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prolonged baby bottle use linked to weight concerns: as usual not as simple as it sounds…

Posted by on May 9, 2011 in Blog Posts | 19 comments

A recent study shows that older toddlers who use baby bottles are at an increased risk of “obesity.”

“…still using a bottle at age 2 as their primary drink container and/or were put to bed with a bottle with a calorie-containing beverage, usually milk.”

” A 2-year-old girl of average size who drinks an 8-ounce bottle of whole milk at bedtime would get about 12% of her daily calories from that bottle, says Rachel Gooze, lead author on the study.” (I would also like to know if there was a higher rate of “underweight” children who are still bottle-fed at age 2? I see prolonged bottle use also as a means some parents resort to to try to get MORE calories into a smaller child. I doubt the study  looked at that…)

Well, I’m not surprised (and I’m not even going to read this study, because it is not controversial as to whether or not typically developing 2 year-olds should be drinking from bottles as primary drink container or put to bed with a bottle…)

What gets me again is the focus on calories. As if the only thing wrong with this picture is that the child is getting more calories. I would imagine that these children may not be supported with feeding in general. Is the child grazing on milk throughout the day? Is the parent filling the bottle and allowing the child to drink, soothe and put herself to sleep with milk? These children are not being fed in an optimal way.

But, instead of leaping to “calories in calories out” explanations, I wish the study had thought of other thing like, (my quotes) “What is going on in these families, what is feeding like in general, how can we support these families?” I would imagine there is little structure, perhaps a chaotic home, perhaps lack of parenting skills to wean the child off the bottle or help with sleep hygiene, perhaps a parent who is stretched completely to the limit or who can’t afford enough food? These kids and parents need feeding support, though I imagine they will just be told, “get rid of the bottle.”

Do you think getting rid of the bottle will solve or push these families towards optimal feeding? Will the bottle be replaced with snack traps or baggies of Godlfish or Fruit Loops? It’s like saying to an adult who has chaotic eating, restriction and disinhibition, “just cut out all sugar” or “just drink Diet Soda.” Will those adults magically become eating competent, or thinner?

What say you?

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19 Comments

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  1. Camilla

    So what are the dental implications of nursing at night? My 19 month old still nurses several times in the night, and I don’t have the stamina to force the sleep issue, much as I would prefer him out of my bed.

    I’m temped at times to use sudafed to sabotage my milk supply. None of the medical advice concerning weaning really touches on the practicalities… if he was demanding bottles, I’d just dilute them incrementally.

    • katja

      I am not aware of the implications of nursing at night. Well-rounded mama blog seems to be up on these issues, you might try asking her. I simply don’t know. If you’re OK with the arrangement, and he is growing well and feeding is going well, and his teeth seem fine, then do what works for your family. When it no longer works, there are other things to try. WRM might have some ideas, this is more complex than hunger or soothing since you are also sharing a bed, so the transition might be rocky if you’re ready to have your bed back before he is.
      Good luck and keep us posted! (I have some resources for sleep and parenting if you have questions when the time comes.)

  2. Jess

    Just to illustrate the point that there are a variety of factors involved: kid’s temperament, family dynamics, nutrition issues, dental issues, quality of life for the parents, etc., here are my data points:

    My son stopped breastfeeding c. 13 months and pretty much stopped using the bottle around the same time (he might’ve had a morning bottle of milk for another couple of months, but then we transitioned to a sippy). The last nursing we dropped was the going to bed nurse, but he never needed a bottle to replace it. He also never cared for the paci, he was just that kind of kid. At daycare, they started the kids drinking out of cups around this time.

    A friend whose daughter was/is a super picky eater would wake up in the night hungry and get 2-3 bottles of milk up until age 2.5 or 3. For her, it was really replacing the calories she wasn’t getting during the day. The whole family has eating problems (Dad lost weight with a protein-shake diet and rarely ate at the table for family meals; Mom is picky and borderline orthorexic (obsessed with eating healthy and organic) but also overweight; meal times are almost always a power-struggle between Mom and Daughter). Personally, I thought the prolonged bottle use was always just a symptom of the family’s generally disordered eating. Their daughter is still a tiny pixie at age 5, but my guess is she might have weight issues as an adult because of all the crazy food pressure now.

    Another friend has 17 month identical twin boys who were born three months premature, plus a 4 year old daughter. The boys still get bottles of milk in bed at night because, hello, the woman has three small children and the bottles help the boys sleep. Problem is, boys have little enamel on their teeth because they were super-preemies (though they’re now happy, sweet, chubby babies). So she might have to give up the bottles because of the dental issue, but otherwise, she would keep doing it because it works for their family. She’s trying to figure it out now.

    • katja

      Great examples! Every family is different, and it’s why we have to ask and be curious as those in positions of “authority” rather than rely on “get rid of the bottle” standard answers…
      Thanks!

  3. The WellRounded Mama

    What I haven’t seen anyone mention yet is the developmental need to suck. I think young children have a natural urge to suck as a self-comforting measure, and these draconian recommendations don’t take that into account. Babies need to suck, everyone understands that, BUT so do young toddlers. It’s a NORMAL part of their development! They grow out of it, but slowly, and at different rates. It’s NOT abnormal at this age!

    I’d much MUCH prefer if this sucking instinct were able to be satisfied via nursing because of the health advantages, continuing immunological protections, and dental protection (dental caries is much less likely from nursing to sleep than from taking a bottle before bed) BUT obviously nursing doesn’t always work out, and of course optimal weaning time is different for every family. It’s unrealistic to expect all sucking needs in every family to be taken care of by nursing. So a bottle before bed is a real dilemma for many families.

    I’d be most worried about the dental implications of formula or cow’s milk before bed (without brushing) to help a child go to sleep. That’s where I get most stuck with the idea of bottles before bed. Nursing to sleep doesn’t have the same dental risks. Yet the toddler who is not still bfing does still have the need to suck and NEEDS to satisfy that. Some do it with pacifiers instead, or their thumbs….and of course those still have pros and cons as well. So there’s no perfect solution.

    But bottom line, babies AND toddlers need to suck, and it’s a normal part of their development and self-soothing routines. If nursing is not an option, I’d prefer to put a toddler to bed with a bottle of water as they got older, or if the child insisted on having milk, then to find a way to brush their teeth afterwards (perhaps wiping gently with a soft cloth?) but however you do it, sucking is a NORMAL part of a child’s development for quite a while.

    Looking at it as simply a calories in and calories out is far too simplistic a view. Ugh.

    • katja

      Thanks for this insight. M did use a pacifier to help with self-soothing and putting herself to sleep. We kept them in the crib when she got older. She had that gap. I think we got rid of the pacifier around age 3 in all situations. The gap closed in about 6 months with no problems. yes, sucking is important. The happiness of the family and child are critical. It’s why simplistic solutions make me crazy. “Just get rid of the bottle!” :(

  4. Jennifer

    As Katja is saying, I think it’s really complicated issue. “Just get rid of the bottle” sounds really easy but it can be really challenging and complicated for families.

    Often the bottle at night is to get kids to sleep, not to get them to eat. Sleep and kids is a very complicated, and controversial issue. In my mind there is no one-size fits all approach to sleep and I’m not sure how a family doctor is supposed to help families with such a complicated issue as sleep in a fifteen minute appointment.

  5. Gretchen

    My 2 1/2 year old and 18 month old still get one bottle per day. After dinner and before bath time.

    They eat a varied diet, are not at all picky and, in general, eat whatever it is that we are eating. So why the bottle? Because we have thrown a lot of change at them and we had to make decisions about what was important/necessary to change and what wasn’t.

    We have been in the process of moving for the last 6 months, sinceabout the same time as my daughter’s 1st birthday. We moved from Switzerland to Minnesota to stay with my parents for a few months until my husband finished his work assignment in Europe. Then he joined us and we moved to a temporary apartment in Chicago. We are waiting for our new house to be completed and then we will move there in about 3 more weeks. The bottles will disappear about a month or so after we are in and settled.

    By the way, we did try to take away that last bottle from my son a little more than a year ago. But with them so close in age and my daughter still getting a bottle, we deemed it was more trouble than it was worth!

    I think there are a lot of reasons why some parents give bottles longer than what is culturally accepted. As long as it works for them, what difference does it make?

    By the way, our pediatrician has no problem with us giving them a bottle. Mostly because both have always been on the low range of the weight charts and he thinks they could use some extra calories. Which is silly, because they do eat just fine and are perfectly healthy. They just happen to be naturally very thin.

    • katja

      Hi Gretchen,
      Sounds like they are thriving, and you are feeding them well so I’m not too concerned! If you read my first reply, you’ll see that I gave my dtr a bottle long after “recommended” but in the big picture it was fine. I also know a family where the kids had a morning bottle well into Kindergarten, and the kids are doing fine.
      I think you hit the nail on the head, “as long as it works for them, what difference does it make?” It sounds like it works for you, and you have a plan :) I do however see parents who misuse the bottle, to keep kids quiet, or pacify, to soothe, to replace feedings… Kids can get into trouble, but I guess what I didn’t get across too well in my post, is that for those families where it doesn’t seem to “work,” there is probably a LOT more than just a bottle going on, and I worry that docs will read this study, and just focus on the bottle, or calories, and not even know to ask about feeding, or confirm, as appears to be the case in your family, that your kids are competent eaters… Does that make sense?

    • Elizabeth

      Because we have thrown a lot of change at them and we had to make decisions about what was important/necessary to change and what wasn’t.

      This is the part that never seems to be accounted for by doctors and studies. Sometimes you have to make choices – there is no such thing as perfect parenting.

      I personally don’t eat a diet that a doctor would think was “optimal”. But I have to consider my mental health as well as my physical health, and I eat in a way that supports both of them as best I can. Even if dieting was good for overweight people in general (and even that is questionable), it wouldn’t be good for me, because of my own personal quirks and challenges.

      I think you’ve made a similar choice for your children. Rather than try to attain some ideal that might be perfect for their bodies (also questionable, but even if we assume it), it may not be better for their whole selves, including both their bodies and their mental and emotional development. You are their parent, and the one who knows and cares the most about them, and you get to make the choice. Good for you for taking the responsibility and doing it.

      • katja

        i agree. There is so much not taken into account in studies, and that docs don’t even know to ask about…

  6. Karla

    My daughter is 14 months and still drinks all her milk from a bottle and I’m not sure when we will switch to other drinking cups. She is in the 5% weight percentile and is a terrible solid food eater. The only way she will eat much is if we feed her pureed food and then feed her the bottle. She usually will only drink 5-6 oz in the bottle at a time and never goes to bed with the bottle. I haven’t gotten much support from my ped. My daughter is doing fine with other developmental milestones but she has always been a terrible eater. She has no desire to eat unless she is starving. She never wants what we have and will rarely take something off our spoon if we offer it. Very frustrating because I feel like our ped thinks we aren’t trying with her. I can’t imagine her drinking from a bottle is going to start her down to a road of obesity. I’m just trying to keep weight on her.

    • katja

      HI- I can only talk in generalities, but a few thoughts… 1) your daughter might benefit from continuing formula for a time to support her nutrition while you better establish feeding 2) if your 14 month old is only eating purees, and it sounds like you are really struggling with feeding, you may need more support. Have you read Child of Mine or How to Get Your Kid to Eat (both by Satter?) It sounds like you are concerned, and like many parents, are trying really hard to nourish your daughter! Like I mentioned in my post, the whole “it’s the bottle making kids fat” is too simplistic. it sounds like you could use some support. Satter’s Feeding with Love and Good Sense Video is amazing (if you have the resources, I highly recommend it, it’s $49…) Or perhaps there are other concerns? I work with clients i similar situations if you’d like to try a phone call…

  7. Eve

    I had a bottle every night until the day I turned four. I don’t remember what was in it; maybe just water. At the time they were probably more concerned about my teeth than about my weight, but didn’t take the bottle away mostly I think because I insisted that I needed it. My mother thinks it gave me an oral fixation that contributed to my fatness, though I didn’t get fat until puberty. Oral fixation is a really Freudian term, and I don’t think I have a greater propensity for putting things in my mouth than other people – I don’t smoke, and don’t like to chew gum. I like to eat, sure, and my relationship with food isn’t the most healthy, but I’m not a binge eater, and I don’t really even eat for comfort. Any eating that I do that seems unnecessary, comes from boredom. So I don’t know. Clearly the extra calories in the bottle didn’t make me fat, but could it have had some effect? Possibly.

    • katja

      If you stopped at 4, but experienced the weight acceleration during puberty, I doubt if the bottle itself was causative. I do wonder if there were other feeding issues going on. Perhaps you started dieting with puberty? Perhaps you had the usual weight gain (often comes before height gain) of puberty and the adults around you overreacted? (I often see this pattern, weight gain with puberty, adults who panic and start the first diet/body-image concerns which leads to kids being less active and often accelerating weight gain beyond what may have otherwise occurred.) Tough to say, but just a few thoughts!

      • Dayna Reidenouer

        Oh! This makes so much sense! I hit puberty early, and my mom freaked out. She took me to a nutritionist when I was 10. I weighed around 100 pounds and was about five feet tall. At the same time, Mom was doing a Slim-Fast regimen. Coincidence?

        Oddly enough, the sister after me was thin as a twig and needed to be on a special diet because she was anemic. Our other sister was shaped more like me (big boobs and hippy), but she didn’t ever get as fat as I did. Our brother is thin, too.

        I always wanted to take ballet lessons, but felt I was too fat. I also wanted to play baseball, but that was around the time my parents divorced, so I didn’t have transportation to/from practices. I think if I had been encouraged in those pursuits instead of just told I was too fat and needed to eat less, I might have turned out shaped differently.

        Don’t get me wrong, I’m not upset that I’m fat. I’ve come to terms with it, but I don’t want other kids to go through the same emotional anguish. Empowerment is key.

  8. Helen Musselman

    When should I stop giving my toddler milk in a bottle? There don’t seem (to me) to be very clear directives on this. He only has a bottle at night – before he goes to sleep – and then usually finishes it first thing in the morning? During the day he drinks water from cups and sippy cups, and eats well. He is 20 months old.

    • katja

      Well, this is a decision that has lots of factors. Some docs will be adamant that it’s 12 months, I think we need to take in a larger picture approach. I fed my daughter one last night time bottle (for me, for the cuddling as to my deep regret nursing didn’t work out, and she is a crazy-independant little one who was not a big cuddler…) So, we had other reasons. At around 18 months, she had more teeth, and I was worried about tooth decay so we stopped. (We did water and she lost interest pretty fast.) She was otherwise well-supported with feeding…) I suppose in general I have two concerns with a 20 month old, one is tooth decay if he drinks it right before bed, and 2) if he is finishing the same bottle in the morning, there may be some food safety concerns… If he is healthy, thriving and otherwise fed well, you can transition out of it anytime! What do you think?