David Blatt

🥄 Baby-Led Weaning or Spoon-Feeding? What Actually Matters for Growth, Choking, and Iron

February 2, 2026 · by David Blatt

Based on the 2026 study "Baby-Led Weaning vs Traditional Spoon-Feeding: A Systematic Review of Infant Growth, Choking Risk, and Iron Status Among Infants Aged 6–12 Months", Márquez-Díaz & others, Nutrition Reviews. https://doi.org/10.1093/nutrit/nuaf288

Worried that baby-led weaning (BLW) could lead to choking—or that spoon-feeding might lead to overfeeding? You’re not alone, and this review looked directly at the safety and nutrition questions parents care about most.

🔬 The Problem: Parents Want Independence *and* Safety at the Same Time

Starting solids is a big developmental leap—your baby goes from milk-only to learning textures, chewing, and joining family meals.

BLW has surged in popularity because it encourages babies to self-feed soft, graspable foods from the start. Supporters say it may help with autonomy and self-regulation, while critics worry about choking and missing key nutrients like iron.

This review zeroed in on the practical questions behind the debate: Does BLW change growth? Does it change choking risk? Does it affect iron status?

📊 The Study: A Systematic Review of the Best Head-to-Head Trials

This paper was a systematic review registered in PROSPERO (CRD42023402900) and reported using PRISMA 2020 methods.

Where the evidence came from

Researchers searched PubMed, CINAHL, Cochrane Library Plus, BioMed Central, plus Google Scholar for gray literature, covering September 2022 to March 2023.

What studies were included

Only randomized clinical trials were eligible, and infants had to be starting complementary foods in the 6–12 month window.

In the end, they included 4 randomized controlled trials from 359 publications screened.

Who participated

Across all included trials, there were 898 infants total:

  • 457 in BLW/BLISS groups

  • 441 in traditional spoon-feeding groups

The trials took place in Turkey and New Zealand, and three of the four were part of BLISS—a modified baby-led approach designed to emphasize iron-rich and energy-dense foods.

How results were analyzed

Because there were only a few studies and some inconsistent reporting, the authors did not run a meta-analysis. Instead, they used a “hybrid synthesis,” combining effect estimates and “vote counting” by direction of effect, with visual plots.

📈 The Results: BLW Looks Comparable on Choking and Iron, Mixed on Growth

✅ BLW may be linked with lower overweight in one trial — overweight 0 vs 17; average weight 10.4 vs 11.1 at 12 months

⚖️ Another trial found no clear difference in overweight — overweight 10.3% vs 6.4%

⚖️ Choking incidents were similar in one trial — choking cases 2 vs 3

⚖️ Across another trial, choking rates didn’t differ by feeding method — 35% choked at least once between 6 and 8 months, with no group difference

⚖️ Iron intake looked essentially the same in one trial — iron intake 7.97 vs 7.90

⚖️ Hemoglobin was essentially the same across trials that measured it — 12.28 vs 12.24 at 12 months; and 11.6 vs 11.7 at 12 months

⚖️ Ferritin showed no meaningful difference in the BLISS trial — difference about -2.6

⚖️ Gagging changed over time (not the same as choking) — about 1.6 times more frequent at 6 months and about 0.6 times as frequent at 8 months in the baby-led group

🧠 How It Works: Why BLW Might Not Be Riskier (When Done Well)

A big takeaway from this review is that BLW isn’t automatically “more dangerous”—but how it’s implemented matters.

1) Choking risk depends heavily on supervision and food prep

The review notes that caregiver education—like understanding the difference between gagging (common while learning) and true choking (airway emergency)—is a major safety factor.

2) Iron outcomes may hinge on whether families are guided toward iron-rich foods

Three of the included trials used BLISS, which specifically encourages iron-rich options (and energy-dense foods), which may help explain why iron intake and iron markers looked similar across groups.

3) Growth is influenced by more than feeding “style”

The authors emphasize that growth differences could reflect differences in breastfeeding duration, diet quality, caregiver support, and other family factors—not just whether the baby self-feeds or is spoon-fed.

🎯 What This Means for You: How to Choose a Feeding Approach Without Panic

If you’re deciding between BLW and spoon-feeding, this review supports a calmer, more flexible mindset:

If choking is your #1 fear

This review found no clear evidence that BLW increases choking risk compared with spoon-feeding, at least in the included trials.

What seems most important is:

  • Close supervision during meals

  • Appropriate food size/texture

  • Learning what true choking looks like vs gagging

If iron is your #1 concern

The trials that measured iron outcomes generally found no meaningful differences between approaches.

Practical move: whichever method you use, make sure iron-rich foods show up early and often (for example, soft meats, well-cooked legumes, eggs, iron-fortified options). The paper strongly emphasizes caregiver education here.

If growth and weight are your #1 concern

The evidence was mixed: one trial suggested lower overweight with BLW, another didn’t show a clear difference.

So rather than choosing a method hoping it “prevents obesity,” focus on what the review implies matters more in real life:

  • consistent routines

  • responsive feeding (pay attention to hunger/fullness cues)

  • nutrient-dense foods

  • support and guidance that fits your family

A helpful compromise many families use

Nothing in this review suggests you must be “all BLW” or “all spoon.” A blended approach—some finger foods, some spoon-feeding, and gradually handing over the spoon—may capture the benefits of both while staying aligned with safety and nutrition goals.

⚠️ Caveats: Why You Shouldn’t Over-Interpret These Findings

  • Only 4 trials were included, so the evidence base is still small.

  • No meta-analysis was possible, which limits the ability to produce one clear pooled estimate.

  • Several studies came from the same BLISS research program, and results may not generalize to every setting or family.

  • Choking outcomes were largely caregiver-reported, and the review flags the need for clearer, more objective definitions in future research.

💡 The Bottom Line: BLW Can Be Safe—But Education Is the Real “Secret Ingredient”

This systematic review suggests that baby-led approaches (BLW/BLISS) do not increase choking risk and do not worsen iron status compared with traditional spoon-feeding—while effects on growth are still uncertain.

If you take one practical point from the science, make it this: the safest, healthiest feeding method is the one you can do consistently—with informed food choices and strong choking-prevention habits.