Clinical paper summary

Do infants fed from bottles lack self-regulation of milk intake compared with directly breastfed infants?

Li R et al. Pediatrics 2010; 125: e1386–e1393.

About the paper

  • Article published in The Journal of the American Medical Association (JAMA) 2012.
  • Infant Feeding Practices Study II (IFPS II) cohort*, the largest longitudinal study of infant feeding practices in the United States. Funded by Centres for Disease Control and Prevention (CDC) and the Food and Drug Administration (FDA), with the aim to better understand the mechanisms behind breastfeeding and childhood obesity

Why it’s important

  • The prevention of childhood obesity is becoming a global public health priority
  • Feeding practices in the first year of life have been reported to affect growth and body composition, with breastfed infants gaining less weight than formula-fed infants and having less risk of overweight and obesity for later childhood

Aim and method

  • There were 2 hypotheses:
           1. Infant weight gain is not only affected by type of milk but also by mode of milk delivery
           2. Regardless of the type of milk in the bottle, bottle feeding might put infants on a faster track of weight gain
  • The paper looked at whether the infant was receiving breast milk, formula milk or a combination and also how the infant was being fed – by breast or by bottle

Key takeaways (results)

  • Those infants fed human milk in a bottle grew faster than those who were breastfed. This may be due to the fact that infants who are bottle fed (regardless if formula or breast milk) find it harder to self-regulate than if they were at the breast and because the mother/caregiver establishes a more controlling behaviour of feeding, i.e. giving the child every drop that is in the bottle, and may not recognise the infants internal cues of hunger and satiety
  • Breastfed infants play a more active role in determining their milk intake compared to infants who are bottle fed


  • The authors state that breastfeeding and breast milk are fundamentally different
  • This study suggests that bottle feeding, regardless of the milk in the bottle (i.e. breast milk or formula milk), may be an independent factor associated with infant weight gain
  • Infants fed from bottles may gradually lose their ability to self-regulate and ultimately gain weight faster than those infants who are breastfed
  • Special attention is needed for infants’ cues of hunger and satiety when bottle feeding

SMA® Nutrition advocates responsive feeding

*CDC worked closely with the FDA to conduct the IFPS II in 2005–2007. IFPS II was a longitudinal study focusing on infant feeding practices throughout the first year of life and the diets of women in their 3rd trimester and at four months postpartum. Infant feeding behaviors include patterns of breastfeeding, formula feeding, solid food intake, and feeding other complementary foods and liquids. In 2012, FDA and CDC conducted the Year Six Follow-Up (Y6FU) of the mothers and children who participated in the IFPS II to characterize the health, development, and dietary patterns of the children at 6 years of age.