Table 5 Major unresolved issues in BLW and practical advices

Major unresolved issues in BLW (and requirements for further research):

• To assess safety, benefits and potential implications of a baby-led approach in terms of nutrient intakes and baby growth and the risk of choking.

• To provide a more standardized definition of BLW, to better compare this approach with a traditional spoon-feeding one.

• To perform an accurate quantification of energy and nutrient intakes, by researchers and family doctors themselves, to avoid the potential bias of self-reporting.

• To investigate biomarkers, such as biochemical iron, vitamins or oligo-elements, to better assess if the nutritional status of the infants is adequate.

• To explore the short-term and long-term impact of BLW on healthy-related outcomes, such as the correct development but also the risks for under- or over-weight, obesity in larger, randomized trials

• To investigate whether BLW approach increases or not the risk of food allergic sensitizations and reactions.

Practical advices for parents willing to follow BLW approach:

• To wait until the baby is ready: healthy infants over 6 months of age are developmentally able to self-feed; however, strong chewing skills in some children may not be fully developed until 9 months.

• To inform and discuss with the family paediatrician about the approach considering both risks and possible advantages

• To monitor with the paediatrician the growth parameters, especially during the first months of weaning and evaluating if supplementations are necessary (i.e. iron, vitamins, oligo-elements ..).

• The foods offered should be prepared to be picked up and easily held.

• Parents should be advised to avoid added salt and sugar

• Meals should be cooked from scratch, without any processed foods. Cooking should be appropriate, i.e., cooking until soft

• To include high-iron food, like small pieces of red meat.

• To choice a variety of foods, that should gradually be introduced in a broader variety of textures, colours and shapes.

• To avoid hard foods, especially small and roundly shaped like nuts and grapes due to the risk of choking.

• To pay attention to the infant’s hunger and satiety cues and respond promptly.

• To ensure that the child should never be left alone with foods.