Dysphagia

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    Baby-led weaning: Empowering little eaters from the start

    ByLondon Speech and Feeding

    I had a mum ask me about Baby Led Weaning the other day. So I thought I would write a blog on all the useful questions she had and what we discussed as it may help lots of mums and dads out there.

    Image by Freepik

    As a Paediatric Feeding SLT, one of the exciting developments in recent years is the growing interest in baby-led weaning (BLW). This approach to introducing solids has gained significant traction, and for good reason. It empowers infants to take the lead in their feeding journey, fostering a positive relationship with food and supporting important developmental milestones.

    What exactly is baby-led weaning?

    At its core, baby-led weaning is about offering your baby appropriately sized and textured solid foods from the very beginning, allowing him or her to self-feed. Instead of spoon-feeding purées, you present whole, soft foods that your baby can grasp, bring to his or her mouth, and explore at his or her own pace. This means no mashing, no blending, and no forcing spoons into reluctant mouths. It’s a fun, messy, and intuitive process that is led by your baby’s natural instincts.

    The genesis of baby-led weaning

    ‘Baby-led weaning’ was popularised by British health visitor Gill Rapley. In the early 2000s, Rapley observed that babies naturally develop the skills needed to self-feed and that traditional spoon-feeding might actually hinder this development. Her work, particularly her book Baby-Led Weaning: The Essential Guide to Introducing Solid Foods (co-authored with Tracey Murkett), published in 2008, brought BLW into the mainstream and provided a structured framework for parents. Her research and observations highlighted the benefits of trusting a baby’s innate ability to regulate his or her intake and explore different textures.

    What’s the deal?

    Implementing BLW is simpler than you might think, though it does require a shift in mindset. Here’s a breakdown of what it typically involves:

    • Readiness is key: The golden rule of BLW is to wait until your baby shows clear signs of readiness. This isn’t about age alone, but rather developmental milestones. Your baby should be at least six months old, able to sit unassisted, have good head and neck control, show an interest in food (e.g., reaching for yours), and have lost his or her tongue-thrust reflex (which pushes solids out of his or her mouth).
    • Offer finger foods: Start with soft, easily graspable foods cut into finger-sized sticks or spears. Think cooked sweet potato fries, steamed broccoli florets (soft enough to mash with gentle pressure), banana sticks, or avocado slices. The goal is for babies to be able to pick it up and get some into their mouth.
    • Embrace the mess: BLW is inherently messy, especially in the beginning. Food will be squished, dropped, and smeared. This is a crucial part of the learning process as babies explore textures, smells, and the properties of food. A wipeable mat under the highchair and a good bib are your best friends!
    • Observe, don’t interfere: Allow your baby to lead. He or she will decide what to eat, how much, and how quickly. Avoid putting food into his or her mouth or pressuring him or her to eat more. This respects his or her hunger and fullness cues, laying the foundation for healthy eating habits.
    • Continue breastmilk or formula: Until your baby is well-established on solids, breastmilk or formula remains his or her primary source of nutrition. Solids are for exploration, taste, and developing skills, gradually increasing in quantity over time.

    The benefits of baby-led weaning

    The advantages of BLW extend far beyond simply getting food into your baby. From a speech and feeding perspective, the benefits are compelling:

    • Develops oral motor skills: Chewing, gnawing, and manipulating various food textures are crucial for developing the muscles in the mouth, jaw, and tongue. This strengthens the oral motor skills necessary for speech development.
    • Enhances fine motor skills and hand-eye coordination: The act of grasping food, bringing it to the mouth, and coordinating these movements significantly refines fine motor skills and hand-eye coordination.
    • Promotes self-regulation and intuitive eating: By allowing babies to control their intake, BLW helps them tune into their own hunger and fullness cues, fostering a healthy relationship with food and reducing the likelihood of overeating.
    • Encourages adventurous eating: Exposure to a wide variety of tastes and textures from the outset can lead to less picky eating later. Babies are more likely to accept new foods when they have been in control of their exploration.
    • Facilitates family mealtimes: BLW integrates babies into family mealtimes from an early age, promoting social interaction and making mealtime a shared, enjoyable experience.

    When is baby-led weaning appropriate, and when not?

    While BLW offers numerous benefits, it’s not a one-size-fits-all approach.

    When BLW is appropriate:

    • When your baby meets all the developmental readiness signs: This is paramount for safety and success.
    • When you are comfortable with the mess and the learning curve: It requires patience and a relaxed attitude.
    • When you are committed to offering a variety of safe, appropriate foods.
    • When you are willing to learn about and practise safe food preparation to minimise choking hazards.

    When BLW might not be appropriate (or requires extra caution and professional guidance):

    • If your baby has a history of prematurity or significant developmental delays: His or her oral motor skills might not be sufficiently developed.
    • If your baby has certain medical conditions or anatomical differences (e.g., cleft palate, severe reflux, swallowing difficulties): These may necessitate a modified approach to feeding.
    • If there are significant feeding difficulties, aversion, or a history of choking incidents.
    • If you feel overly anxious about choking: While BLW, when done correctly, is not associated with a higher choking risk than traditional weaning, parental anxiety can impact the feeding experience. Education and consultation with a professional can help alleviate these concerns.

    A note on safety: Choking hazards

    It’s crucial to understand the difference between gagging and choking. Gagging is a natural reflex that helps prevent choking and is very common in BLW as babies learn to manage food in their mouths. Choking is silent and serious. To minimise choking risks:

    • Always supervise your baby closely during mealtimes.
    • Offer appropriately sized and textured foods. Avoid small, round, hard foods like whole grapes, nuts, popcorn, and large chunks of meat.
    • Ensure your baby is sitting upright and calm.
    • Educate yourself on infant CPR.

    Final thoughts

    Baby-led weaning is a wonderfully empowering approach that celebrates a baby’s natural abilities and fosters a positive and independent relationship with food. As Speech and Language Therapists we often see the positive impact it has on oral motor development, self-regulation, and overall feeding confidence. By understanding what it entails, when it’s appropriate, and prioritising safety, you can embark on this exciting journey with your little one, helping him or her become a confident and capable eater from the very first bite.

    If you would like help and support with weaning your baby whilst continuing to breastfeed then please get in touch!

    Sonja McGeachie

    Highly Specialist Speech and Language Therapist

    Owner of The London Speech and Feeding Practice.

    Health Professions Council registered
    Royal College of Speech & Language Therapists Member
    Member of ASLTIP

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Feeding Therapy – What can a Speech Therapist help with and how does it work?

    ByLondon Speech and Feeding

    Feeding our child can be the most satisfying time of the day or it can be the worst, stressful and hardest thing to do. Parents usually contact a Feeding Therapist once things have become totally stressful and unmanageable as often parents feel that ‘it will get better’ and ‘let’s wait and see’. Whilst this is generally a good, relaxed way of thinking, when it comes to feeding, eating and drinking, it does not take much to completely put a child off a particular food or texture. Once refusal has set in and not been responded to in quite the right way then feeding rarely gets better without intervention and support.

    What can have started as a physical, concrete problem can quickly develop or acquire a psychological and sensory aversion aspect as well. A child may have started out with an allergy to cow milk protein or gastro-oesophageal reflux for example or perhaps our child has an oral motor difficulty such as the tongue not rotating well, or lips not closing tightly enough around a bottle teat. Because those difficulties were not understood we now have a combination of both physical discomfort, oral weakness and sensory aversion making it a heady cocktail of feeding difficulty and refusal, which needs careful unpicking before each issue can be addressed sensitively and effectively.

    A dyad

    We call the relationship between the feeder and the child a dyad: both individuals play their part and both need ‘to work together’ to ensure meal times are happy events. The parent/feeder is responsible for offering and providing the meal and the child is ‘responsible’ for taking the food, spoon or drink and swallowing it.

    Formation

    For the past few years Speech and Language Therapist Students in the UK have received basic feeding/swallowing training as part of their undergraduate degree courses. However, relatively few SLTs in the UK end up specialising in this area and take further professional courses to develop this area of specialist knowledge and input. To be sure that an SLT is able to work in the complex field of eating, drinking and swallowing they must undertake further training and complete increasing levels of competency in this field. This is something to bear in mind for parents when looking for a suitable feeding therapist for their child.

    Important to know

    Parents are not alone. Many families are experiencing the same difficulty and there is help available both in the NHS and in the private sector.

    Children’s feeding can be improved greatly and the best approach is a joint team centred around the child between the parents, the dietician, medical and therapy professionals.

    By working closely together we can build confidence and skill and find ways of making mealtimes enjoyable and free of stress.

    What happens in my feeding clinic

    Parents feed their child and I coach them, model strategies, and support the feeding process.

    I provide information on their child’s developmental skill level, oral motor skill. I advise on appropriate food consistencies, optimal positioning. We talk about self-feeding and parent feeding. And we look at strategies during feeding that will improve feeding skills.

    I can help with mealtime planning and scheduling. And we decide together on when to practise what type of strategy.

    We create our meal goals together based on what is important to the families.

    Parents are invited to videotape strategies and advice I give to serve as reminders for home practice.

    I offer episodes of follow-up which sometimes can be online. Or parents can bring their child back to the clinic for another mealtime and practice of certain strategies, to follow on from our current status, and take things forward gently and steadily.

    If I can be of help with your child’s feeding journey, please get in touch on via my contact form.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

    Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

    The London Speech and Feeding Practice

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    A bite-sized guide to Speech and Language Therapy: feeding and swallowing

    ByLondon Speech and Feeding

    What is a Speech and Language – Feeding Therapist?

    You’ve probably heard of speech therapists helping people who stutter or struggle to pronounce words. But did you know that they also work with children and adults who have problems with eating and swallowing? This specialised area is called Speech and Language Therapy: Feeding and Swallowing, or Dysphagia Therapy.

    Why does a Speech Therapist help with eating and swallowing?

    The mouth, tongue, and throat are all involved in both speech and swallowing. When there’s a problem with any of these parts, it can affect both your ability to talk and to eat. For example:

    • Weak tongue muscles: Can make it hard to chew food and to form sounds.
    • Difficulty coordinating swallowing: Can lead to choking or aspiration (when food or liquid goes into the lungs).
    • Sensory issues: Can make certain textures or tastes feel unpleasant or overwhelming.
    • Communication: If we are not able to express ourselves we are likely to have difficulties during daily mealtimes: how do we ask for ‘more’ of something, how do we say we have had enough or we don’t like a particular food?

    How does a Speech and Language Therapist help?

    Our work involves a combination of assessment and therapy. We carefully observe how your child feeds, eats and swallows, and we look into your child’s mouth to help us see what the cause of the difficulties are: could be a very highly-arched palate, it could be a very flaccid/low tone tongue, it could be poor dentition. Then, we create a personalised treatment plan to address your specific needs.

    Here are some of the things we might do:

    • Teach swallowing techniques: We can help your child learn strategies to improve or facilitate a safe swallow.
    • Recommend dietary modifications: We may suggest changes to your child’s diet to make it easier to eat and swallow.
    • Provide sensory therapy: If your child has sensory needs we can help your child become more comfortable with different textures, tastes, and smells.
    • Work on oral motor skills: We can help to encourage more effective chewing, or drinking skills, or we can help your child to close his/her mouth more during chewing or drinking from a straw.
    • Collaborate with other professionals: We often work closely with doctors, nurses, occupational therapists, and dietitians to provide comprehensive care.

    What kinds of problems do Speech and Language Therapists help with?

    We see a wide range of feeding and swallowing difficulties, including:

    • Delayed feeding: Children who are slow to develop feeding skills or who have difficulty transitioning to solid foods.
    • Tongue-ties: Babies can have significant difficulties with feeding when the tongue is very tightly tethered to the floor of the mouth.
    • Refusal to eat: Children who refuse to eat certain foods or textures.
    • Aspiration: When food or liquid goes into the lungs, which can lead to pneumonia and other serious complications.
    • Chewing difficulties: Problems with chewing food, such as difficulty breaking down food or keeping food in the mouth.
    • Swallowing difficulties: Problems with swallowing, such as feeling like food is stuck or choking.
    • Neurological conditions: Conditions like cerebral palsy, down syndrome or other genetic syndromes can affect feeding and swallowing.
    • Developmental delays: Children with developmental delays may have difficulties with feeding and swallowing.

    Is there hope?

    If your child is struggling with feeding or swallowing, know that there is help available. Speech and Language Therapy can make a significant difference in your and your child’s quality of life. We’re here to support you every step of the way.

    Remember, you don’t have to suffer in silence. If you’re concerned about your child feeding or swallowing, please reach out. You can find a Speech and Language Therapist with a Feeding/dysphagia qualification near you via www.asltip.co.uk or contact me.

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

    Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

    The London Speech and Feeding Practice

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Baby-Led Weaning: A Speech and Language Therapist’s Take

    ByLondon Speech and Feeding
    adorable baby playing with food
    Image by freepik

    Let’s face it, introducing solids is a rollercoaster for parents. You’re bombarded with advice (solicited and otherwise) on purees, spoon-feeding, and the much-discussed ‘baby-led weaning’ (BLW). As a speech-language/feeding therapist I see the world through the lens of communication and development, as well as safe munching and swallowing. BLW can be a fantastic option for many little foodies. But is it right for yours? Let’s take a dive into the messy, hilarious world of toddler feeding.

    BLW in a nutshell

    Your baby, perched in their highchair, eyes wide with excitement and curiosity reaches out for a platter of food. He/She grabs a fat avocado slice, and curiously explore it with his/her lips, gums and tongue. He/She spits some of it out, mashes bits of it into his/her hair, there was a tiny swallow and the rest is smeared onto the high chair tray. Now he/she grabs a bit of the banana and rinse and repeat as before, except this one he/she keeps in his/her mouth for bit longer and takes a tiny bit more before the rest gets deposited into his/her bib.

    This, in a nutshell, is BLW! It’s all about letting your little one take the lead in exploring new foods, textures, and tastes. No spoon-feeding, just pure, messy, self-directed feeding fun.

    The pros of letting your little one loose on solids:

    • Motor Skills: BLW is a sensory party for developing motor skills. Picking up that slippery banana or gumming a chewy piece of toast strengthens those tiny hands and mouth muscles. These are the very skills they’ll need for future talking and chewing.
    • Texture Time: BLW exposes your baby to a variety of textures right from the start. Think soft, steamed broccoli florets or smooth, banana half-slices. This sensory exploration helps them develop an understanding of different textures in the world, which can translate to better oral motor skills needed for speech development.
    • Independence: BLW fosters a sense of self-feeding independence. Your toddler learns to control how much he/she eats and the pace of his/her meal. This can lead to better self-regulation later on, not just with food, but in other areas of his/her development too.
    • A wider variety of flavours: BLW encourages exposure to a wider variety of tastes and smells. Let your baby discover the sweetness of roasted sweet potato or the tang of mashed avocado! This early exploration can lead to less picky eating down the road.

    There are some valid concerns:

    • Gagging vs. Choking: One of the biggest concerns parents have about BLW is choking. However, gagging is a natural reflex that helps babies learn to move food safely around their mouths. Choking is much rarer, and with proper food selection and supervision, the risk is very low. The con here really is parental anxiety more than anything else and if you can overcome this then a bit of gagging is just fine and part of the process. Choking, again most children do choke occasionally a bit! Of course, close supervision and common sense is very important here.
    • It’s ever so messy!: Be prepared for mashed banana on the highchair tray, rogue peas flung across the room, and a general sense of chaos. But then again, this is an important part of the learning process! I would encourage you to embrace the mess (within reason and your personal tolerance level) and focus on the fun of exploration.
    • Nutritional Concerns: Some parents worry that babies won’t get enough nutrients with BLW. While it might take a while for them to master the art of self-feeding, a healthy child’s body is pretty good at self-regulating. Offer a variety of healthy options, and he/she will eventually get the hang of it.

    BLW: Is it right for your Little One?

    BLW isn’t a one-size-fits-all approach. Here are some things to consider:

    • Developmental Milestones: Babies should be able to sit up with good head control and show an interest in food before starting BLW.
    • General good health and absence of food intolerances, allergies, or other significant health issues which might dictatea more controlled feeding regime.
    • Gag Reflex: A strong gag reflex is a good sign. It shows your baby’s natural ability to move food safely around their mouth. If, however, your baby’s gag is overly sensitive and causes frequent bouts of vomiting please consult your health care professional for an assessment (GP, Paediatrician, Dietician, Speech and Language – Feeding Therapist).
    • Your Comfort Level: BLW requires a relaxed and patient approach. If you’re feeling stressed about the mess or potential choking hazards, it might not be the right fit for you.

    A final mouthful:

    BLW can be a fantastic way to introduce your baby to solids. It promotes exploration, independence, and a love for food. Remember, there’s no pressure to go all-in on BLW. You can always combine it with spoon-feeding or purees to find an approach that works for your family and your child. The most important thing is to create a positive and relaxed mealtime environment where your little one can explore the wonderful world of food at their own pace.

    P.S. As an SLT, I always recommend chatting with your health care professional. This way you can address any concerns you might have and ensure your baby is developmentally and physically on track for this exciting new chapter.

    Don’t hesitate to contact me!

    Sonja McGeachie

    Early Intervention Speech and Language Therapist

    Feeding and Dysphagia (Swallowing) Specialist The London Speech and Feeding Practice

    The London Speech and Feeding Practice

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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    Answers to very common questions I get as a Feeding Therapist

    ByLondon Speech and Feeding

    What are hunger cues in newborn babies? How do we recognise when our baby is hungry? How often should we feed our baby?

    These are very common questions I get as a Feeding Therapist. And so I thought I would write a blog on it.

    A mother holding her baby on one arm in her lap while holding a cup
    Image by Freepik

    First-time parents’ journey

    First-time parents often imagine that feeding, particularly breastfeeding, will be an easy and natural process without too many problems. It can be a rude awakening to find that feeding our newborn is not at all easy and can be fraught with complications. It is fair to say that in most cases by the time our baby is about eight weeks old most mums have got the hang of feeding, either by breast and/or bottle, and things are falling into place.

    But until that time it can be a difficult journey:

    • getting to know one’s baby,
    • getting to know their feeding rhythm,
    • falling in with it,
    • TRUSTING that baby knows what they need and knows when they have had enough,
    • TRUSTING and not going crazy with going down an on-line rabbit hole of information and guidance mostly unnecessary and often quite simply FALSE!

    Many mums I have met set out with the best intentions to breastfeed for as long as possible. However, they arrive in my clinic anxious and often have given up with the breast; now we are on bottle feeds and things are still very tricky for several reasons. There are too many reasons for this blog to cover but I thought I would start with the basics and ‘reading hunger cues’ is one of those early basics.

    Image by shurkin_son on Freepik

    Reading hunger cues

    So let’s dive in:

    Newborns communicate hunger through a variety of cues. Here are some early signs to look for:

    • Early hunger cues: These are the best times to respond to baby’s hunger for a more peaceful feeding. Look for things like:
      • Becoming more alert and active
      • Turning head from side to side in the cot
      • Rooting (turning their head towards your breast or a bottle, especially when stroked on the cheek)
      • Putting hands/fists to mouth
      • Sucking on fists or lips
      • Opening and closing mouth, smacking sounds
    TOP TIP: THIS IS WHERE YOU SHOULD GET READY TO FEED. Breast or bottle. Either way get ready. We do not want our baby to get into later hunger cues, which are below:
    • Later hunger cues: If we miss the early cues, babies will progress to more insistent hunger cues. These include:
      • Fussiness or whimpering
      • Rapid sucking motions
      • Increased squirming
      • Head bobbing

    Generally, remember that we do not want our baby to cry for their food. Because once they are riled and cry they are not relaxed enough to latch, especially when latching is hard!

    Feeding on demand vs. scheduled feeds

    We now know and have researched how babies are fed best and safest, how weight gain is ensured best, both for breastfed and bottle-fed babies.

    It’s generally recommended to feed on demand—unless your baby is tube-fed or has some other pressing health concerns or is failing to thrive.

    What are the benefits of on demand feeding?

    • We need to respond to baby’s individual needs and hunger cues because every person is unique!
    • Babies need to learn and regulate their own hunger and satiation cycles
    • Promotes better weight gain and growth
    • Leads to more peaceful feeding experiences

    Scheduling can come later

    A loose schedule might emerge naturally when your baby is around 2–3 months old, but it’s best to follow your baby’s lead.

    Tips:

    • Some newborns may feed every 2–3 hours, while others go longer stretches. Pay attention to your baby’s cues and feeding habits.
    • Crying is a late hunger cue, and frequent crying can make feeding more difficult. Responding to earlier cues is best.
    • If you have concerns about your baby’s feeding patterns or weight gain, consult with a Speech and Language Therapist/Dysphagia Therapist and/or Lactation Consultant.

    Check out these useful resources on  the topic of Demand Feeding:

    Do get in touch if you would like some in-person or on-line 1:1 support with this. It can be overwhelming to figure it all out alone.

    Find a speech and language therapist for your child in London. Are you concerned about your child’s speech, feeding or communication skills and don’t know where to turn? Please contact me and we can discuss how I can help you or visit my services page.

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