Prolonged Baby Bottle Feeding: A Health Risk Factor
Deysi is a 2-year-old girl who lives with her parents in a one-bedroom apartment. Her mother and father work outside of the home, approximately 10 hours/day. Child care is provided by a network of women who include licensed home-based providers and a variety of friends and extended family members. On most evenings, Deysi's father picks her up from the child care site and gives her a fresh bottle of chocolate-flavored milk for the 45- minute trip home. She usually falls asleep while drinking it; Deysi's parents see this routine as a comfort for their daughter that usually results in a most welcomed, quiet car ride home at the end of a busy day.
Maintaining Continuity of Care
Prolonged baby bottle use (beyond 12 months of age) is a common feeding practice that is often accompanied by recumbent feeding at nap or night-time sleep. Kaste and Gift (1995) reported that 19.9% of U.S. children at age 2 years use a baby bottle at bedtime with contents other than water. In their review of the 1991 National Health Interview data set, they found that 9.3% of 3 year olds continued to use a bottle. Further, prolonged bottle use was most often associated with Hispanic ethnicity, poverty, urban residence, and low parental education levels. A more recent community based study found that 40% of 2 year olds continued to use a bottle as did 16% of 3 year olds and 8% of 4 year olds. In this smaller study (N = 191), the significant contributing factor for late bottle weaning was mothers' return to work. Their findings were derived from a sample of children with middle class, well-educated parents (Hammer, Bryson, & Agras, 1999). A systematic review of published research on prolonged baby bottle use yielded several studies that confirmed a significant association between prolonged bottle feeding and/or bottle feeding at sleep time and the incidence of Baby Bottle Tooth Decay (BBTD). For example, an Irish study of 5-year old children (N = 636) found that the presence of caries was significantly related to a history of taking a bottle to bed (Creedon, & O'Mullane, 2001). An Australian study of 3,375 4-to-6-year-old children found that the presence of early childhood caries (the presence of caries on at least one primary tooth in children under 6 years of age) was significantly associated with past infant feeding practices, including both sweetened bottle content sand going to sleep with the bottle (Hallett & O'Rourke, 2002). In the U.S., a study of 120 Hispanic families supported the findings of these international studies. In this research, the practice of going to sleep with the bottle was found to be significantly associated with early childhood caries (Huntington, Kim, & Hughes 2002). In addition to BBTD, the review yielded studies that demonstrate additional pediatric morbidities associated with prolonged bottle use. A few studies warn that prolonged bottle use increases the risks associated with iron deficiency anemia and obesity, mwhich the Agency for Heathcare Research and Quality (AHRQ, 2003)confirms are on the rise among American children. In a small study (N = 34), Lampe and Velez (1997) compared two groups of 18-month-old toddlers, those who were still bottle fed and those who were weaned from the bottle at 12 months of age. They found that prolonged bottle use was associated with drinking significantly more milk (mean daily intake 26.3 ounces vs. 16.1 ounces) and lower mean iron stores as measured by levels of serum ferritin concentration. The later difference was not, however, statistically significant. Building on this research, Bonuck and Kahn (2002) surveyed 95 caregivers of predominantly Black and Hispanic children aged 18-56 months (average 36 months) about the practice of prolonged bottle feedings. Two-thirds of the children reportedly received daily bottles of milk or sweet...