Eleonora Laderchi

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.

Human milk (HM) is the best feeding option for preterm infants; however, when mother’s own milk (MOM) is not available, pasteurized donor human milk (DHM) is the best alternative. In this study, we profiled DHM microbiota (19 samples) using 16S rRNA amplicon sequencing and compared its compositional features with the MOM microbiota (14 samples) from mothers who delivered prematurely (PT-MOM). As a secondary study aim, we assessed the specific effect of pasteurization on the characteristics of the DHM microbiota. DHM showed significantly higher alpha diversity and significant segregation from PT-MOM. Compositionally, the PT-MOM microbiota had a significantly higher proportion of Staphylococcus than DHM, with Streptococcus tending to be and Pseudomonas being significantly overrepresented in DHM compared with the PT-MOM samples. Furthermore, pasteurization affected the HM microbiota structure, with a trend towards greater biodiversity and some compositional differences following pasteurization. This pilot study provided further evidence on the HM microbial ecosystem, demonstrating that the DHM microbiota differs from the PT-MOM microbiota, possibly due to inherent differences between HM donors and mothers delivering prematurely, and that pasteurization per se impacts the HM microbiota. Knowledge about HM microbiota needs to be acquired by investigating the effect of DHM processing to develop strategies aimed at improving DHM quality while guaranteeing its microbiological safety.