Introduction

From the age of six months, international guidelines recommend the introduction of complementary foods of different textures, flavours and appearances alongside breast milk [1]. Breastfeeding, which should continue until 2 years of age or beyond [2], or formula feeding, as the baby is introduced to complementary foods, is gradually reduced during this period. The introduction of complementary feeding is a crucial stage of growth for children that has long-term effects on physical, cognitive, and socio-emotional well-being [3]. Given the potential influence that the methods for introducing complementary feeding can have on developmental domains, this transition period has drawn substantial attention. One such approach is Baby Led Weaning (BLW) which is recognized for promoting independence, helping to regulate food intake, and can encourage healthier eating habits in a safe environment [4]. BLW is gaining popularity in scientific literature [5]. Supporters argue that it fosters autonomy, develops motor skills, and positively impacts eating habits and acceptance of healthy foods [6]. Recent studies have investigated the BLW method, namely its effect on the risk of choking [7,8], iron status [9], anemia and obesity [7] and concluded that the BLW does not pose any risks compared to the traditional approach. However, most authors state the dearth of sufficient evidence, which has led to the lack of internationally accepted guidelines or their recommendation of the BLW method over traditional forms of introducing complementary feeding [10].

Literature on BLW has focused on how it’s implemented, how it affects children’s health, the perspectives of those involved (parents and health professionals [HP]) and/or a mixture of the above. Of these areas, the least studied are the perspectives of HP [11,12], even though their influence on parents’ choice of methods for introducing complementary feeding is recognized [13].

HP, including nurses, dietitians, pediatricians, and general practitioners, play a crucial role in promoting safe feeding practices. Improved education and increased research into BLW are essential to provide evidence-based guidance, helping parents make informed decisions about their children’s nutrition and development. BLW remains as scientifically under-researched subject [12]. Authors agree that there is a lack of sufficient studies, both on the method itself [5,10] and, more specifically, on HP perspective [11,12]. We aim to determine the knowledge and attitudes of HP familiar to BLW regarding the use of this method in complementary feeding. Additionally, we seek to evaluate how socio-demographic characteristics influence HP’ knowledge and attitudes towards BLW.

Materials and methods

Results

Initially, 180 HPs participated in our study, but the application of inclusion/exclusion criteria resulted in a final sample size of n = 118, as described in Fig 1.

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Fig 1. Flow diagram on sample recruitment and exclusion.

https://doi.org/10.1371/journal.pone.0334768.g001

Table 1 details the sample distribution regarding socio-demographic characteristics and general knowledge about the BLW method.

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Table 1. Participants’ socio-demographic characteristics and general knowledge about BLW.

https://doi.org/10.1371/journal.pone.0334768.t001

Most respondents were female (86.4%) and nurses (78%). The age distribution reveals a relatively older population, with 39.8% being 50 years or older. The sources of information on this method were relatively evenly distributed among training, websites, other healthcare professionals, and the parents or caregivers themselves.

Most respondents were aware of the benefits of the BLW method (86.4%). Only a small portion of respondents (23.7%) had never recommended the application of this method, and 53.4% had already witnessed children consuming food according to the BLW method. The results of the inferential analysis with independent and dependent variables are presented in Table 2.

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Table 2. Variables statistical correlation analysis between socio-demographic and general knowledge about BLW and the dimensions of the instrument.

https://doi.org/10.1371/journal.pone.0334768.t002

Among the three constituent dimensions, positive child-centred contributions showed the highest mean values, followed by positive parent-centred contributions. In contrast, mean scores for BLW constraints were lower, indicating fewer perceived difficulties associated with the method.

The variable profession did not present a normal distribution; therefore, the non-parametric Kruskal-Wallis test was applied. No statistically significant differences were observed among professional groups across the three dimensions. For all other variables, assumptions of normality and homogeneity of variance were met, and one-way ANOVA tests were performed. Partial eta squared (η²ₚ) and observed power (π) were also computed.

The sex variable proved to be statistically significant in relation to the positive child-centred contributions dimension F (1,118) = 22.792; p < 0.001; η²ₚ = 0.164; π = 0.997) with female HP demonstrating a more positive attitude (M = 4.3; SD = 0.59) compared with male HP (M = 3.5; SD = 0.53). In the positive parent-centred contributions dimension (F (2, 118) = 5.187; p < 0.025; η²p = 0.043; π = 0.617), women also demonstrated more positive attitudes (M = 3.7; SD = 0.74) than male HP (M = 3.2; SD = 0.42).

Age emerged as a differentiating factor across all three dimensions, in positive child-centred contributions (F (2,118) = 7.517; p < 0.001; η²ₚ = 0.116; π = 0.939), in positive parent-centred contributions (F (2,118) = 3.886; p = 0.023; η²ₚ = 0.063; π = 0.692) and in BLW constraints (F (2,118) = 3.662; p = 0.029; η²ₚ = 0.060; π = 0.664). A post hoc Tukey HSD test revealed significant that younger participants (23–39 years) reported higher positive child-centred contributions than those aged 40–49 years (p < 0.001) and ≥ 50 years (p = 0.011). Similarly, they reported higher positive parent-centred contributions than the 40–49 group (p = 0.017). Regarding BLW constraints, younger participants perceived fewer constraints than those aged ≥ 50 years (p = 0.029). No other pairwise comparisons reached statistical significance.

Participants who were aware of the benefits of BLW exhibited a significantly more favourable representation of its implementation (F (1,118) = 25.560; p < 0.001, η²ₚ = 0.181; π = 0.999), reporting higher positive child-centred contributions (M = 4.3; SD = 0.58) and higher positive parent-centred contributions (F (1,118) = 5.187; p = 0.025; η²ₚ = 0.043; π = 0.617; M = 3.7; SD = 0.73). Similarly, health professionals who frequently or always recommend BLW demonstrated a more positive perception and less apprehension regarding its implementation in children (F (3,118) = 15.433; p < 0.001; η²ₚ = 0.289; π = 0.999), reported greater positive parent-centred contributions (F (3,118) = 9.466; p < 0.001; η²ₚ = 0.199; π = 0.997), and perceived fewer BLW constraints (F (3,118) = 5.389; p = 0.002; η²ₚ = 0.124; π = 0.928).

A Tukey HSD test was performed to examine differences in the three dependent variables. For positive child-centred contributions, significant differences were found between those who never recommend BLW and all other groups – sometimes (p < 0.001), frequently (p < 0.001), and always (p = 0.009) – indicating that those who never recommend BLW reported markedly lower scores. For positive parent-centred contributions, participants who never recommend BLW scored significantly lower than those who sometimes (p = 0.008) or frequently (p < 0.001) recommend it. Additionally, those who sometimes recommend BLW scored higher than those who frequently do (p = 0.025).

Regarding BLW constraints, significant differences were observed between those who never recommend BLW and both the frequently (p = 0.044) and always (p = 0.039) groups, as well as between the sometimes and frequently (p = 0.021) and always (p = 0.038) groups. Overall, participants who more often recommend BLW perceived fewer constraints related to the method.

HP who had observed a child eating according to the BLW method evaluated it as more beneficial in terms of positive child-centred contributions (F (1, 118) = 8.510; p = .004; η²p = 0.068; π = 0.825; M = 4.3; SD = 0.50) and positive parent-centred contributions (F (1, 118) = 4.084; p = 0.046; η²p = 0.034; π = 0.518; M = 3.7; SD = 0.66). Finally, HP who had witnessed a child eating according to the BLW method evaluated it as more beneficial in a positive child-centred contributions (F (1,118) = 8.510; p = 0.004; η²ₚ = 0.068; π = 0.825; M = 4.3; SD = 0.50) and in greater positive parent-centred contributions (F (1,118) = 4.084; p = 0.046; η²ₚ = 0.034; π = 0.518; M = 3.7; SD = 0.66).

Discussion

This study examined the knowledge and practices of HP already familiar with the BLW method. Findings suggest that these professionals generally hold a positive attitude toward BLW and recommend it as a strategy for introducing complementary feeding. This favorable perspective may be influenced by the perceived benefits of the method, such as promoting motor development, encouraging infant autonomy, and greater likelihood of developing a diverse and balanced diet [12]. These advantages are believed to contribute to key developmental milestones and foster healthy eating habits in early childhood. The literature also suggests that in addition to these benefits, BLW is consistent with the introduction of solid foods when the baby shows signs of readiness, promotes food variety, and help with early exposure to different textures, which supports the development of chewing skills and acceptance of new foods [19]. Also, BLW promotes respect for hunger and satiety cues, which helps prevent overfeeding and supports intuitive eating [15,19–21].

Among HP who accepted to participate in our study and were involved in child nutrition, 31 were not aware of the BLW method as Fig 1 details. This highlights a gap in professional training and practice that does not include this approach to infant feeding. Continuing education is crucial to ensure professionals are aware of new practices and research in child nutrition [11]. This lack of knowledge not only affects the quality of guidance offered to families but can also impact children’s health and development. Uninformed professionals may discourage parents from exploring this approach, even though it has benefits for both parents and children. As the children play an active role in the use of this approach, it has advantages over the traditional method in that it gives them greater involvement in their own feeding. The absence of accurate information can create confusion among parents, who may find contradictory information in unreliable sources such as social networks and blogs [22,23]. This misinformation can lead to unsafe eating practices and, consequently, long-term health problems [24].

Our results highlight that HP who are women have a more positive attitude than HP who are men towards the BLW method, which may be attributed to social, cultural and psychological factors that shape the childcare experience. Historically, women have been associated with childcare and nutrition [25], which may result in a greater predisposition to adopt methods that emphasize children’s autonomy and health even among HP. Furthermore, literature has established that caregivers who are women, especially mothers, often seek information about child nutrition and childcare in support groups [26], social networks [27] and specialized literature [28]. It is reasonable to hypothesize that a similar pattern occurs among female HPs, where a more active search for information may contribute to a more positive attitude towards the BLW method, as our results suggest.

Several recent studies [11,15] and a 2024 scoping review [12] show that HP’ awareness of BLW is high but recommendations vary, often reflecting differences in perceived safety, training, and information sources. In mixed-methods and qualitative studies, parents commonly report learning about BLW through informal and social-media channels rather than only through HP advice, and HPs identify limited training and concerns about safety as reasons for cautious recommendations [11,12,15].

In our study, the sample included health professionals of different ages and genders; however, we observed that female and younger HPs (23–39 years) tended to demonstrate a more positive attitude toward the BLW method compared with their older or male counterparts. Although few studies explicitly test HP age or gender as primary predictors of attitudes toward BLW, literature on generational differences and technology use indicates that younger clinicians and recent graduates are more engaged with digital media and are often more open to adopting novel practices [29,30]. Together, these findings support the interpretation that sociocultural factors, broader access to online information, and evolving family dynamics may contribute to younger and female HPs holding more positive attitudes toward BLW compared with older colleagues [1,15,31].

In our sample, acceptance of and positive attitudes toward BLW were similar across healthcare professionals, regardless of their specific role: nurses; nutritionists; and other HP. This may be attributed to growing evidence supporting the benefits of this approach. Scientific consensus can facilitate communication between professionals, allowing them to offer cohesive and well-founded guidance to families, regardless of their area of intervention. When different professionals share a common vision, families receive consistent and reinforced information about food introduction. This not only improves parents’ understanding of the method but also contributes to the implementation of safe and effective feeding practices. Furthermore, it can encourage interprofessional collaboration, promoting more holistic and family-centered care. However, studies indicate that there is still a lack of comprehensive understanding and conflicting information about BLW, and that there is still a great need for research in this area [32]. Some authors even mention that, for this reason, there is still a limited percentage of professionals who recommend the method [16,17]. Our results differ from these findings, probably because only HP familiar with the BLW approach were included. Including all HP, knowledge or not regarding BLW, could lead to different results.

The growing popularity of BLW represents a significant shift from traditional spoon-feeding practices toward a more infant-led, autonomy-based approach. From a public health perspective, this shift underscores the importance of ensuring that families receive accurate, evidence-based information to minimize potential risks, while optimizing benefits related to self-regulation and dietary diversity [10,14,16]. Consequently, the increasing adoption of BLW demands that healthcare professionals adapt their counseling to evolving parental preferences and emerging evidence. The literature highlights the need for clear, standardized guidance and further research on the safe and effective implementation of this method [10]. Continuing professional education and additional investigation into the long-term outcomes of BLW are therefore essential to ensure that healthcare professionals can provide consistent, evidence-informed support to families [14]. A balanced and informed approach that acknowledges both the benefits and potential risks of BLW will contribute to promoting healthy, safe, and developmentally appropriate feeding practices from the earliest stages of life.

Conclusions

Our findings suggest that regarding HP, women and younger age groups tend to have a more positive perception of the BLW method. No significant differences were observed between different types of HP, suggesting that BLW is similarly accepted across professions. The growing popularity of BLW reflects an ongoing shift in infant feeding practices toward more autonomy-based approaches, underscoring the need for healthcare systems to adapt to these changes. Clear, evidence-based guidelines are essential to ensure consistent and safe recommendations for families. Furthermore, sustained professional training and continuous access to updated evidence will enable health professionals to provide confident, informed, and standardized support for families adopting BLW.

Supporting information