Complementary Feeding and Risk of Choking: A Survey Among Parents and Primary Care Pediatricians in Emilia-Romagna, Northern Italy

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Abstract
Background: Complementary feeding has traditionally relied on traditional spoon feeding (TSF), in which parents gradually introduce semi-solid foods under close supervision. More recently, Baby-Led Weaning (BLW) has become popular, promoting infant autonomy in handling solid foods. To address concerns regarding choking and nutritional adequacy, the Baby-Led Introduction to SolidS (BLISS) method was developed. Some families instead adopt autonomous responsive feeding, which combines structured guidance with respect for the infant’s self-regulation. Although concerns about foreign body aspiration (FBA) persist among caregivers and pediatricians, current evidence shows that, when conducted safely, BLW may not increase this risk compared with TSF. This study investigated the prevalence of complementary feeding practices and their perceived relationship to FBA, exploring perspectives of caregivers and primary care pediatricians in Emilia-Romagna, Northern Italy. Methods: Between March 2022 and May 2024, 149 parents and 126 pediatricians completed anonymous questionnaires. Results: Among parents, 67% initiated complementary feeding at ≥6 months; 43.6% reported autonomous responsive, 32.8% BLW, and 23.5% strict TSF. Pediatricians more frequently endorsed flexible approaches: 61.1% supported autonomous responsive feeding, 37.1% BLW, and 12.7% TSF. Notably, strict TSF was applied by 23.3% of parents, almost twice the proportion recommended by pediatricians. Suspected choking episodes were reported by 41.6% of parents but showed no significant association with feeding method or demographic factors. Conclusions: BLW and related flexible practices are increasingly adopted and, when implemented safely, may not increase FBA risk. Pediatricians appear to recommend BLW, or hybrid approaches, more often than parents apply them, suggesting possible gaps in communication and shared decision-making.

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