Infants who feed themselves at no greater risk for choking

Infants who feed themselves are no more likely to experience choking than infants who are spoon-fed, an experiment found.

In what’s known as baby-led weaning, infants feed themselves small, graspable pieces of food. In contrast, infants who are spoon-fed are provided puréed foods by an adult.

Baby-led weaning appears to be increasing in popularity, but concerns have been raised about whether it increases the risk of choking on food.

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To investigate, researchers in New Zealand randomly assigned 206 infants to a modified baby-led weaning group or traditional feeding.

In the study, those in the baby-led group received extra contact and support by phone or face to face with a certified lactation consultant as well as extra home visits from a research assistant to reinforce choking prevention.

For instance, parents were strongly encouraged to delay the introduction of complementary foods to six months when infants were able to sit upright and feed themselves safely.

Researchers also gave the parents questionnaires about their babies at six, seven, eight, nine and 12 months. The questionnaire asked about:

• Choking, when a piece of food partially or completely blocks the airway, affecting breathing.
• Gagging, a reflex closing of the throat and pushing the tongue to the front of the mouth.

Those who reported choking were asked more questions about symptoms, who resolved the choking, the food, what form it was fed in and who fed the child.

Choking risk foods

The number of children who choked did not differ between the two groups at any age, associate professor Rachael Taylor of the department of medicine at the University of Otago and her co-authors said in Monday’s issue of the journal Pediatrics.

“Infants following a baby-led approach to feeding that includes advice on minimizing choking risk do not appear more likely to choke than infants following more traditional feeding practices. However, the large number of children in both groups offered foods that pose a choking risk is concerning.”

Half of all infants were offered one or more foods posing a choking risk during three days of diet recording at seven months of age. Most of these events occurred when infants were feeding themselves, regardless of the study group.

The researchers’ list of foods to avoid when introducing solids includes very small foods such as nuts and grapes, raw vegetables, raw apple, hard fruit, citrus fruits unless each segment is peeled, popcorn, sausages, carrots or other food cut into rounds or coins.

“Close supervision of all infants’ eating occasions (regardless of the method of infant feeding) is of paramount importance so that any unavoidable episodes of choking can be identified and managed promptly,” the study’s authors recommended.

They cautioned the results shouldn’t be extrapolated to unmodified versions of baby-led weaning.

The researchers also suggested giving caregivers advice on cutting up raw vegetables. They acknowledged parents received a wealth of information in the first year of a child’s life and choking-related messages could be overshadowed by breastfeeding or safe sleeping advice.

The low response rate, 23 per cent of eligible births, is a drawback of the study. The sample was also socioeconomically advantaged, which may not generalize to other populations. 

The study was funded by Lottery Health Research, Meat Livestock Australia, Karitane Products Society, Perpetual Trustees, the New Zealand Women’s Institute, and the University of Otago, with contributions from Heinz Watties Ltd.