Iron and Baby Led Weaning

Let’s take a look at what we know.

One pilot study out of New Zealand shed some light on how much iron babies who are fed using the BLW approach are getting.

In their study of 23 families, babies were divided into two groups.

One group (the BLISS group — these are parents participating in a modified-BLW weaning approach including education on iron and energy requirements and guidelines for feeding) received education about high iron foods, energy dense foods, and foods that may cause choking prior to starting solids using BLW, while the other group proceeded with BLW without any specific nutrition or choking education.

Even though the study was small, the researchers found some interesting things.

For one, parents who were educated about iron, calorie density of foods, and choking hazards offered their babies more high iron foods which resulted in more iron consumed, though this was not statistically significant.

They also gave their babies more high calorie foods and steered clear (mostly) of choking hazards.

{Read more about choking and BLW here: Baby-Led Weaning: A Developmental Perspective}

Babies of BLW-educated parents also introduced more food variety to their babies than those who approached BLW without special instruction.

In both groups, however, iron intake fell short of the nutrient requirement as outlined by the Institute of Medicine (IOM).

Although the researchers did not specify how much iron each group consumed during the study, they did note that babies of BLW pre-educated parents were served 20.1 grams of red meat per day (2.4 servings) compared to the babies of non-educated parents who received only 3.2 grams of red meat (0.8 servings) per day.

What is missing is evidence that the iron that was consumed in babies from BLW pre-educated parents was enough. Specifically, that there were adequate blood levels of iron in BLW babies.

Moving on…

Another 2016 study looked at 51 babies aged 6 to 8 months who were either spoon fed or fed with the baby led weaning approach. The researchers evaluated the baby’s caloric and nutrient intakes.

They found that calorie intakes were similar between BLW babies and traditionally spoon-fed babies, however intakes of total and saturated fats were higher in BLW infants, and intakes of iron, zinc and vitamin B12 were lower amongst BLW babies.

In a 2017 review study which looked at all research to date, the authors concluded that the evidence to date indicating BLW promoted healthy eating and healthy weight gain was weak, although promising.

In a more recent study (2018), researchers looked at the issue of iron status and other nutrients in BLW babies to address these shortfalls in the literature. They recruited about 100 participants each to a control and test group (200+ participants in total).

In the test group, parents were provided 8 weeks of education and support on BLW, using a modified approach to BLW including iron and energy intake education. Iron intake was measured and iron status was also evaluated. The results: iron intake and status was found to be adequate in BLW babies.

Additionally, however, sodium, fat and added sugar intake was found to be higher in BLW infants than control subjects. Overall, using the modified BLW which outlines daily iron and energy intake (1 serving of iron-rich food and 1 serving of energy-dense food at each meal) seemed to meet baby’s needs for iron and energy, but parents can give more attention to salt and sugar sources in their baby’s diets.

iron baby led weaning

Iron-Rich Foods for Baby are Critical

At birth, babies are theoretically “loaded” with sufficient iron to get them through the first 6 to 8 months of life. This depends, however, on a few things: mom’s iron stores and iron status during pregnancy, whether baby was born prematurely, and the timing of the umbilical cord clamping (early clamping reduces blood volume delivery to baby while delayed clamping (2-3 minutes after birth), which allows baby to receive about 30-50% of total blood volume from the placenta).

The truth is, we don’t know the iron endowment status of most babies at birth. If you have listened to my TEDx talk, you know my first-born was anemic at 18 months.

This, I believe, was due partly to my own iron-deficient status during my pregnancy with her. In other words, I believe she wasn’t “endowed” with a strong iron status because I was struggling to achieve a normal iron status myself (more on that later).

From the fourth month and on, your baby’s iron stores are used rapidly because he is experiencing tremendous growth, and as such, expanding his blood volume quickly, while developing his own iron stores in his body.

Experts note that iron deficiency may be difficult to assess in this period due to these rapid changes in body composition.

In children under age 4 who live in industrialized countries (hello, USA), it’s estimated that about 20% are iron deficient. More than 9% of the US population is iron deficient.

It is estimated that about 20% of children are iron deficient. #healthyeating #brainfood #ironstrong Click To Tweet

Iron Deficient Mom = Low Iron Endowment in Baby

When I had my first child, I was 30 years old. I had been an active adult, mostly participating in running for exercise. When I was pregnant, I became iron deficient.

I started on iron supplements around 4 months into my pregnancy, and continued with increasing doses of iron to normalize my blood levels. By the end of the pregnancy, I was taking large doses of iron and eating an iron-rich diet (hello, steak! One of my favorite meals!!).

Despite this, I struggled with anemia throughout my whole pregnancy.

My daughter was breastfed for the first 6 months before I returned to work. Twenty years ago, no one told me to give my daughter iron supplements at 4 months…so I didn’t.

(Now, the advice is to provide 1 mg iron/day starting at 4 months to all breastfed babies.).

My daughter started solids around 5-6 months of age using iron-fortified rice cereal fed with a spoon. She wasn’t the easiest baby to feed, and we struggled a bit.

At her one year checkup, she was flirting with the 5%ile for weight (read: she was underweight).

At her 18 months checkup, she was anemic.

Looking back and knowing what I do now, I believe she wasn’t “endowed” with strong iron stores at birth because I was anemic throughout my pregnancy.

She didn’t receive an iron supplement at 4 months, and even though she ate iron-fortified cereal and meats, it wasn’t enough to keep her blood iron-rich.

My early experience with iron and anemia — for myself and my daughter– has given me a clearer perspective on feeding babies. We all need to pay particular attention to nutrition and food sources of nutrients for our children.

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