Strategies to promote responsive bottle-feeding in WIC predict less frequent use of food to soothe and healthier weight status for infants with negative temperaments

Does paced bottle-feeding improve the quality and outcome of bottle-feeding interactions?

BACKGROUND

Responsive feeding is recommended and occurs when caregivers use infants' behavioral cues to guide the timing, pacing, and duration of feeding. Paced bottle-feeding is an approach designed to promote responsive bottle-feeding by mimicking the behavioral benefits of breastfeeding. This study evaluates the efficacy of paced bottle-feeding compared to typical bottle-feeding and breastfeeding for promoting responsive feeding and other markers of healthy feeding outcomes, such as slower feeding rates and lower likelihood of spitting up.

METHODS

This within-subject, experimental study involved 29 mothers and their typically developing full-term infants. Participants were observed during three feeding conditions: Breastfeeding, Typical bottle-feeding, and Paced bottle-feeding. Each feeding session was video-recorded and coded using the Nursing Child Assessment Caregiver-Child Interaction Feeding Scale. Outcome measures included maternal sensitivity to infant cues, infant clarity of cues, infant milk intake, meal duration, and feeding rate. Mixed linear models were used for data analysis.

RESULTS

Maternal sensitivity to infant cues and infant clarity of cues were similar between paced bottle-feeding and typical bottle-feeding but lower than breastfeeding. Paced bottle-feeding led to significantly longer feeding durations and slower feeding rates than typical bottle-feeding, with no significant differences in milk intake. Infant clarity of cues moderated impacts of feeding condition on maternal sensitivity to infant cues; when infants exhibited lower clarity of cues, maternal sensitivity to infant cues was lowest during typical bottle-feeding compared to paced bottle-feeding and breastfeeding.

CONCLUSIONS

Paced bottle-feeding effectively slowed feeding rates and extended meal durations. Paced bottle-feeding was also associated with greater maternal sensitivity to infant cues compared to typical bottle-feeding when infants had lower clarity of cues. These findings provide preliminary evidence of the potential for paced bottle-feeding to promote responsive feeding.

A Pilot Feasibility Randomized Controlled Trial of Effects of Opaque Bottles on Maternal Sensitivity, Infant Intake, and Infant Weight Status

BACKGROUND

Conventional clear infant feeding bottles provide visual cues about the amount of milk consumed, which may decrease caregivers' sensitivity to infant cues, increase infant intake, and lead to greater infant weight gain.

OBJECTIVE

This study examined feasibility, adherence, acceptability, and preliminary effectiveness of an intervention in which families received clear vs opaque bottles.

DESIGN

A pilot feasibility randomized controlled trial was conducted.

PARTICIPANTS/SETTING

Participants included mothers (N = 76) with young infants (2.9 ± 1.4 months old). Data collection occurred between December 2018 and July 2022 and within San Luis Obispo and Santa Barbara Counties, California. All assessments occurred within participants' homes.

INTERVENTION

Participants were randomized to use clear (Clear group, n = 38) or opaque (Opaque group, n = 38) bottles for 12 weeks.

MAIN OUTCOME MEASURES

We assessed feasibility of recruitment and retention, participant perceptions of study bottles, participant adherence to the intervention, maternal sensitivity to cues, infant intake (mL and mL/kg), and infant weight-for-length z-scores (WLZ).

STATISTICAL ANALYSES PERFORMED

Data were analyzed using linear regression, χ2 analysis, and repeated-measures analysis of variance (ANOVA).

RESULTS

Of 842 potential participants, 295 (35%) could not be reached after initial contact, 166 (20%) declined to participate, and 305 (36%) were ineligible. Of those who declined, 16 (10%) declined because they did not want to use study bottles. No differences were observed for loss to follow-up for Clear (8 of 38; 21%) vs Opaque (5 of 38; 13%) groups (P = 0.36) or for reported use of assigned bottles for Clear (89.8% ± 24.5% of daily feedings) vs Opaque (90.1% ± 22.1%) groups (P = 0.96). No group differences were observed for sensitivity to cues (P = 0.52) or intake (mL, P = 0.53 or mL/kg, P = 0.56) at follow-up. Opaque group infants had lower WLZ at follow-up compared with Clear group infants (mean difference, 0.47; 95% confidence interval, 0.08, 0.86; ηp2 = 0.17), adjusting for baseline WLZ.

CONCLUSIONS

Relative to providing clear bottles, providing families with opaque bottles appeared feasible and acceptable, with good adherence. Although preliminary, study findings suggest the potential of opaque bottles to support healthier weight outcomes for bottle-fed infants.