All Babies Choke: Lessons from a Randomized Trial

For the video version click here.

This week we're talking about "Baby-led weaning". Google it if you'd like. Yes, it's a thing. The idea of BLW – as those in the know call it – is basically to let a kid eat solid food as soon as they can sit up and reach out for things – usually around 6 months. Here's a baby eating a pork chop. 

You can't argue with the expression.

See?

I can’t help but think about my mom here. I wasn’t allowed to eat bacon until I was 12, and even that was a negotiation.  Do babies who eat solid foods early choke more than babies raised on the traditional pureed mush? That was the question researchers in Australia posed when designing a randomized trial appearing in the journal Pediatrics.

I hereby avow that I will review any randomized trial with "baby-led" in the title.

They took 204 healthy newborns and randomized them to a standard diet – you know, that’s the pureed stuff we all ate from about 6 months on – versus “Baby-led Introduction to SolidS” or BLISS. Those in the BLISS group were encouraged, from 6 months on, to eat solid foods.

Now, the researchers were a bit strict about this.

They gave parents an extensive list of food to avoid - choking hazards like raw apples, nuts, and sliced carrots. They pointed out that any foods should be at least as long as the child's fist in one dimension. Mom, I would like to point out that bacon might be ok here.

Tonight's menu? An entire, cooked yam.

They evaluated the kids every 2 months to determine the rates of gagging and choking (the latter requires some sign of air stoppage).

The major findings?  The BLISS kids gagged more at 6 months, but less at 8 months – suggesting the earlier exposure might have helped them develop some mouth-muscle control. But in terms of choking – what we're really worried about – no difference.

Actually this is where the study got interesting to me, because I never really knew how often babies choke.

There were 199 choking events among the 204 kids. Fortunately 50% resolved without assistance but that still left 98 where the parent had to do something. Again, this was regardless of randomization to the BLISS group.

But here’s the interesting thing. The majority of the choking events occurred with foods that didn’t appear on the choking hazard list.  In fact, of the 3 choking events that required emergency medical assistance, two were due to milk.

Does a body good my foot.

So, moms and dads, and various busybodies, it seems that infants are going to gag and most of them, at some point, will choke. What they are eating might not matter. Just be there when it happens.

Future methodologist.