Health consequences of prolonged bottle feeding among low-income preschoolers in the WIC program

Includes bibliographical references (pages [40]-42)The American Academy of Pediatrics and the American Dental Association recommend that all children be weaned from the bottle by one year of age to reduce the risk of baby bottle tooth decay. However, little research has been done to find out how many parents are following this recommendation and whether failure to wean at one year creates any health consequences other than the risk of tooth decay. For this thesis, data were collected from the health charts of 360 low-income preschoolers (aged 1-4 years) enrolled in the WIC Program of the Cook County Department of Health at Skokie, IL, to determine 1) the age at which most children in fact do wean from the bottle and 2) the relation, if any, of late bottle weaning to weight-for-height and to hemoglobin levels. Examination of the children’s diet histories revealed that the majority of children were still bottle-feeding at age two years and that about 25% had not yet been bottleweaned at age three years. The incidence of prolonged bottle feeding did not differ between ethnic groups, with the exception of children from Orthodox Jewish families, who were more likely to be breastfed one year or more and less likely to be bottle fed during the preschool years. Among children older than two years, both the incidence of abnormal weights ( i.e., weights above the 90th or below the 10th percentile as plotted on weight-for-height growth charts) and the incidence of low hemoglobin levels were greater among bottlefeeding children than among the children who no longer fed from bottles. These differences, when examined individually, did not reach significance. However, among children aged 18-48 months, prolonged bottle-feeding was significantly associated with adverse health consequences in general. Bottle-fed children were more likely to be “high risk” nutritionally. Among 149 bottle-fed children, 50% had at least one of the following risk factors: high weight for height or low weight for height, and/or low hemoglobin levels. Among 109 bottle-weaned children, only 37% had such risk factors (Pearson chi square, p = .029). More research needs to be done in other WIC clinics to confirm this association between prolonged bottle feeding and adverse health consequences. A more detailed analysis of the diets of bottle-feeding preschoolers may determine whether the bottle habit predisposes children to poor eating habits and an iron-deficient diet. If this link is established, then dietitians must devise more effective ways to motivate parents to bottle wean their children more promptly. Currently, parents appear to be ignoring the public health message to “ban the bottle.”M.S. (Master of Science