Counseling parents of infants about when to stop using bottle can reduce tooth decay, obesity and iron deficiency

Prolonged bottle-feeding is linked to tooth decay, obesity and iron deficiency, and once children turn 2, they don't want to give it up

Family doctors and pediatricians can influence when parents wean their children from the bottle, thereby helping to reduce tooth decay, obesity and iron deficiency, according to a new study by researchers at St. Michael's Hospital and The Hospital for Sick Children (SickKids).

Only five minutes of advice at the nine-month "well baby" checkup about the dangers of prolonged bottle use resulted in a dramatic, 60-percent drop in the number of babies still using the bottle at age two, said Dr. Jonathon Maguire, a pediatrician at St. Michael's and lead author of the study.

Most of the babies whose parents received the advice stopped using the bottle by their first birthday, compared to 16 months for babies whose parents received no instruction, Maguire said. The American Academy of Pediatrics recommends complete bottle weaning for healthy children by 15 months, but Maguire said many doctors and parents are not aware of this. Many parents continue bottle feeding well past that time, even until their children are three or four years old.

"If physicians counsel parents of young infants about the dangers of prolonged bottle use and when to stop using the bottle, the counseling actually works," said Maguire, whose research appears in the current issue of Pediatrics, the leading journal in the field.

"This shows it's possible for health professionals to positively influence the health behaviour of young children before they develop unhealthy habits and will hopefully lead to healthier children and healthier adults that they become."

Maguire and his colleagues from SickKids, Drs. Patricia Parkin and Catherine Birken, have created TARGet Kids!, an ongoing study of children's health and development in collaboration with community-based pediatricians and family physicians. It involves the largest database of inner-city children in Canada. Maguire is also an associate staff physician and adjunct scientist at SickKids.

"We and others have previously found an association between prolonged bottle feeding (beyond 16 months) and iron deficiency. Iron deficiency occurs in about 30 per cent of Ontario toddlers and is associated with developmental delays, behavioural problems and poorer school achievement, and, in rare cases, strokes," said Parkin, senior author of the study, staff physician and senior associate Scientist at SickKids, and associate professor in the department of paediatrics at the University of Toronto.

Eighty-six percent of parents whose children were still using the bottle after age two said it was because the child preferred the bottle over the sippy cup. Maguire said the older children are, the more difficult it becomes to modify their behaviour.

"By the time they reach two, it becomes very difficult for parents to transition their children away from the bottle," he said. "It needs to be done at a younger age when children's behaviour is more easily modified."

The research published in Pediatrics refers to children who drink milk and juice from bottles; most infant formula is fortified with iron. The families involved in the research were patients of three pediatricians in downtown Toronto.