Baby Led Weaning Nutrition
More and more babies are starting out on solids using the Baby Led Weaning (BLW) method.
But I have questions, especially when it comes to getting enough iron with this approach to feeding.
Baby led weaning (BLW) originated in the UK by Gill Rapley, and is popular worldwide, including the United States.
Children who are fed using this method use whole foods, often provided in graspable shapes and dissolvable forms (sticks of cooked veggies, ripe fruit or soft bread) that baby can manage to eat on his or her own.
Research on BLW has been emerging, and much of it focuses on baby’s ability to self-feed and self-regulate his intake, and more recently, some news on choking risk and nutrient adequacy.
From my professional view (I didn’t use BLW with my kids), one of the best things I see with BLW is self-regulation—that is, baby starts and stops eating according to his or her appetite.
Despite this good news, I wonder if BLW is adequate in nutrition, especially for breastfed babies?
Especially with regard to iron.
This is the question that keeps coming up for me. It doesn’t help that there is little research to quiet my concerns. However, there is some evidence to consider.
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) received guidelines and 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 resulting in more iron consumed, though this was not statistically significant from the control group.
They also gave their babies more high calorie foods and steered clear (mostly) of choking hazards.
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.
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.
Why is Iron So Important for Baby?
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), allows baby to receive about 30-50% of total blood volume from the placenta).
From the fourth month and on, baby’s iron stores are used rapidly because they are experiencing tremendous growth, and as such, expanding their blood volume quickly, while developing their own iron stores in their bodies.
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.
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, nobody 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 breastfed babies).
She 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 for her length).
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 clear perspective on feeding babies. We need to pay particular attention to nutrition and food sources of nutrients.
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The breastfed baby may be at higher risk for iron deficiency and iron deficiency anemia, especially if proper complementary food sources of iron are consumed in insufficient amounts and/or an iron supplement is skipped.
Inadequate Iron is No Good for Baby
When a young child is iron deficient or has iron deficiency anemia, a negative impact on their health may occur, including changes in immune status, delayed mental development, and below average school achievements.
This happens partly because there is a preferential use of iron in the body to make hemoglobin (a protein found in red blood cells which carries oxygen to cells and organs in the body), which may shunt iron away from the brain when iron intake is low in the diet.
The American Academy of Pediatrics (AAP) now screens for iron-deficiency anemia at 12 months, stating, “There is growing evidence that iron deficiency and iron deficiency anemia have long-term effects on behavioral and neurodevelopmental issues that can appear one to two decades after the anemia is treated.”
Where Babies Get Iron
While breastfed babies get iron from breast milk, at 6 months, the contribution of iron from breast milk isn’t enough when considering the dramatic rise in baby’s iron requirements.
Formula-fed babies get iron from drinking iron-fortified formula.
At 7 months, baby’s iron requirements jump from 0.27 mg per day (Adequate Intake) to 11 mg/day (RDA).
Complementary foods, otherwise known as solids, should begin around 6 months to help ensure all babies receive adequate iron.
Traditionally, iron-fortified cereals have been the first food for baby, delivered by spoon. But modern day feeding, including BLW, is steering parents away from this approach.
I am not convinced it’s entirely possible for babies to get enough iron and other nutrients such as zinc and B12, using this approach, especially if they are breastfed.
However, I believe thinking about, and planning for iron-rich foods in baby’s diet is necessary to offer the best chance at optimal development and growth.
Making Sure Baby Gets Enough Iron with Baby-Led Weaning Nutrition
Young babies who are transitioning to solids and who are breastfed are at risk for low iron intake.
If you are following BLW, you’ll want to keep your eye on iron and offer iron-rich foods. Born to Eat, a book that focuses on how to nourish and nurture your baby through BLW, offers feeding strategies and recipes to help you ensure all nutrients are met with this method.
In our book Fearless Feeding, my co-author and I suggest offering two servings of iron-rich foods each day for the baby transitioning to solids, regardless of whether he or she is following spoon-feeding or BLW methods.
4 tablespoons of iron-fortified oatmeal with an egg yolk (7 mg iron)
meat puree with green beans (3 mg)
The key challenge with baby led weaning is that even though high iron foods are offered, babies may not eat enough to meet their iron needs.
Their tummies are tiny and they are just learning to chew, making the actual ingestion of iron (and zinc and B12) a big question.
Below I have listed the iron content of common high iron foods (from the USDA Nutrient Database), but you can see that portions are much bigger than a young baby (or even older baby in some cases) would likely eat.
- Beef (1 ounce): 1 mg
- Chicken, dark meat (1 drumstick): 1 mg
- Lamb: (1 ounce): 0.5 mg
- Egg (1 large): 0.6 mg
- Black or pinto beans (1/2 cup): 1.8 mg
- Raisins (1 small box): 0.8 mg
- Cheerios (1 cup): 9.3 mg
- Spinach (1 cup): 0.81 mg
- Tofu (1 cup): 2.7 mg
- Lentils (1 cup): 6.6 mg
*Heme sources of iron (from animal sources) are more readily absorbed than plant-based sources; you can increase the absorption of iron from plants by adding a source of vitamin C (citrus fruit, for example).
Consider Modified Baby-Led Weaning
If you’re feeling that you might be missing the mark with iron, you can always do a blend of baby led weaning and spoon-feeding, making sure that what is on the spoon is an iron-rich food.
Pureed meat, including beef, chicken and turkey (dark meat especially) can provide iron, as well as zinc and vitamin B12.
Until we have more studies about the adequacy of nutrient ingestion with BLW, I favor a combined approach that includes spoon-feeding and hand-held solids using baby led weaning.
This combined feeding approach will help optimize self-feeding and self-regulation, while also ensuring adequate nutrition, especially for iron.
I think this promotes the best of both (worlds) approaches!
How do you make sure your baby gets enough iron?