Abstract
BackgroundThe traditional spoon-feeding approach to introduction of solid foods during the complementary feeding period is supported by consensus in the scientific literature. However, a method called Baby-Led Introduction to SolidS (BLISS) has been proposed as an alternative, allowing infants to self-feed with no adult interference. To date, there have been no trials in the Brazilian population to evaluate the effectiveness of BLISS in comparison to the traditional approach.Methods/designTo evaluate and compare three different complementary feeding methods. Data on 144 mother-child pairs will be randomized into intervention groups by methods: (A) strict Parent-Led Weaning; (B) strict Baby-Led Introduction to SolidS; and (C) a mixed method. Prospective participants from Porto Alegre, Brazil, and nearby cities will be recruited through the Internet. The interventions will be performed by nutritionists and speech therapists, at 5.5 months of age of the child, at a private nutrition office equipped with a test kitchen where meals will be prepared according to the randomized method. The pairs will be followed up at 7, 9, and 12 months of age. Data will be collected through questionnaires designed especially for this study, which will include a 24h child food recall, questionnaires on the child’s and parents’ eating behavior, oral habits, eating difficulties, and choking prevalence. At 12 months of age, children will undergo blood collection to measure hemoglobin, ferritin, and C-reactive protein, saliva collection for analysis of genetic polymorphisms, and oral examination. Anthropometric parameters (child and maternal) will be measured at the baseline intervention, at a 9 month home visit, and at the end-of-study visit at the hospital. The primary outcome will be child growth and nutritional status z-scores at 12 months; secondary outcomes will include iron status, feeding behavior, acceptability of the methods, dietary variety, choking, eating behaviors, food preferences, acceptance of bitter and sweet flavors, suction, oral habits, oral hygiene behavior, dental caries, gingival health status, and functional constipation.DiscussionThe trial intends to ascertain whether there are potential advantages to the BLISS complementary feeding method in this specific population, generating data to support families and healthcare providers.Trial registrationBrazilian Clinical Trials Registry (ReBEC): RBR- 229scm number U1111-1226-9516. Registered on September 24, 2019.
Highlights
The traditional spoon-feeding approach to introduction of solid foods during the complementary feeding period is supported by consensus in the scientific literature
An alternative approach named Baby-Led Weaning (BLW) which consists of allowing the infant to make their own food choices, deciding the quantity and sensory characteristics of food according to their own energy needs, has been widely disseminated through digital media [11]
The Brazilian guideline recommends traditional spoonfeeding based on responsive feeding and suggests that soft foods can be offered to the child to handle if they are large pieces, and that meals have their consistency gradually progressed until, at twelve months of age, they reach a food consistency used by the child family [13]
Summary
Adequate nutrition in early childhood has the potential to influence health consequences in later life. With growing recognition of the importance of nutrition in the early stages of life for health and discussion as to the best method for introducing complementary foods, investigation of best feeding practices at this stage should be a high priority. Other authors have published studies of food introduction methods [18, 52], none has been conducted in the Brazilian population with this approach. Additional pioneering contributions of this study will be reporting on the potential association of food introduction practices with prevalence of functional constipation, eating difficulties, oral health, and flavor outcomes. Our findings will bridge the research gap on complementary feeding methods, with potential impact on short- and long-term health outcomes.
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