Mothers' experiences with bottle feeding

Despite breastmilk providing the best source of nutrition for infants and mothers being actively encouraged to breast feed, the majority of infants at some time during their first 12 months of life will be given an infant formula. In Australia, about 83% of mothers start  breast feeding in hospital. By six months of age only about 48% of infants are still breast fed and by 12 months this has further declined to around 23% (1). The Australian Dietary Guidelines for Children and Adolescents recommend the use of a commerical infant formula when breastfeeding is discontinued before 12 months of age (2). A recent systematic review of the published literature has looked at parents' experiences with bottle feeding, in order to find out where they received information, the support given and how they prepared and gave the feeds (3).

Six qualitative studies and 17 quantitative studies, mainly from the UK and the USA were included in the review. Two were from Australia.

The review found bottle feeding mothers felt guilty about not breast feeding. They also felt pressured into breast feeding which ultimately made them angry. Many felt a sense of failure and shame about not giving their baby the best milk and worried about the consequences of this in later life.  Mothers were also uncertain as to whether they were preparing feeds correctly. These negative feelings were contrasted with a sense of relief that feeding their baby was now easier.

Although mothers were given plenty of information on breast feeding, they were not given enough information on bottle feeding by hospital midwives and health professionals. While most information came from health professionals, when this was not forthcoming information was obtained from family, friends and other bottle feeding mothers.

Many of the hygiene and safety measures required when making feeds were not followed. Iincorrect mixing was a common  resulting in over or underconcentrated feeds. Some mothers also added cereal to  the bottle. These practices could impact on weight gain and obesity. Some mothers in the USA made up feeds using warm tap water rather than cool boiled water and others microwaved feeds which is not recommended.

Parents changed formulas, with and without the advice of a health professional, because of regurgitation, excessive crying, colic and constipation . Changing formulas without proper investigation  runs the risk of labelling the child unnecessarily as having an allergy or intolerance and avoiding or restricting that food may have long term health and nutritional consequences.

The review concluded that mothers do not receive enough support when deciding to bottle feed. While it is important to promote and encourage  breast feeding, mothers deciding to formula feed need to be supported in a professional, non judgemental way. They  need to be reassured  they can still bond with their baby and can still be good mothers if they bottle feed. Importantly, they need to be given the correct advice about preparing feeds so that their baby is not put at risk. These recommendations are in line with the Australian Dietary Guidelines for Children and Adolescents and the Marketing in Australia of Infant Formula (MAIF) Agreement(4).

References.

1. Parliament of Australia, House of Representatives Standing Committee on Health and Aging,  Breast Feeding- the Best Start. Report into the health benefits of breast feeding. August 2007. Commonwealth of Australia www.aph.gov.au/house/committee/haa/breastfeeding/report/chapter2.pdf

2. NHMRC. Dietary Guidelines for Children and Adolescents in Australia. Commonwealth of Australia 2003

3.Lakshman R, Ogilvie D, Ong KK. Mothers" experiences of bottle-feeding: a systematic review of the qualitative and quantitative studies. Arch Dis Chil 2009;94:596-601   doi:10.1136/adc.2008.151910

4. Marketing in Australia fo Infant Formulas: Manufacturers and Importers Agreement ( MAIF Agreement) . April 2003  www.health.gov.au/internet/main/publishing.nsf/Content/health