BLS and choking?

[@llli*mommal]

OP, aren't you glad you asked the question?

I think the discussion just goes to show how individual everyone's approach to solids is, and how much of it boils down to observing your own particular baby and figuring out what best meets his/her needs while also fitting into your parental comfort zone.

[@llli*bluesea]

Thanks so much for your responses and insight!! I definitely see the benefits of BLS and will go w/ my gut when making food. I had peeled the skin off the sliced apple, which probably made it too easy to snap off a chunk, peeling the whole apple or doing wedges w/ skin is probably better idea. I do totally see that she's not really interested in food for 'eating' (like other PPs have said) so our 'highchair' time has just been another fun activity for us

[@llli*djs.mom]

I fully think getting your child involved in the RITUAL of meal time is very important. And FWIW following BLS I had a baby who was EBF and was eating 3 solid meals a day with 2 snacks by a year old. And at 7 still consistently is eating 5-6 servings of Fruits and veggies a day and eats something green every day. I would call him a good eater. Solid food is a huge and complex life long issue and something I have never taken lightly. It was very daunting to make the leap to solids and try to make sure that solid food was going to come anywhere close breastmilk in terms of nutrition.
Here are some other principles I observed : I fed my son only whole real foods. Nothing processed at all. No food that had any salt until after the year point. As their livers can't process salt before then. No juice at all before his 3rd Birthday. No High fructose syrup at all. In anything. Since this is processed through their liver. No added sugar (sugar that did not come from fructose) before his 3rd B-day. Water with all meals. No White food. (Rice, bread, pasta sugar). Now I did a lot of this because my research favored the idea that if a child is fed only whole real foods and whole grain vs Bleached for 3 years than when presented with the other kinds of foods and snacks (which is going to happen. In preschool and Elementary school and forever after.) That they are more likely to reject them on their own. Which is true. My son won't eat chicken nuggets and he rejects any bread rice or pasta that isn't brown. Except hamburger buns! And he will push away from stuff that is sugary much sooner than his counterparts in the 1st grade. He also still drinks only water with dinner every night and thinks of juice as a "treat". The presence of sugar is ever present and has to be battled daily and eventually you can't really avoid it if you plan on participating in Halloween and Easter. So just to keep him away from HFCS for THREE YEARS I could cling to. And I did. And the older they get the more challenging it is. In preschool I could send him to school every day with Beans and Rice and other Hot food. With elementary school come no way to heat food and the dreadful rut that is sandwiches every day. And label reading and finding lunch meat with no nitrates. But I continue to work to stay out of food ruts and continue to make sure he is willing to try new things. Things I don't like or eat. He likes Sushi, and seaweed and tofu. Variety and NOT getting into ruts with 3 foods they like is key IME. So Good luck!

[@llli*sprocket]

You don't think the Rapley's research is science based or that she didn't do any research? When I was practicing this it was a just a report BASED on her research. And a list of do's and don'ts. She has since written the book based on her research. Which IIRC was based on 6years of research on the subject.

There are almost no peer-reviewed studies on this subject. There is one study from 2012 that does attempt to evaluate the benefits of BLW vs spoon-feeding and it is extremely flawed, with several potential sources of confounding and bias. And it finds risks and benefits to both styles. Strict BLW not without controversy among infant nutrition experts, and there is basically no data to support it over purees (or vice versa). And there is absolutely no evidence that babies are more or less likely to choke when they feed themselves.

In the absence of any good evidence, I think we all have to just do what works best for our babies. It sounds like we can all agree that whether one loves purees rejects them, it is important to, as much as possible, involve babies in family meals, offer a variety of healthy, home made foods, follow their cues, and set a good example by eating well yourself!

[@llli*djs.mom]

There are almost no peer-reviewed studies on this subject. There is one study from 2012 that does attempt to evaluate the benefits of BLW vs spoon-feeding and it is extremely flawed, with several potential sources of confounding and bias. And it finds risks and benefits to both styles. Strict BLW not without controversy among infant nutrition experts, and there is basically no data to support it over purees (or vice versa). And there is absolutely no evidence that babies are more or less likely to choke when they feed themselves.

In the absence of any good evidence, I think we all have to just do what works best for our babies. It sounds like we can all agree that whether one loves purees rejects them, it is important to, as much as possible, involve babies in family meals, offer a variety of healthy, home made foods, follow their cues, and set a good example by eating well yourself!

Are you talking about one study to counter hers? Because her study and research was not done in 2012. What nutrition experts are finding controversy with EBF babies eating only whole unprocessed foods? And in her study there IS data that speaks to the sucking reflex associated with spoon feeding being more likely to cause choking and of course non of the babies that she studied ever did choke. So I would call that data.

[@llli*mammi]

@OP. I combined solid food such as cucumber sticks, carot sticks with pureed food.
It worked very well for me and my son. I cut the sticks thick and long enough to grab and then I let them wilt because I was worried if the veggies were snappy a peice could snap off and he might choke. It does not take long for a carrot to wilt, and also worked with apples.
Often then I would make purree from the remaining fruit and veggies (i used to cut up to much quite often in the beginning) and feed him that with a spoon. When he was a little older, about 12 months, I sometimes bought organic baby food in jars, but to be honest most of the stuff tastes so vile I only ever really gave him homemade pureed food along with pieces of whatever he wanted off my plate.
I used to put both types of food out in front of him together, so that he could decide / indicate what he wanted (sticks/pieces or purree) and he used to grab my hand to show me he wanted puree and grab the veggie sticks when he wanted himself. This worked well for us.

[@llli*mammi]

as an off topic aside - I confess I am intrigued by debates as the above. Food is so intensly cultural. the traditional / staple diets for babies are so different from country to country. I think it has to do very much with what plants are native to where you live. In agruclutural cultures based on grains babies were fed grain-based for generations. In areas where you can choose and pick all this lovely fruit it would be diffferent of course.

For example, where I live (northern Europe) no one would dream of offering avocado to a baby, ever. because it is not a staple in our diet. (it is not grown here, but you can buy them but they are typically unripe/to hard to eat and imported from far away).

the tradtional babyfood of my home country for a long time back was (and still is in fact) a cooked wheat based cereal. I never gave it my my son but i was consider weird by almost all my female relatives, etc for rejecting it.
I offered him instead regional and seasonal veggies and fruit (we grow them and for what we do not grow on our patch I try to shop regional as much as poss), and cooked oats. Where I live eating seasonal and regional (to me more important than organic) means lots of potatoes in winter (which I mashed and also offered boiled and in slices), carrot, and various other root vegetables including red beets which he loves and apples, pears etc fresh and canned, as seasonal.

[@llli*sprocket]

Are you talking about one study to counter hers? Because her study and research was not done in 2012. What nutrition experts are finding controversy with EBF babies eating only whole unprocessed foods? And in her study there IS data that speaks to the sucking reflex associated with spoon feeding being more likely to cause choking and of course non of the babies that she studied ever did choke. So I would call that data.

As far as I can tell (searching databases of medical literature anyway) she has done no published research. If you read her website, she is actually pretty clear: she's offering a "theoretical framework which enables BLW to be argued and supported scientifically". But so far, as far as I've been able to discover, the scientific support hasn't arrived yet. The 2012 paper that I mentioned is one of the only peer-reviewed studies I've yet to read that even addresses with an actual scientific study whether there are differences in nutrition-related outcomes in babies who are spoon-fed vs self-fed. And like I said, it doesn't counter hers, it found risks and benefits to both methods. It got a lot of press but like I mentioned before, was criticized by the community as being flawed and biased in both its approach and interpretation. You can read the paper itself and the whole discussion here: http://bmjopen.bmj.com/content/2/1/e000298.full (see also the end of the page where it says "responses to this article"). The controversy that I was referring to has to do with some experts questioning whether strict baby-led weaning is nutritionally adequate for most babies. That 2012 study found that babies who only eat by self-feeding took in less food on average and in fact were more likely to be underweight. It also found that babies who were spoon-fed were more likely to be overweight. That is just one pair of risks and benefits that I was referring to. No one is saying that baby-led weaning isn't nutritionally adequate. It just hasn't been studied with any kind of rigor at all, and there is some limited evidence that has led some experts to ask the question.

I'm not arguing for one or the other. I know that for my 7.5 month old who has just started solids in the last few weeks, a mix of both finger foods and some purees or mashed foods, which we sometimes help her to get into her mouth with a spoon, seems to be the right balance for her currently. That has so far been the approach that has allowed us to observe what she wants/needs, allowed her to practice feeding herself, given her opportunities to learn about new textures and while still giving her the variety that we want to give her (including some iron-rich foods which she is not prone to eating with her fingers). I am not convinced that strict BLW is optimal for my baby at this stage, but that conclusion is only based on my experience with her so far--your mileage my definitely vary--and on the lack of evidence that I have found in support of or against it. There are some theories out there about why it could be beneficial, and I'm quite intrigued by many of them! But not all.

[@llli*djs.mom]

At the time that I did this with my baby all that there was was this www.rapleyweaning.com/assets/blw_guidelines.pdf (Obviously NOT) the updated version since we began solids in Summer 2006. (That seems to have slightly different wording but the information and do and dont's have remained the same.) The only thing I don't see listed here is the source of her research. Which is strange. At the time that I chose to follow this protocol Rapley was the deputy director of Unicef's Baby friendly initiative. http://www.unicef.org.uk/babyfriendly/ I do believe that my paper (that I printed out and kept in my purse for 6months) spoke to her years of research on the subject that sited how the paper came to be written. I want to say it was 6 years of research. It was extensive. Her Master thesis I believe. As well as the protocol she recommended when out as a health visitor. Most of what is up now deals with the book. Which seems to be a bit loftier or a write. And what you are quoting about "theoretical framework which enables BLW to be argued and supported scientifically," is specifically in terms of that Book. Which is basically where things are being medically challenged. But she practiced it as a healthcare worker for years and did follow a number of families. I am not sure WHAT happened after I managed to get my baby successfully through without ever boiling or peeling anything or feeding him one puree (or ever having him choke) in terms of her research. But from what I can gather research is still very scarce because doctors are afraid to recommend it because if they do and someone DOES choke than they will be held liable. So it's something where people have to be willing to assume risk even though there doesn't really seem to be any. It's perceived. http://bmjopen.bmj.com/content/2/6/e001542.full

[@llli*kevins-mom]

I've been doing baby-led solids with my son (who is now 10 months and almost never gags on his food anymore). He never took to purees, so we only did "table foods" with him. The first few times, his gag-reflex kicked in, but we knew with the size of food he was eating, he would not choke.

Keep in mind that the most common foods that are choked on are grapes, hotdogs, carrots, etc...

At this age I always cut these foods (and foods similar in size) the long way, so they are easy to pick up but if he swallows them whole - it will likely not become lodged in his airway. There is absolutely nothing wrong with purees and she will gradually get more accustomed to eating table foods. I wouldn't force it if you are not comfortable with it!