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Original Investigation
September 2017

Effect of a Baby-Led Approach to Complementary Feeding on Infant Growth and Overweight: A Randomized Clinical Trial

Author Affiliations
  • 1Department of Medicine, University of Otago, Dunedin, New Zealand
  • 2Department of Preventive and Social Medicine, University of Otago, Dunedin, New Zealand
  • 3Department of Human Nutrition, University of Otago, Dunedin, New Zealand
  • 4Department of Women’s and Children’s Health, University of Otago, Dunedin, New Zealand
  • 5Office of the Dean, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand
JAMA Pediatr. 2017;171(9):838-846. doi:10.1001/jamapediatrics.2017.1284
Key Points

Question  Does a baby-led approach to complementary feeding reduce the risk for overweight?

Findings  In the randomized clinical trial Baby-Led Introduction to Solids with 206 participating mothers, the mean body mass index z score of infants who followed a modified version of baby-led weaning was not different at 12 (0.44) or 24 (0.39) months of age compared with infants who followed traditional spoon-feeding (0.20 and 0.24, respectively). No evidence suggested a difference in the prevalence of overweight.

Meaning  A baby-led approach to complementary feeding does not appear to result in healthier growth or a reduced risk for overweight compared with traditional feeding practices.


Importance  Baby-led approaches to complementary feeding, which promote self-feeding of all nonliquid foods are proposed to improve energy self-regulation and lower obesity risk. However, to date, no randomized clinical trials have studied this proposition.

Objective  To determine whether a baby-led approach to complementary feeding results in a lower body mass index (BMI) than traditional spoon-feeding.

Design, Setting, and Participants  The 2-year Baby-Led Introduction to Solids (BLISS) randomized clinical trial recruited 206 women (168 [81.6%] of European ancestry; 85 [41.3%] primiparous) in late pregnancy from December 19, 2012, through March 17, 2014, as part of a community intervention in Dunedin, New Zealand. Women were randomized to a control condition (n = 101) or the BLISS intervention (n = 105) after stratification for parity and education. All outcomes were collected by staff blinded to group randomization, and no participants withdrew because of an adverse event. Data were analyzed based on intention to treat.

Interventions  Mothers in the BLISS group received lactation consultant support (≥5 contacts) to extend exclusive breastfeeding and delay introduction of complementary foods until 6 months of age and 3 personalized face-to-face contacts (at 5.5, 7.0, and 9.0 months).

Main Outcomes and Measures  The primary outcome was BMI z score (at 12 and 24 months). Secondary outcomes included energy self-regulation and eating behaviors assessed with questionnaires at 6, 12, and 24 months and energy intake assessed with 3-day weighed diet records at 7, 12, and 24 months.

Results  Among the 206 participants (mean [SD] age, 31.3 [5.6] years), 166 were available for analysis at 24 months (retention, 80.5%). The mean (SD) BMI z score was not significantly different at 12 months (control group, 0.20 [0.89]; BLISS group, 0.44 [1.13]; adjusted difference, 0.21; 95% CI, −0.07 to 0.48) or at 24 months (control group, 0.24 [1.01]; BLISS group, 0.39 [1.04]; adjusted difference, 0.16; 95% CI, −0.13 to 0.45). At 24 months, 5 of 78 infants (6.4%) were overweight (BMI≥95th percentile) in the control group compared with 9 of 87 (10.3%) in the BLISS group (relative risk, 1.8; 95% CI, 0.6-5.7). Lower satiety responsiveness was observed in BLISS infants at 24 months (adjusted difference, −0.24; 95% CI, −0.41 to −0.07). Parents also reported less food fussiness (adjusted difference, −0.33; 95% CI, −0.51 to −0.14) and greater enjoyment of food (adjusted difference, 0.25; 95% CI, 0.07 to 0.43) at 12 months in BLISS infants. Estimated differences in energy intake were 55 kJ (95% CI, −284 to 395 kJ) at 12 months and 143 kJ (95% CI, −241 to 526 kJ) at 24 months.

Conclusions and Relevance  A baby-led approach to complementary feeding did not result in more appropriate BMI than traditional spoon-feeding, although children were reported to have less food fussiness. Further research should determine whether these findings apply to individuals using unmodified baby-led weaning.

Trial Registration  http://anzctr.org.au Identifier: ACTRN12612001133820