The Role of Infant Appetite in Extended Formula Feeding
The Role of Infant Appetite in Extended Formula Feeding
This is the first study to explore the determinants of extended formula feeding. Quantitative and qualitative results supported the hypothesis that extended formula feeding may be directly related to poorer appetites in children. Standard measures of appetite showed that higher 'food-avoidant' appetitive traits (SE, SR and FF) and lower 'food approach' traits (EF and FR) were both associated with extended formula feeding. Formula consumers had lower cow's milk consumption, but higher percentage of daily energy from milks than non-consumers. In total, 206 of the 250 formula consumers also consumed cow's milk, suggesting that formula milk was not simply an alternative to cow's milk. In addition, consumers had lower daily energy intake from food and the lack of difference in the daily energy intake of consumers and non-consumers suggests the formula milk was given instead of food, not in addition to.
These findings suggest that if a parent perceives their toddler to have a poor appetite they may continue using formula to compensate for perceived insufficient nutrition from food. However, these data were not truly prospective, so we cannot determine whether low food intake was a stimulus for parents to continue formula or whether formula suppressed appetite and subsequent food intake. It has previously been suggested that milk during toddlerhood suppresses appetite, and therefore caution must be taken when concluding that poor appetite drives milk intake, but poor appetite and low food intake were commonly cited by mothers as reasons for continuing formula.
A quarter of mothers received recommendations from healthcare professionals to continue with formula, despite UK guidelines stating that "infant formula, follow-on formula or growing-up milks are not needed once your baby is 12 months old." It is important that feeding messages and guidelines are relayed consistently by health professionals and that parents have access to current and correct feeding information.
Twins have lower birth weight and are born earlier than singletons, and while appetite remained a significant predictor of formula consumption after adjustment for birth weight and gestational age, it is possible that twin status promotes parental concern about weight and growth. Nevertheless, prematurity or poor growth were not the main reasons cited by parents for continuing with formula.
One previous US study found that the duration of formula feeding (>12 months) was positively associated with weight at 12 and 18 months of age in infants that had been initially breast fed from birth but not in those that had been formula fed from birth. This is a new field of research, and further research should examine the associations between extended formula feeding and later childhood weight, as well as cultural differences, as we found more non-white than white parents offered formula milk.
This study had the advantage of combining quantitative and qualitative methods to explore the determinants of extended formula feeding. However, health and developmental milestones of the children were not assessed at the time of dietary assessment and it is therefore not clear how this may have impacted on parental feeding decisions. In addition, qualitative interviews were conducted 5 years later, and while this may reduce the acute emotional issues around the topic and encourage frankness, there was a risk that mothers had forgotten their motives at the time.
Discussion
This is the first study to explore the determinants of extended formula feeding. Quantitative and qualitative results supported the hypothesis that extended formula feeding may be directly related to poorer appetites in children. Standard measures of appetite showed that higher 'food-avoidant' appetitive traits (SE, SR and FF) and lower 'food approach' traits (EF and FR) were both associated with extended formula feeding. Formula consumers had lower cow's milk consumption, but higher percentage of daily energy from milks than non-consumers. In total, 206 of the 250 formula consumers also consumed cow's milk, suggesting that formula milk was not simply an alternative to cow's milk. In addition, consumers had lower daily energy intake from food and the lack of difference in the daily energy intake of consumers and non-consumers suggests the formula milk was given instead of food, not in addition to.
These findings suggest that if a parent perceives their toddler to have a poor appetite they may continue using formula to compensate for perceived insufficient nutrition from food. However, these data were not truly prospective, so we cannot determine whether low food intake was a stimulus for parents to continue formula or whether formula suppressed appetite and subsequent food intake. It has previously been suggested that milk during toddlerhood suppresses appetite, and therefore caution must be taken when concluding that poor appetite drives milk intake, but poor appetite and low food intake were commonly cited by mothers as reasons for continuing formula.
A quarter of mothers received recommendations from healthcare professionals to continue with formula, despite UK guidelines stating that "infant formula, follow-on formula or growing-up milks are not needed once your baby is 12 months old." It is important that feeding messages and guidelines are relayed consistently by health professionals and that parents have access to current and correct feeding information.
Twins have lower birth weight and are born earlier than singletons, and while appetite remained a significant predictor of formula consumption after adjustment for birth weight and gestational age, it is possible that twin status promotes parental concern about weight and growth. Nevertheless, prematurity or poor growth were not the main reasons cited by parents for continuing with formula.
One previous US study found that the duration of formula feeding (>12 months) was positively associated with weight at 12 and 18 months of age in infants that had been initially breast fed from birth but not in those that had been formula fed from birth. This is a new field of research, and further research should examine the associations between extended formula feeding and later childhood weight, as well as cultural differences, as we found more non-white than white parents offered formula milk.
This study had the advantage of combining quantitative and qualitative methods to explore the determinants of extended formula feeding. However, health and developmental milestones of the children were not assessed at the time of dietary assessment and it is therefore not clear how this may have impacted on parental feeding decisions. In addition, qualitative interviews were conducted 5 years later, and while this may reduce the acute emotional issues around the topic and encourage frankness, there was a risk that mothers had forgotten their motives at the time.
