Adapted Baby-Led Weaning (Adapted BLW): An Overview
“My baby was born prematurely, he can’t do baby-led weaning (BLW).”
“My baby has been tube fed. Is it possible for her to self-feed?”
“My baby has Down syndrome and they told me he can’t do BLW. Is this true?”
As health professionals working with babies starting solids, these are often concerns we may hear from caregivers. Since BLW is still a controversial topic, some find it challenging to believe this approach can be adapted to all babies (because yes, it can!), regardless of any diagnosis or condition they may have.
A baby with Down syndrome eating spaghetti autonomously / Source: Canva
Jill Rabin, speech-language pathologist and international board-certified lactation consultant, introduced the Adapted Baby-Led Weaning Approach® (ABLW) over a decade ago. The training she taught for my International Starting Solids Network was a gamechanger for the world of starting solids.
What is ABLW?
With BLW, babies self-feed with pieces of food at around 6 months. With ABLW, babies often start pieces of food later, and they may require more support and assistance. While it may take more time before they begin self-feeding, it is possible. The goal is that there is no pressure and that the baby is in control of the feeding.
Who can benefit from ABLW?
All babies! However, ABLW is specifically designed for neurodiverse babies and babies with feeding challenges. For example: babies who are born prematurely or tube-fed, as well as babies with a genetic condition, a history of gastrointestinal symptoms, allergies, food aversions, or motor challenges.
Why do ABLW?
ABLW provides many benefits. Among others, it helps with:
Core engagement
Eye-hand coordination
Midline orientation (some neurodiverse babies tend to use only one hand)
Practicing to chew, which helps with digestion (compared to swallowing purees)
Sensory input (exposure to different textures)
Because babies doing ABLW might find self-feeding more challenging, it is important to let them practice instead of assuming they will not be able to. In fact, it is suggested to start pre-feeding and therapeutic feeding before fully transitioning to solids.
What is Pre-Feeding and Therapeutic Feeding?
Pre-feeding and therapeutic feeding are part of a sensory-motor approach to help babies develop oral motor and feeding skills for a safe transition to solids (Overland & Merkel-Walsh, 2013).
Babies may need to work with a feeding therapist to develop foundational oral motor/pre-feeding skills that will help prepare them to safely transition to solids. Once they begin solids, therapeutic feeding techniques can be implemented by carefully selecting the shape, size, and texture of foods that will target specific feeding skills (Overland & Merkel-Walsh, 2013).
What is pre-feeding?
Pre-feeding is used to develop oral motor skills that will help with transitioning to feeding. Pre-feeding skills work on jaw, tongue, lip, and cheek movements (Overland & Merkel-Walsh, 2013).
Jaw strength and tongue movements are needed to develop chewing skills;
Lip closure helps with swallowing and straw drinking; and
Cheek stability can help with open-cup drinking.
Certain tools like Sensi® kits and Chewy Tubes® can be used to practice pre-feeding skills and get comfortable with different sensory inputs:
TalkTools® Sensi® kit
Chewy Tubes®
What is therapeutic feeding?
Therapeutic feeding is when a food is used to facilitate a feeding skill. A specific food is selected, like a meltable solid food, and the baby is assisted in placing it on their first molar area to encourage them to grip it with their gums, lateralize their tongue, and use enough jaw strength to bite through it (Overland & Merkel-Walsh, 2013).
Another example is we give a baby a flat mango pit or a meatless rib bone to work on lateral tongue movements and jaw strength. We do not expect the baby to take a bite, but rather use it as a food teether.
Bridge devices like silicone feeders and NumNum GOOtensils™ can also be helpful to support skill development and slowly introduce food.
To keep in mind with ABLW
Responsive feeding
Since babies doing ABLW may need more assistance with bringing food to their mouth, it is important to remember to practice responsive feeding and not force babies to put food teethers or therapeutic tools into their mouth. We want to encourage motivation and interest without feeling resistance from the baby.
A baby using a silicone feeder. He needs some assistance (left/up) and then self-feeds (right/down) / Source: Canva
Patience
Being patient is also important to keep in mind because it may take longer for babies doing ABLW to transition to a new texture. They may stay on purees or soft solids for a longer time before actively starting to chew pieces of food.
Providing safe food sizes: Big Small Big
To feed safely and minimize the risk of choking, the following progression is suggested:
Start with large strips in the pre-feeding stage that are easy for the baby to hold and gnaw on.
When the baby is ready, move to smaller pieces of food, like pieces of banana or avocado, to practice their pincer grip, lateralizing their tongue, and chewing skills.
Go back to larger pieces of food where the baby can learn to take graded bites, such as taking bites off of a sandwich.
The texture and shape of food can be modified according to the baby’s gross motor skills, hand-to-mouth skills, feeding skill development, and endurance.
As a health professional, you must attend the 2-hour training on ABLW to be more confident. Videos of real cases are included, and you learn all about how different babies require different tools, types of foods, and approaches to feeding.
Challenges can arise in all babies starting solids, and you will certainly find strategies used in ABLW that are practical and beneficial for the babies you work with.
Reference
Overland, L. & Merkel-Walsh, R. (2013). A sensory motor approach to feeding. TalkTools.
Thank you to Jill Rabin, SLP and IBCLC, for having provided the content for this post. Written by Angie Daher, McGill University Dietetics student, and edited by Jill Rabin & Jessica Coll