When I first introduced adapted baby-led weaning to the family of a 10-month-old girl with complex medical needs, her doctor and extended relatives were skeptical. Complications from Down’s syndrome meant she spent her first seven months in the hospital and relied on a feeding tube for nutrition.

By successfully adapting to baby-led weaning, she’s made a remarkable transition. She eats independently, enjoys family meals and no longer needs a feeding tube. While her success is life-changing, it’s an outcome I’ve witnessed countless times as a feeding therapist and founder of adapted baby-led weaning (ABLW).

ABLW is a modified version of traditional baby-led weaning for babies with motor or feeding challenges, such as pediatric feeding disorder (PFD). It follows the principles of transitioning to solid foods originally pioneered by Gill Rapley, PhD. It’’s adjusted to accommodate the needs of children with PFD, neurodivergence and/or delayed motoric capabilities.

What is adapted baby-led weaning?

Adapted baby-led weaning (ABLW) maintains the core principle of child-led feeding to foster motor skills and a positive relationship with food. It incorporates specific adaptations to safely use the approach for kids with additional feeding challenges. The timeline may vary depending on a child’s motor readiness, especially for kids with conditions like Down syndrome.

ABLW involves gradual progression, according to the child’s needs, and features “bridge” tools like silicone food holders and frozen straws to encourage skill development. The clinical team supporting a child with PFD should be involved with the transition to baby-led feeding.

The goal is to set kids up for a lifetime of healthier eating and enjoyment.

Starting adapted baby-led weaning for children with PFD

Most children with PFD benefit from adapted baby-led feeding. The process can take longer than typical baby-led weaning, but it eventually leads to safer eaters, who chew better and have improved digestion. ABLW helps children grow to become intuitive eaters who manage various food types –– regardless of shape, size or texture. Additionally, this approach can sometimes eradicate food aversions.

Following are some general steps to start. Each step includes many components.

Step 1: Assess readiness

Before starting, ensure your child is developmentally ready. This includes sitting with minimal support and showing interest in food. You can begin by offering teething toys.

Step 2: Choose appropriate foods

Begin with large, easy-to-hold foods like raw carrot strips or steak strips. If you’re just starting out, be especially careful when your child develops more hand and jaw strength. They may be able to get pieces off. When that happens, you’ll have to move away from those foods until they are older and have more evolved skill.

The goal isn’t to eat the food for nutrition or calories. Rather, it’s to practice hand-to-mouth coordination, texture and tasting. Introduce preloaded spoons with mashed foods and open-cup drinking with nectar-consistency liquids.

Step 3: Gradual progression

As the child’s skills improve, introduce foods like banana spears, cheese sticks, toast strips, waffles or pancakes. The goal is to eventually progress to small pieces of food while focusing on skill development rather than volume intake.

Do’s and don’ts of adapted baby-led weaning

Do’s:

1. Work with a clinician knowledgeable about adapted baby-led weaning: tailor the approach to your child’s needs by collaborating with a feeding therapist who understands baby-led weaning.

2. Encourage self-feeding: Let children feed themselves as soon as they’re ready to start ABLW, whether with foods or preloaded spoons.

3. Use bridge devices: Tools like silicone feeders and frozen straws can help develop chewing skills and alleviate parental concerns.

4. Monitor progress: Adjust the food’s shape, size and texture based on the child’s developing skills.

5. Emphasize skill development: Focus on improving hand-to-mouth coordination and gumming or chewing to make eating a learning experience.

Don’ts:

1. Avoid small, hard foods: When your baby is just starting ABLW, offer big foods, like a mango pit. Small foods can be choking hazards, especially for children with motor difficulties.

2. Don’t rush the process: Allow your child to develop independently. This approach may take longer but leads to safer and more skilled eaters.

3. Don’t be afraid to let your child get messy: As your child explores self-feeding, adapted baby-led weaning is messy, especially in the beginning. If the mess is a struggle, try ABLW before bath time.

Common misconceptions of baby-led weaning for kids with PFD

Myth 1: Adapted baby-led weaning is dangerous

People sometimes think baby-led weaning is dangerous because they believe it means the child eats only table foods and uses no spoons or purees. However, this is not true. Baby-led weaning means babies feed themselves from the onset. Parents might load a spoon with food and hand it to the baby, who then feeds themselves.

In the case where parents pick the wrong size and shape of food for their child’s skill level, self-feeding can be dangerous –– especially for children with feeding challenges. If done correctly with the help of someone knowledgeable, adapted baby-led feeding is not dangerous.

Myth 2: Baby-led weaning is only for typically developing kids:

Baby-led weaning can be adapted for children with feeding difficulties or neurodivergent conditions, including those who are tube-fed.

Myth 2: Babies need teeth to start baby-led weaning

Babies can gum their food effectively and safely start baby-led weaning without teeth.

Myth 3: Gagging means choking

Gagging is a protective reflex and a normal part of the eating learning process. Choking, on the other hand, is silent and requires immediate intervention.

Myth 4: Kids with NG-tubes or G-tubes can’t try ABLW

You absolutely can try ABLW for kids who have complex feeding issues, such as tube feeding or aspiration. You’ll need to work closely with experts and take precautions, such as adjusting thickness or modifying what you present. There are ways to offer different foods safely.

Some helpful baby-led feeding tools for kids with PFD

• Fresh fruit feeder: A silicon food holder for introducing new textures safely

• Big straws for frozen foods: Useful for practicing sucking and drinking skills

• Preloaded spoon: Helps teach self-feeding with mashed foods

• First open cup: Allows children to drink from an open cup at a slow rate

It’s hard to imagine needing to teach baby-led weaning to previous generations of parents when table food was the only option for children. Baby-led weaning is a natural and effective way to teach children self-feeding skills, while pouches of baby food and toddler-size cutlery are relatively new concepts.

Baby-led weaning can be particularly beneficial for kids with PFD, offering therapeutic benefits and fostering a more positive relationship with food. Always seek guidance from a feeding therapist, registered dietitian or doctor to ensure the approach is safe and tailored to your child’s needs.

For more information or access to adapted baby-led weaning education resources, go to JillRabin.com. Click here to see the book Rabin co-authored with Gill Rapley, the pioneer of baby-led weaning. Click here to see more helpful products for baby-led weaning.