175 | Baby-Led Weaning vs. Purées: Which Is Better?

Food before one is just for fun. Do you agree or disagree with that statement? I really do understand why some people say that. We really don't want our parents obsessing about everything that the child is eating, but I'd argue that those early meals are doing a whole lot more than just making a mess. Welcome back to the Exam Room Nutrition Podcast. I'm your host, Colleen Slum. I'm a PA and dietitian, and today we're talking all about starting solids. My guest is Kinsey Matt Zeller. She's a registered dietitian and PhD candidate at Colorado State University who studies infant feeding and growth. In this episode, we unpack why purees and baby-led weaning have become two opposing camps and whether the research actually favors one over the other. We also talk about the moment that terrifies parents the most when their baby gags. We talk about what's normal, what's dangerous, and how do we walk our parents through this. Plus, Kinsey talks about portion sizes, which foods should come first, and two important nutrients parents need to prioritize. We had so much fun in this episode. So grab your coffee or drive safe and enjoy my conversation with Kinsey. All right, Kinsey, I am so excited to chat with you today. I love this topic. I live and breathe this topic. So I'm really excited to learn from you. So welcome to the podcast. Thank you. I'm so excited to be here. Let's get into the evidence. So I want to first talk about timing. So, you know, some parents are told four months, others are told six months. And I even saw a thread on like a Facebook post that someone's pediatrician told them nine months. And so um, I know we have some guidelines with when a baby is developmentally ready. So I would love for you to clarify all of that and let us know what do we tell our parents?

Yeah, amazing question. I would say first and foremost, across the globe, all of our major health organizations recommend waiting until six months to start solids, but that developmental time point does depend on what we call like the four main characteristics. So the first two are kind of connected. Babies should be able to sit up on their own, unsupported, and they also should have head and neck control. So when they're sitting, their head is not flopping all over the place. And that's a really big safety thing. So they should be able to sit alone, unassisted in a high chair or on the ground. They should be showing interest in your food. They should be looking at your food when you're eating and then reaching for toys and other items and bringing them to their mouth. So that way we know once they start feeding themselves, they know where their mouth is and they can actually get that food to where it needs to be.

So, can you explain like why are we wanting those babies to be able to sit unassisted and have that head and neck strength? Why is that important?

Yeah, we want them to be able to appropriately swallow their food. We want them to be able to move the food in an adult pattern. So instead of, you know, spitting it out or having it go down the wrong pipe. This is a baby's first experience with a food texture that's not liquid. And so we want them to be able to safely swallow and safely sit on their own in order to better feed themselves and feed themselves safely.

Okay, let's talk about texture. This is a big one. And somehow pureed versus baby-led weaning has become two very different parenting camps and opinions. So I would love for you to unpack if the evidence actually supports one approach or the other. And can parents maybe use a combo?

Yeah, baby-led weaning is like one of my absolute favorite topics in this space. Uh, it's something that I personally do a lot of research on. And I think at a very high level, there isn't one that's better than the other. We don't have evidence of that quite yet. I will say it is a fairly new research area. It only has been studied in research for the last probably two decades. And a lot of that research has come from the UK and the New Zealand area, and less so, at least in the US. And so that's what we're trying to do is maybe find and do some research on it in this setting. When it comes to outcomes associated with baby lead weaning and pure's, most of the research has looked at things like dietary intake and growth. And for the most part, it's fairly similar. These babies are mostly growing the same. We see some differences in dietary intake, but I think a lot of that comes down to what are parents offering more so than like a puree versus baby lead weaning being better or worse. As for a combo, I think if you ask like a baby lead weaning purist, they're gonna say no, that babies should be the only one feeding themselves. They should be the only ones putting food in their mouth. But for parents, I think baby lead weaning versus purees or a conventional approach is more so about the texture than it is like who's actually doing the feeding. And you should absolutely do finger foods, purees, lumpy foods, as many textures as you can to best mimic whatever diet they're going to be following for the rest of their life.

Now, when I talk about baby lead weaning and, you know, using or introducing those soft, mashable foods, parents kind of look at me like they are scared out of their mind. You know, they're like, this is a baby. How can I give them, you know, solid foods? Because they're very concerned about choking. So has the evidence shown that baby lead weaning increases choking risk? And if not, help us tease out that conversation between the difference of gagging and choking, because I think that's an important distinction.

Absolutely. So I would say choking is one of the things with baby lead weaning that there have been some pretty decent studies on. So currently there's no difference in choking between baby lead weaning versus parent lead weaning versus somewhere in the middle. But I think a big caveat to that is parents need to be educated on foods that are choking risks, regardless of whether you're going to be giving a puree versus a finger food, because eventually your baby will be exposed to non-pureed items. And so, in a lot of these studies, these parents receive dietary education and counseling to know what foods they should and shouldn't be giving. So I think all parents need to be informed on choking hazard and choking risk foods. But gagging and choking are two very, very different experiences that a baby could have. Gagging is so common and it's very, very natural. It's what their bodies are supposed to do when they're exposed to a new texture. Because it's the brain's way of saying, whoa, all I've had is breast milk or formula, and this is a new texture. This might not be safe. And I think the biggest difference I would say between gagging and choking, the best way to know is that gagging is loud. Babies are coughing, they're crying, they're spitting, and that again is normal. And choking, on the other hand, is silent. So the airway is blocked, they're not able to cough or choke or breathe or do any of those loud sounds. And so that's why we say it's so important to watch your baby as you're giving them solid foods. You shouldn't be leaving them alone at the table because choking is silent and it is an emergency if it happens.

Yeah, that's exactly how I describe it as well. And I try to tell families about this before it happens because it is very scary as a new parent when your child gags. So I almost tell them, like, this is going to happen. And here's what to do if it if and when it does. And so, what do you encourage parents to do if the child is gagging? Like, what's the next best step?

Honestly, the best thing you can do is watch them, but let them sort it out on their own. They have to kind of develop that skill again for safety. So that's normal. And it's helping them to not choke on things. So watching them, helping them calm down. So talking in a soothing voice, you can kind of give their back a little rub, but we're not going to be doing any sort of like back blows or anything like that. Uh, and just kind of let them try and pass the episode on its own.

And now correct me if I'm wrong, but it is completely safe to let baby try that food again right then and there. It's not like they have to just end the eating episode.

Absolutely. Yeah, you can continue going on. And if baby is now getting, you know, they're frustrated and they're overwhelmed, like maybe it's not going to be a super successful feeding session. And that's also okay. And you can try that food again in a little bit, maybe once everybody has been able to take some deep breaths and come back down to baseline.

Yeah. I always try to encourage parents, especially moms, but sometimes the dads are the super nervous ones that like you have to stay calm. Like if you can stay calm, you will calm your baby even faster too. And they will now not associate that with a bad experience, right? We want feeding to be a pleasant experience. Now we talked about feeding when baby is at least six months and able to sit unassisted, but I have a question about the parents who are very concerned. I've had some families say that they're gonna wait even past six months more out of fear, or maybe baby did have a gagging episode and they're afraid to offer those solid period foods. And so is there a harm in delaying complimentary foods beyond six months?

We do know that complementary foods and specifically high allergen foods need to be introduced between four to six months or six to eight months. And so if you want to wait a little bit, that's probably okay. But the longer you wait, the more you're gonna increase the risk of things like a food allergy response or something along those lines as well.

Yeah. And I feel like there's that sweet spot, there's that window of where baby's gag reflex is easier to kind of minimize and desensitize. When I find that parents who wait until like nine or 10 months to even introduce any solids at all, really the child struggles a lot with their gag reflex. Is that something that you've seen as well?

Absolutely. And I think you also then have started to push when they're going to be exposed to these different textures. And because that gag reflex has not been, I don't know, challenged, I guess you could say earlier on, I think you do increase the risk of having a larger or a scarier gagging event and then potentially delaying foods even longer.

So another piece of advice that I hear is to just give the baby what you're eating. So I'm curious how true is that? Do you uh support that recommendation? And if so, maybe talk us through what needs to change if we're adapting like a family meal for maybe a six or seven month-old.

I think at its core, it's a great idea. Babies should be involved in family meals. You shouldn't have to make them their entire own dedicated baby meal per se. So I think the biggest things that I often counsel on is salt being the first. So we tend to eat too much salt, at least in the US. And so adding salt at the table for your own meal. So as you're preparing whatever food it is you're making for dinner, instead of salting as you go, just wait, salt your own food after you've dished it. And then that's fine for your baby to eat as long as it was prepared in a developmentally appropriate way. I think the other nutrient, especially that we talk about in babies, is sugar and added sugar and how we should be limiting that as much as we can. And so if you're making something like a pasta and you're using like jarred pasta sauce, maybe looking at the food label, picking an option that's a little bit lower in sugar. And then again, you can serve that to your baby in a way that's developmentally appropriate. Now, for a six to seven month-old, we're really gonna be looking for pieces of food that are about the size of baby's fist. They only have the palmer grasp at this age, so they can't necessarily pick up those small pieces and bring them to their mouth. And you want to make sure that the food is soft. We're not gonna be giving things like raw carrots or any of the harder, crunchier foods because they they can't safely eat those quite yet. So I think at six to seven months, making sure that the size is appropriate and the nutrition content kind of reflects what we would like our babies to be eating. And then as they get older, you can start to, you know, as they develop that pincer grasp, maybe cut the food into smaller, non-choking hazard pieces and offer those as well.

Kinzie, you mentioned allergens. So I want to linger here for a little bit and clear up some conflicting information that I've even seen online from guidelines and even some of my colleagues when they mention introducing allergens, and that, and that's how long we have to wait in between introducing you know different allergens. So some guidelines say three to five days. I've seen some that say 24 hours, and then even some that are like, you don't have to wait at all. So, based on the literature and what you've read, what is your recommendation for introducing allergens?

Yeah, and I think the the key is it's those big eight, big nine, if you're including sesame for allergens. Those I do typically recommend say like waiting around three days, but mostly because you shouldn't just introduce allergen one day and then assume everything's good. In the immune response that uh babies have to allergen proteins in foods, it probably won't happen on the first time. It's more likely to happen on like a subsequent exposure. And so my personal recommendation is you introduce it on day one, just a small amount, introduce a little bit more on day two, and then a little bit more on day three. And then after that, we can assume that if they were going to have a reaction, they probably would have. And then you can introduce the next allergen after that. So it's kind of waiting three days, but you're not just, you know, not offering any allergens during those three days. You're kind of increasing the amount to try and see if you do have a food allergic reaction. And so I would say for any of like the major allergens, that's typically what I recommend. For foods that aren't allergens, like fruits, vegetables, I don't think you need to wait. I think for the most part, these babies are not going to have a reaction to say, like pureed apples. And so you give it, you know, the 15 minutes to two hours after introducing the food, and then you're probably okay to introduce it again or to introduce a new one.

Yeah. I I really like that um strategy. And this is probably a topic that causes the most anxiety for parents. And I think a lot of it has to do with social media. I'm not sure if you've seen, but like parents are like parked in the ER, you know, parking lot and feeding their baby an egg and just in case it happens. And I'm like, I tell my families, I'm like, please don't do that. Like, you don't need to sit in the ER waiting, you know, parking lot. And so I've actually talked about allergens quite in depth. I have a full episode dedicated to that. It's episode 126 titled Introducing Allergens, a step-by-step guide to early allergen introduction. And we really talked about how do you introduce, you know, peanuts and eggs and sort of the systematic way in which parents can do that. So if you want to dive a little bit deeper into allergens, go listen to that episode. Um, another question that I get asked a lot is how much do I feed my baby? And then following that is like how many times a day do I do this? So they're really asking about like a meal schedule. So can you walk me through what would be the best guidelines for that?

For sure. And it's going to depend majorly on how old they are. So when we're thinking like we're starting six months, six to seven, even maybe eight months, I recommend one, maybe two meals a day. So when we first start solids, one meal a day is typically going to be enough. We call it complimentary feeding for a reason because they're still getting all of their nutrition from breast milk or formula. And so we're just trying to get them exposure to uh those allergens, to tastes and textures. So I say pick whatever meal you have the most time for. If that's breakfast, great. If that's dinner, also great. And just making sure that you have time where your baby is happy, where you're not so stressed about like trying to get your own meal on the table, whatever meal works best for your family. There isn't any evidence that, you know, introducing solids in the morning is any better than at night, or vice versa. And when you start those meals, especially those first couple of months, they're really like not eating a whole lot. So complimentary feeding is also about exploring the food. So babies are going to just put it on their hands, they're gonna put it on their face, they're gonna get it all over. And so you might not see your baby eat any more than like two to three tablespoons for those first couple of weeks. And then as they get older and they get hungrier and they gain those skills to eat solid foods, you will start to see it pick up in terms of volume. By the time they hit a year, we would recommend trying to get to like an adult style feeding schedule. So they get breakfast, lunch, and dinner, maybe a snack. If they go to say childcare, a lot of times the childcare providers will get them closer to that schedule because they're feeding everybody at the same time. But that's definitely not expected at six months for them to be eating like a full three meals a day.

Yeah, I agree with you. And do you talk about an infant's like innate hunger and fullness cues? Is that still true with solid foods, especially those, you know, six to nine month kiddos? Do we feed them until they're not interested in the food anymore, or should we limit how much we're giving them?

That's a really good question. And I think it's gonna depend on quite a few different factors for each baby. I think one of the best ways to do it, especially in those early couple months, is you give your baby a bottle. You don't have to have them finish it. So if they typically take like a six-ounce bottle, maybe you do three ounces, give them a little bit of time, give them the meal, let them eat to their heart's content. And then if they still seem like they're hungry after the meal, then you can give the rest of that bottle or nurse also. So I think it helps them to honor those hunger cues. Babies are incredibly adept at regulating how much they're eating, when they're eating, and letting us know as long as we listen to them and listen to the things that they're communicating to us. And so I think with complimentary foods, it's kind of the same thing as like when you talk about, you know, responsive feeding for both bottles, breast milk, solid foods, all of it kind of follows the same idea that we should be trusting babies to let us know when they're hungry and let us know when they're full.

Yeah, parents have a hard time doing that. They're like, but how do I know? And I'm like, I promise you, they will communicate it to you. Just gotta be listening. And another thing that we hear a lot is that food before one is just for fun. And I I understand kind of the philosophy behind that, but I would love from your perspective, is that accurate? And then I would love if you can unpack which nutrients are really important during, you know, this from six to uh 12 months old.

I think that the idea that food under one is just for fun, like does like a huge disservice to all of the things that we know complimentary foods are good for. And so there's a reason we introduce them in the first place. It's because at that age, breast milk is no longer meeting all of the nutritional needs, which is our gold standard. Um, and but before I kind of get to those nutrients, I think the other thing that I want to mention is it's also our window for flavor and taste and food preferences. And so what you give your baby during this time, even if all they're doing is like rubbing it on their face or smelling it or interacting with it, they're still going to be more likely to eat those foods than if you just don't introduce it at all. So it's more than just the nutrients. And as they kind of progress through those six months from, you know, six months to a year of age, complimentary foods take up a lot of the nutritional load. So these babies are getting, you know, a third of their calories by nine months from complimentary foods. And by the time they hit a year, it's almost like three quarters of their calories. And so, yes, at first, complimentary foods are just kind of for fun and exploration and all of these other things, but they very quickly become a huge part of baby's diet. And so making sure that we're giving them nutrient-dense complementary foods, I think is fantastic. So when it comes to nutrients that I recommend, the big one is gonna be iron. So, iron-rich complementary foods have always been the recommendation when we first start. And that's because breast milk is low in iron. And so by six months, they've run out of their iron stores that they've had from birth. So we need to kind of supplement that from our complementary foods. And so we're gonna find those iron-rich foods and prioritize them if we can. It's gonna be things like our meat and our poultry, our legumes, lentils, beans. Those are probably the nutrient that I spend the most time saying if you have to pick one thing to focus on, iron, I think, is a good one. Alongside iron comes zinc. And so zinc and iron are often found in the same kind of food. So if you're prioritizing, you know, meat and poultry, you're still gonna get both iron and zinc. Same thing with lentils. So again, we're thinking about immune function and growth with both of those nutrients. I think when we talk about meat, poultry, beans, lentils, all of that is gonna fall into like protein sources. And so it's really hard to talk about iron and zinc without talking about protein sources. And the thing about babies is we don't know a lot about what kind of proteins they should be getting from complementary foods. This is something that we're currently working on publishing from a trial. So stay tuned. But for now, I think you can meet both iron and zinc needs from both plant-based and meat-based protein sources. The other thing which we've kind of touched on also is things like lowering your sodium intake and added sugar for babies. But the last one I think is really interesting is saturated fat. And so saturated fat in adults is something that we're typically recommending that people limit and not prioritize. But babies really need saturated fat. They have a huge amount of brain development going on, and all of that needs saturated fat for that to happen. And so I do not recommend limiting saturated fat. It's one of the reasons why we say, yep, meat, poultry, all of that is just fine in babies because that saturated fat they're getting is also beneficial.

It's very interesting because, you know, you're gonna have a parent who might be on their own like weight loss journey or health journey. And, you know, if they have a cardiac condition, they've probably been told by their clinician to avoid saturated fats. And so, you know, it can be challenging for them to hear some of these recommendations. But I always go back to explaining the why behind our recommendation. I think it makes sense to people. Right. Now, that also brings me to sort of this talk of like ultra-processed foods and almost like baby convenience foods. And I'm thinking of pouches, melts, teethers, you know, those types of things that come in crunchy little packages and are really cute and great marketing. But I'm curious because you've studied this, are these recommended for babies? Should we avoid them? What are your thoughts on that?

In babies, they look a little different than a lot of times what we think of in adults, because even a lot of those like packaged snacks, especially if they're marketed for babies under a year. So if you know they say six plus months or eight plus months on the label, they're probably going to be fairly low in sodium, fairly low in added sugar. But the second that it reaches that like toddler threshold, so they're now marketing for like 12 months and up, there's very, very high amounts of salt. A lot of them have sugar. And we've found in our studies that toddlers, infant products, they're all kind of used interchangeably by a lot of these parents. And so I don't think that ultra-processed foods at their core, especially the ones that are made for babies, are necessarily like the worst things in the world. Things like iron-fortified cereals are also ultra-processed. A lot of those, like yogurt melts and teethers, also have a lot of like B vitamins and iron in them. And so it does give them exposure to some of those nutrients that we're concerned about. But if it's also increasing their added sugar and their sodium and it's programming their preferences for these flavors, I think that that's where we start to run into problems, but we just don't know if that is making a difference quite yet.

You know, and I get it, some of those are convenient, especially, you know, those pouches, those applesauce pouches. And now there's like so many things in there. They have like some cereal and kale and all these different things kind of in this beautifully packaged pouch that makes it easy when you're on the go. And at the same time, they're not getting that sensory experience of food, which I think is so important for the baby. They're not, like you have mentioned, putting it on their face, rubbing it in their hands, smelling it, they're just getting it from package to mouth. So I think that eliminates a lot of that sensory exposure, which is super important for infants.

I absolutely agree. And I think you don't have to be perfect. If you're out at like the zoo or something, like, yeah, a pouch is great. Like if you don't have time for your baby to like make a mess of the high chair, I think a pouch can be a really good convenience option, but it probably shouldn't be like our only option that we're giving.

Yeah, I agree. Variety is key for us as adults, but also for your baby too. Absolutely. So, Kinsey, we've talked about quantity, like how much we should be consuming, when we should be introducing these foods, but we haven't really touched on what your favorite first foods are. And so I would love to hear what the guidelines say and what are your recommendations.

So we don't have, I would say, like fantastic evidence of like this one food is like the best superfood you can give to your baby. That's the absolute one you should start with. I think a lot of parents find it easier to start with like non-allergen related foods to get them like a little bit of experience under their belt before we like jump in with peanut butter. So my first food recommendation is almost always like some sort of meat product. Like I think steak is a really good one for your baby to chew on. Um, you can even do things like a ground beef patty. I think a lot of parents find it easier to start with like a vegetable. And so if we're gonna start with a vegetable, I often say something like a sweet potato or something with like a pretty high vitamin A content is usually where I go to first. So I say anything that's an iron-rich source should be food number one. And then following that, some sort of vegetable.

Yeah, it's interesting because the guidelines have changed. I remember when I was in school as a dietitian, it used to be to avoid, you know, fruit and you want to introduce vegetables first, and you would start with like the yellow and then the green, and like there were colors that we would suggest. And the thinking was because fruit is sweet, if we introduce that first, then they're gonna have this bent toward sweet food. And we've kind of debunked that now, but I would love your perspective on that. Do you think that's true? Is it perfectly fine to start with something that's sweeter? Just your thoughts on that.

I think it's totally fine. Again, like we've talked about everything in moderation and variety. So yeah, you probably shouldn't have them having, you know, fruit is every meal and like not giving any other products. But for the most part, if you're giving your baby enough variety, it's also like not the worst thing in the world if your baby grows up preferring to eat fruit because we know that fruit is still good for you, even if there does, like there is some sugar in it.

And what are your thoughts on iron fortified infant cereal? This is sort of a hot topic sometimes that comes up in the news and that's you know, back in the day with the rice and the arsenic. So just your thoughts on that. And if parents want to use infant rice cereal, what are you recommending?

Yeah, I say if that's the only way that you can get iron in, like if you're really like, I'm not gonna give meat, I'm not comfortable giving beans yet. Like, if that's the only iron source you have, like absolutely use it. I typically recommend either like an oat or like a multi-grain rice cereal, anything that might be a little bit more of like a whole grain option. But again, shifting more towards like a real whole food approach. So a bean or a lentil or steak, I think is the goal with iron.

Kinsey, this has been so fun. Thanks for letting me pick your brain. If people want to learn more about you or what you're studying, where can they connect with you online?

Yeah, online. I'm on Instagram and TikTok as Kinsey the RD. And then we are my lab, I guess, is located at Colorado State. And so we also do a lot of things on our lab website as well.

Awesome. I will link down to all of that below. Definitely get connected with Kinsey. Thank you so much for the gift of your time for and for being here today. Thank you for having me. It was great. And thank you guys for carving out some time for nutrition today. I will see you next week.