Key messages

• Feeding babies with formula or bottles increases the risk of overweight and/or obesity in babies due to the tendency for overfeeding.
• Responsive feeding, where the parent feeds a baby following their hunger and fullness cues, and which mimics breastfeeding, can reduce this risk
• Responsive feeding advice is not routinely provided in Australian consumer resources, hence parents/carers may not be aware of how to reduce risks of overweight and obesity in early life.

What is the problem?

Feeding babies with infant formula or bottles can increase the risks of overweight and/or obesity. Feeding through a bottle and feeding with formula is linked with greater pressure to finish the bottle, hence ignoring satiety cues, which is an important self regulation skill.

Responsive feeding is when parents/carers feed following the baby’s hunger and satiety cues and use the bottle feeding process as a bonding opportunity.  Responsive or paced bottle feeding practices can reduce the risk of overfeeding.  However, responsive feeding advice is not yet routinely provided in written resources for consumers.

In this study, we examined what responsive feeding information is available in Australian healthcare organisations.

What did we do?

We undertook a desk review to identify and evaluate the information provided in infant formula-feeding resources currently available online from Australian healthcare organisations.

What did we find?

We found 36 resources for consumers, which discussed responsive bottle feeding on topics informed by the Australian Infant Feeding Guidelines: using bottle teats, how to feed responsively, how much to feed and using a feeding cup. The average score on responsive feeding in these resources was 33.8%, with scores ranging from -17% to 100%.  Most resources scored lower due to a lack of information and/or incorrect information on responsive feeding.

Figure 1 shows that most topics were not addressed in resources (labelled in blue), such as how to feed responsively: watching the baby for cues they need a break during feeding; holding the baby upright during feeding; identifying that babies feed in suck-swallow bursts. Most resources addressed topics on bonding during bottle feeding and the risks of bottle feeding babies who fall asleep.

Some resources provided incorrect information recommending babies be fed a certain amount of formula without considering differences in appetite.  This is concerning as it could unintentionally promote non-responsive feeding practices.  In addition, few resources correctly advised parents to transition to cup use from 6 months onwards.

Resources released after 2015, when the UNICEF UK responsive feeding guidelines were released, showed more comprehensive coverage of responsive bottle feeding topics (Figure 2).   We found that resources from South Australia Health and Queensland Health provided the most comprehensive information about responsive feeding – but this is only part of the information that consumers need to know about bottle and formula feeding babies.

Figure 1. Correctness of responsive feeding and bottle feeding information in consumer resources.

Figure 2. Association between comprehensiveness of information score and year of resource publication or latest update.

Why does it matter?

Parents relied on health professionals and organisations for trusted advice on infant feeding.  The lack of comprehensive responsive bottle feeding resources from Australian health organisations may increase the risk of overfeeding and put babies at risk of developing overweight and obesity.

Given that Australian infant feeding resources were guided by the 2012 NHMRC infant feeding guidelines, incorporating responsive bottle feeding information is urgently needed at the next update in 2024.   This will increase health professionals’ awareness of responsive feeding practices and enable more comprehensive bottle feeding advice to become more widespread in health organisations.

Next steps

This study highlights the information gaps on responsive bottle feeding practices, particularly on transitioning to cup feeding from 6 months of age.  Further studies are underway to co-design resources with consumers.  The work will be part of Heilok Cheng’s PhD thesis on investigating the associations between formula/bottle feeding and risks of dental caries, overweight, and obesity.

Reference: Cheng, H., Rossiter, C., Size, D., & Denney-Wilson, E. (2022). Comprehensiveness of infant formula and bottle feeding resources: A review of information from Australian healthcare organisations. Maternal & Child Nutrition, 18, e13309. https://doi.org/10.1111/mcn.13309

Project lead(s): PhD candidate Heilok Cheng and Professor Elizabeth Denney-Wilson, The University of Sydney. Team: Donna Size, Child and Family Health Nurse, Sydney Local Health District; Chris Rossiter, The University of Sydney