As a registered dietitian who focuses in family feeding, the main reason I recommend baby-led weaning (BLW) is because it encourages lifelong intuitive eating. BLW is a self-feeding, family-oriented feeding style. Baby picks up and brings the food to their mouth from the very first bite of solid food. Many parents are gravitating to this approach because it's convenient, cost-effective, and nutrient-dense. It also assists in development, teaches safe eating, promotes variety, and encourages positive eating.
Baby-led weaning works for most babies. There are some instances BLW is contraindicated. One of those is if baby has swallowing difficulties. With that being said, parents with a child with a tongue tie may not even consider doing baby-led weaning but this does not have to be the case. To explore this idea, the International Baby-led Weaning Network provided a training on tongue tie . The speaker was Carole Dobrich, a registered nurse and International Board Certified Lactation Consultant. Carole is an expert in tongue tie which is illustrated by her creation of an internationally used medical assessment of tongue tie and surgical intervention.
Here is a summary of what I learned during this training on baby-led weaning and tongue tie.
First, it’s important to know that there is still a lot to learn about tongue tie and starting solids. This can be seen through limited research around the subject. Currently, it’s recommended to take each child case-by-case when it comes to starting solids.
The main consideration is the function of the tongue. If the baby has been successfully moving breast or formula milk from the front of the mouth to the back of the mouth and swallowing it down, then it’s a good indicator of the working function of the tongue. Although it is less common, it is possible that issues with a tongue tie could start to occur when starting solids.
There are not general recommendations on the approach to start solids for a baby with a tongue tie. The speaker, Carole, conferred with a panel of the leading experts in tongue tie and asked what they recommend. The panel agreed that it doesn’t matter if a child is given pieces of food (BLW) or pureed foods first. Both approaches need the same amount of caution and education from the caretaker and assessment from a health professional. Professionals that could help you include registered dietitians, medical providers, speech therapists, and/or occupational therapists that are knowledgeable in tongue tie and family feeding. It is recommended that the health assessment should include the child eating food (not just a physical assessment of the mouth).
Safe eating is important for all babies and for all solid starting approaches. If parents are properly trained in baby-led weaning, then the baby and parent learn safe eating practices (see my webinar course "Beginning Baby-led Weaning"). It is also recommended for all parents to be trained in baby CPR/First aid before starting solids. Other than understanding general guidelines for safe eating and choking prevention, a parent with a baby with a tongue tie should also be aware of signs that the child is not coping with the feedings. These signs include excessive gagging, refusal, packing, expulsion, difficulty with multi-textured foods, poor intake and weight loss. Quickly identifying if baby is not coping with feedings is important to reduce the risk of choking and aspiration (1).
Keep in mind that for all babies, first feedings are not perfect. Baby is working on picking up food, putting it in their mouth, experiencing different tastes, smells, textures. Many times food doesn’t get into the mouth or if it does, it gets spit right back out. This is not necessarily a sign that baby is not coping with solids. It may just be part of the starting solids process or an issue with the environment or strategy. This is why guidance and assessment from a health care provider is important.
Babies with a tongue tie have individualized needs when starting solids and baby-led weaning can be an option for some babies. Work with me to learn more about BLW, create a plan for your baby, and to schedule a feeding assessment.
Maggie Perkins is a registered dietitian that does nutrition telehealth for families.
She focuses in family feeding, intuitive eating, and Health at Every Size©.
Her private practice, Tomata, is based out of North Carolina.
The material in this blog is not intended to be used as medical advice. Please work closely with a competent health care team on your specific medical needs.