What's In the Bottle?
Nancy Mohrbacher Tuesday, May 17, 2011 at 8:54AM Scientists have found that babies not breastfed have a 30% to 40% increased risk of childhood obesity.1 Milk intake and weight gain vary greatly among formula-fed and breastfed babies. (For more, see my earlier post.) Formula-fed babies consume 49% more milk at 1 month, 57% more at 3
months, and 71% more at 5 months.2 This significant difference in milk intake is due in part to how milk flows from breast and bottle. Recent studies have examined these feeding differences in more detail to help answer the question “How is obesity risk affected when the feeding bottle contains mother’s milk?”
The study mentioned above provides a partial answer. Caregivers’ behaviors during bottle-feeding—which are independent of the milk—influence babies’ intake. For example, when bottles contain more than 6 oz. (177 mL), babies consume more milk. Also, babies whose caregivers encourage them to finish the bottle are heavier than other babies.
An important part of obesity prevention is the ability to self-regulate what we eat to match our energy needs. Breastfeeding naturally teaches babies this self-regulation by giving them more control over feedings. While breastfeeding, baby must actively draw milk from the breast. He learns to take milk when hungry and stop when full. This helps baby become attuned to his body’s hunger and satisfaction cues. During bottle-feeding, baby’s role is more passive. Fast, consistent flow and regular coaxing to take more milk, even when full, can lead to a habit of overfeeding and poor self-regulation.
In one recent study of 1250 U.S. babies, researchers used bottle-emptying as a measure of poor infant self-regulation.3 (An earlier study verified this link.4) It didn’t matter whether expressed milk or formula was in the bottle. The more often the babies were fed by bottle during their first 6 months, the more likely they were to empty the bottle during their second 6 months. Only 27% of the babies who were exclusively breastfed during their first 6 months emptied the bottle during their second 6 months. Of those fed at first by both breast and bottle, 54% later emptied the bottle. Of those fed at first only by bottle, 68% later emptied it.
Mother’s milk plays a vital role in a healthy beginning. But as these studies demonstrate, there is more to breastfeeding than the milk. Even when mother’s milk is in the bottle, regular bottle-feeding can increase a baby’s risk of childhood obesity.
References
1Dewey, K.G., Infant feeding and growth. In G. Goldberg, A. Prentice, P.A. Filtreau, S., & Simondon, K. (Eds.) Breastfeeding : Early influences on later health (pp. 57-66). New York, NY: Springer.
2Kramer, M. S., Guo, T., Platt, R. W., Vanilovich, I., Sevkovskaya, Z., Dzikovich, I., et al. Feeding effects on growth during infancy. Journal of Pediatrics 2004; 145(5): 600-605.
3 Li, R., Fein, S.B., & Grummer-Strawn, L. Do infant fed from bottles lack self-regulation of milk intake compared with directly breastfed infants? Pediatrics 2010; 125(6): e1386-e1393.
4Li, R., Fein, S.B., & Grummer-Strawn, L.M. Association of breastfeeding intensity and bottle-emptying behaviors at early infancy with infants’ risk for excess weight at late infancy. Pediatrics 2008; 122 Suppl 2: S77-S84.
Reader Comments (6)
Interesting research. I EP'd for 2 years due to latching issues caused by a lip tie that was undiagnosed. It took a while to figure out how much my daughter would need from a bottle, but I can guarantee nobody could make her finish anything if she didn't want to. As I've returned to work, my son is the same way - if he's not interested, he will not take EBM from the bottle.
My son is 6 months old and has been exclusively bottle-fed pumped milk (refuses to nurse despite many interventions). He is below the 5th percentile for weight. We were encouraged to get him to drink more, but when he's decided he's had enough, he will not. He definitely self-regulates!
I think that it has a lot more to do with coaxing and encouraging children to "finish their bottle" than anything else. I went back to work at six weeks PP and pumped while at work, it didn't take long before my little one was eating WAY more than I was bringing home, and I wasn't bringing home the chump portions either. On average I would bring home 18 - 24 ounces and she was eating more than that at a little over 9 weeks old at the time.
Being frustrated and concerned with being able to keep up I decided to ask my family (those that were watching her my mom and my husband) to try to distract before assuming that she's hungry, to go through everything else that could make her uncomfortable and then feed her if it's only been a short while. I also started placing the milk into smaller portions. 1 and 2 ounce bags only. After I started doing that, I found that a lot of it was she would just drink some when offered and some was going down the drain. She maxed out at 15 ounces give or take a day even at a little over one year old (when I stopped pumping at work).
Also, anecdotal of course, my daughter was exclusively breast until 6 weeks, in those six weeks -- she gained more than she has (in a similar time period) ever! She gained 1lb in her first week! She was 90th percentile (on the formula based charts), she dropped to the 50th percentile (or I should say stopped gaining so quickly) sometime between 6 and 8 months (and they switched to the breastfed based charts I think).
Thanks for this article, I very much enjoyed reading it!
My five-month old has been exclusively breastfed since she was born, taking two bottles of expressed milk during the day at daycare in addition to me nursing her during my lunch hour. She was nursed exclusively during the first 3 months of her life, and has been given bottles of expressed milk for two of her eight daily feedings (on average) for the last two months after I returned to work. She has been in the 90th percentile for weight ever since she was born, regardless if my milk came directly from me or a bottle. Bottle or no bottle, it's high-octane breastmilk that's responsible for her weight and health, and that's all that matters to me.
I think this is very well written and very true. My colleagues and I see it again and again in the mothers we counsel. Especially the combination feeding ones. I do wonder about other things can can make a difference, for example some breastfeeding mothers may be more conscious of how to pace bottle feeding, while some caregivers are not. Some people use it as a way to get the baby to sleep longer and want the baby to eat as much as possible, others are using as little as possible while they rebuild their milk supply. But the over feeding with bottles, though it may not be a rule, is a very strong trend.
Hi Nancy
What a well-written article - great info & reliable references.
Cheers, Julieanne