The Sensory-Motor Approach to Modified Baby-Led Weaning for Babies with Feeding Challenges

by Jill Rabin & Lori Overland

Baby-Led Weaning has become “all the rage” with many parents choosing this method of transitioning their little ones to solid foods. Everyone is jumping in, with speech pathologists, dietitians, occupational therapists and moms flooding social media and the internet with BLW courses, BLW Facebook pages, BLW food and Pinterest ideas and countless Instagram accounts. The mention of BLW often raises the eyebrows of many pediatricians, who often deem BLW as dangerous and greet even the idea of it with extreme apprehension, even with neurotypical babies. You can imagine the response when Baby-Led Weaning is suggested for babies with special needs!

I became interested in Baby-Led Weaning in the beginning of January 2013, when a lactation consultant colleague handed me a DVD and said “you really should watch this”. It was Gill Rapley’s DVD on BLW and my colleague had seen her present at a local conference. I watched it in its entirety and my feeding practices with young babies was forever changed! While this DVD focused on neurotypical babies, I saw so many positives in the approach for children with feeding and developmental challenges and thus my method of modified baby-led weaning began to evolve. I realized that babies with special needs couldn’t hold, grasp or bring certain foods and food shapes to their mouths, and also lacked some of the foundational feeding and motor skills necessary to safely self-feed. I had to come up with “bridge device” ideas and techniques to assist babies with physical and developmental challenges in being able to feed themselves safely, until they could transition to BLW just like their typically developing peers. Using optimal seating measures, silicone feeders, preloaded spoons, texturally safe foods and teaching parents responsive feeding techniques, many of my babies with special needs, including those with Noonan and Down syndrome, have become safe and efficient self-feeders. I have found that using this approach encourages core engagement, hand to mouth skill, refinement of fine motor skills and improved feeding/chewing skills, along with facilitating independence. After successfully using this approach with my special population, I sent a few videos to Gill Rapley, one of the authors of the BLW book. While I think Gill was initially reticent about it due to use of “feeding tools”, she realized the benefit of these “bridge” modifications and she and her co-author even had me write an essay for their 10th anniversary BLW book about modifying their approach.

In 2016, I gave a full day feeding course in my home state of Illinois, and part of the course was information on how I modified BLW for my patients with feeding challenges. I was warned that morning prior to the start of the course, that some people attending thought what I was doing was “crazy” and “dangerous.” I felt that at the conclusion of that course I was able to change some minds based on videos shown and how I safely used this approach to facilitate feeding ability. Skepticism in the attitudes of feeding professionals and using BLW with babies with special needs is finally starting to change. Feeding therapists are finally realizing the impact this method can have in creating independent, safe and intuitive, self-feeding babies who determine their intake, eating when they are hungry and stopping when they are full. There is now even an Instagram called @ableappetites that focuses on modified baby-led weaning with little ones with Down syndrome! The modified BLW approach can also be effective in helping babies who exhibit feeding aversion in their first six months with breastfeeding and/or bottle-feeding. I have found that in using this child-directed approach with transitioning to solids, we can often minimize and even eradicate the aversion.

This modified BLW approach became even more refined in 2018 when Lori Overland and I became friends at a feeding course (Kristie Gatto’s IAOM course). As Lori and I were two of the “older” attendees at the conference, we quickly bonded and happened to be sitting on the same side of the room. I started showing her videos of how I was modifying BLW, and while she initially found the approach “interesting”, she was skeptical and discerning about how underlying oral motor skills needed to be better addressed to ensure appropriate prerequisite foundational feeding skills. She returned to her practice and started trying some of these modified BLW techniques and began combining them expertly with her sensory-motor feeding techniques. We reconvened a year later and created “A Sensory-Motor Approach to Modified Baby-Led Weaning” which we presented at ASHA’s national convention in 2019. Lori and I will be presenting on this topic again on August 4th via a Talk Tools webinar (See link below). We combine Lori’s sensory motor approach to my modified baby-led weaning approach to facilitate optimal outcomes for our feeding challenged patients. We have really enjoyed the favorable response that our combined techniques have yielded from our peers! Here are some helpful ideas on ways to use this combined approach:

From Lori: As every baby will need a different prefeeding program based on their specific issues, it is hard to give therapeutic hints. Here is a summary of the sensory-motor approach to feeding:

A sensory motor approach to feeding starts with a task analysis of the skills for breastfeeding, bottle- feeding, spoon-feeding, chewing, cup drinking and straw drinking. As gaps in sensory motor development are identified, a pre-feeding program is designed. The goals of pre feeding and therapeutic feeding programs are to facilitate oral sensory motor skill development to support safe, nutritive

eating. For example, a child with a diagnosis of Down syndrome may mash or suckle foods in the front third of the mouth. A pre-feeding program may address jaw strength and stability to facilitate the ability to break down food on the chewing surface, cheek mobility (buccinator muscle) to assist in stabilizing a solid bolus, lip closure (upper and lower portions of the orbicularis oris muscle), elongation through the lateral borders of the tongue (transverse muscle) as a prerequisite to working on lateral tongue movement, and contraction through the sides of the tongue (superior and inferior longitudinal muscles) to facilitate tongue lateralization (Overland, L. & Merkel-Walsh, R, 2013).

From Jill: Modified Baby-Led Weaning Ideas:

To prepare for modified baby-led weaning, families may need some bridge devices such as flat-bowled spoons or a silicone feeder. It should be noted that not all babies with special needs will need these devices. First and foremost, proper seating to facilitate postural stability is essential.

Things to consider:

1. An adjustable highchair such as the Abiie Beyond wooden high chair or Stokke Tripp Trapp which both have a foot rest.
2. Consider purchasing flat bowled spoons such as Num Num Gootensils, eZtotZ or ChooMee, to use for preloaded spoons.
3. Consider purchasing a silicone feeder such as the Nature Bond feeder, to use as a “bridge” device to assist babies in bringing food to their mouths and to help facilitate chewing.

Link for Lori and Jill’s webinar scheduled for Tuesday, August 4th, 2020 at 12:00 p.m. eastern standard time

:https://talktools.com/collections/webinars/products/webinar-a-sensory-motor-approach-to-modified-baby-led-weaning-for-at-risk-infants-august-4-2020-12-2pm-eastern?variant=34724127015080

Overland, Lori L., and Robyn Merkel-Walsh. A Sensory Motor Approach to Feeding: Lori L. Overland and Robyn Merkel-Walsh. TalkTools, 2013.

Rabin, Jill. “Child-Directed Feeding.” Breastfeeding and Down Syndrome, edited by Ella Gray Cullen, Down Syndrome Pregnancy, 2019, pp. 153–165.

Rapley, Gill. Baby-Led Weaning, Completely Updated and Expanded Tenth Anniversary Edition: the Essential Guide to Introducing Solid Foods-And Helping Your Baby to Grow up a Happy and Confident Eater. Experiment LLC, The, 2019.