It was a fascinating meeting and exchange that I had the chance to have with Gill Rapley. Her name probably doesn't ring a bell, yet she is part of many of your lives. Gill, a doctor in paediatric nutrition, is the one who first put a name to Baby Led Weaning (BLW) and the author of the best-selling book " Baby Led Weaning ".
I asked her several questions to find out about her background, her discovery of EMR and her various research on baby's dietary diversification.
Can you introduce yourself, what is your professional background?
I was a health visitor from 1978 to 1996. A health visitor is similar to a nurse or nursery nurse, with particular responsibility for children under five. He or she is in contact with all parents and advises them on all aspects of child rearing and family health, of which nutrition is an important part.
I have also been a midwife and lactation consultant (IBCLC). I have always been interested in how babies are able to feed themselves, and recognised that many feeding problems are created by people trying to control the baby's feeding.
How did you find out about EMR?
I 'discovered' EMR during my work as a health visitor - but I didn't know it was that at the time!
In my work, I met many parents whose babies at about 8 months of age refused to eat some or all of the food offered to them on a spoon. However, the parents often told me that their baby would eat the same thing if they were allowed to take the piece themselves. In addition, when parents let their babies feed themselves, they were willing to eat a much wider variety of foods. So it seemed to me that it was the feeding, not the food, that was causing the problem.
So I started to encourage all parents to let their babies feed themselves as soon as they seemed to want to, rather than waiting for a problem to develop.
Part of my role as a health visitor was to monitor and assess the infant's development.
At 6 months, this means a baby who can sit upright (with some support), reach out for things that interest him, grab them... and put them in his mouth!
As I learned more about how babies breastfeed and their feeding instincts, I became increasingly interested in how they could naturally and spontaneously switch to solid foods, given the opportunity.
During this same period, I had three babies of my own! Like many parents in the 1980s, I started spoon-feeding them from 4 months onwards, according to current advice. But it didn't feel right and my heart wasn't in it. By the time I had my third baby, I was confident enough to trust her, rather than follow the rules. She showed me that she was ready to start eating solid food by reaching out and grabbing it. This was EMR - but it didn't have a name, so we didn't talk about it. In fact, many parents who practised it thought they were being lazy, because it was so much easier. Twenty years later, my research showed me that I was right to let my youngest child lead the way with food.
It is important to remember that EMR is not new and I do not claim to have invented it. It has been practiced by many parents around the world for generations. What is new is the name, and that is what makes it possible to talk about, share and understand the process.
Can you give me your definition of EMR? Since you are the one who called it that.
DME is an approach to introducing solid foods that allows the baby to set the pace. From around 6 months, babies sit at the table with their parents and are given the opportunity to handle food and feed themselves, without a spoon or puree.
Although the term "BLW" includes the word "weaning", it is not the end of breastfeeding. Rather, it is the beginning of a long process that ends with the termination of breastfeeding. Letting the baby lead the way ensures that the timing of the start of this process is right for the baby.
DME allows babies to explore and learn about food - and practice chewing it - before they need it to feed themselves. It works because all healthy babieswith no particular problems start reaching out and grasping objects (toys, mobile phones, car keys, etc.) at around 6 months of age, and they put everything in their mouths. They do exactly the same with pieces of food. They are motivated by curiosity, not hunger. If we let them explore food at their own pace, without pressure, they not only learn the properties of food, but they discover that meals are enjoyable.
For most babies, early non-dairy foods should be seen as a source of learning and skill development, not as food - the baby can still get everything he or she needs nutritionally from breastfeeding (breast milk or formula).
Only later will they discover for themselves that this new food fills their tummy.
Babies want to handle food. They seem to need to explore it to know that it is safe. Most adults would not be happy to allow someone else to put something in their mouth that they have not seen or do not recognise - and babies are not born able to recognise adult food! They also need to see adults putting food in their own mouths that looks the same. So they need to share food and meals with adults.
Finally, babies want to be independent. Feeding builds self-esteem and independence.
Is it possible to do mixed DME, especially when baby goes to the nursery at lunchtime?
Let's be clear: I'm all for parents doing what's best for them and their child. If that means a combination of spoons and self-feeding, so be it.
But these are two very different approaches to feeding.
DME is not just about giving your baby takeaway food, but also about trusting them to know what they need - and how much - and giving them enough time to eat and explore. If you are also spoon-feeding, you are not really trusting your baby and not giving him time to do so. In this case, the whole approach is parent-led, not baby-led.
Many parents who say they are 'doing a bit of both' are actually just following the conventional approach, without realising it.
A generation has passed since EMR was first talked about and most parents today are unaware of the advice that was common before 2002. Back then, solid foods were recommended from 4 months, with finger foods introduced from 6 months, in addition to the purees the baby was already receiving. What was new about DME was not the fact that babies were fed themselves at 6 months, but the lack of need for purees and spoons.
Babies are hardy and flexible. Many cope very well with a parent-led approach while nursery staff do something different. This is probably much less confusing for the baby than when parents try to combine the two approaches at home. On the other hand, there are babies who, after having had the opportunity to feed themselves, start to refuse the spoon. Therefore, some nurseries are forced to offer EMR!
It is important to talk to nurseries etc. about EMR. There are many advantages to this approach for them. Staff can supervise several babies eating at the same time, rather than having to feed them individually. And babies can eat alongside older children. Staff will also see benefits in babies' gross motor skills, social skills, etc. In the UK, many nurseries are now adopting EMR and encouraging parents to try it.
In France, 15 to 20% of parents use EMR. It is still a little known practice, especially among health professionals. How does it work in England?
The UK does not have data on the proportion of families who follow EMR, but it is almost certainly over 20%. What is probably true is that many more parents claim to do it, or think they do, when they don't actually do it (see previous question!). Most have probably at least heard the term "Child-Led Diversion" even if they don't really know what it is.
Similarly, most UK health professionals (health visitors, paediatricians, speech and language therapists, dieticians, etc.) will have heard of it, although not all will have taken the time to find out what it means and why it can be beneficial.
Theknowledge of health professionals was largely guided by parents. At first, most health professionals were sceptical. But because parents were implementing EMR, professionals were compelled to learn more. Today, many professionals are very supportive of this approach. Researchers too have gradually become interested in the issue, especially as it has become clear that EMR is not just a temporary 'fad'.
Anything else to add about your findings and baby feeding?
Yes, some thoughts:
- The hardest part for DME parents islearning to trust their baby, especially when they think they will never eat anything! Many babies take several weeks to start swallowing solid foods, but it doesn't matter if they are healthy and taking breast or infant milk well.
- Breastfeeding and EMR go well together. In both cases, the best success is achieved if the baby is allowed to control the process. But this does not mean that babies fed on infant formula cannot feed themselves. If there is a difference, it is probably due to the parents, who may find it harder than breastfeeding parents to let go and trust their child.
- Finger food and self feeding have always been recommended from about 6 months. It is strange that concerns aboutchoking were hardly mentioned until people started hearing about EMR.
- It is possible that EMR offers a natural and safe way to introduce potential allergens to babies. Most self-feeding babies carefully examine each new food, sniff and lick it and experiment with small tastes. This ensures that they ingest very small amounts, which we now know is a good way to develop tolerance. Also, I have heard many stories of parents whose child avoided a particular food as a baby and was later found to be allergic to it. Babies seem to know how to protect themselves.
- I am often asked if EMR is suitable for all babies. It's a bit like asking " Is walking suitable for all babies?”. Clearly, some babies, for example those with certain disabilities or illnesses, and those born very prematurely, may need to be spoon-fed certain foods, either initially (because their nutritional needs precede their ability to feed themselves) or because their health condition means they will always need extra support. But this should not mean that they are not able to feed themselves as much as possible. We should be supporting each child in what they can do, rather than focusing on what they can't do. I know of several speech and language therapists who use an adapted form of EMR with their patients - particularly with children with Down's syndrome - with excellent results for their coordination, motor skills and independence, as well as their feeding.
- More research is needed on DME in general, but especially on choking. My observations of babies suggest that when they are able to, for example, bring a grape to their mouth without assistance, they will have developed the oral skills to manage it safely inside their mouth. I have also heard many parents say that as a toddler their DME baby was not interested in putting pebbles, Lego bricks, etc. in their mouth. We need to better understand the importance of allowing babies to experience food in their own way, developing their motor and oral skills as they go, in relation to the more general problem of choking in children.
To go further I invite you to discover his best-selling book " Baby Led Weaning, the essential guide«
5 Comments. Write a new one
[...] to know baby's nutritional needs and to start diversification or DME. So to help you with baby's meals, we've put together this meal/meal chart [...]
Excellent article! Can't wait to get started with my little one! Thanks
Thanks a lot! Glad you like it 🙂
Fascinating article! Many thanks to Gill Rapley for sharing her vast experience on the subject and to Ma Petite Assiette for her new bilingual journalistic talent...
Thank you very much for your feedback!