Running Head: EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 1

Effects of Breastfeeding Over Bottle Feeding on Infants During the First Year of Life

Hanna Jean Beroy, Anthony Coonfare, Dawn Kabetso, Kayla Keefner & Emily Morrison

04/09/2019

NURS 3947: Nursing Research

Dr. Valerie O’Dell

EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 2

Abstract

The purpose of this research was to look at the different feeding practices that can affect an

infant’s growth over the first year of their life, the mother who is in charge of feeding the infant,

and how it can affect the nurse when they taking care of the new mothers. The correlations

between breastfeeding, bottle feeding, and mixed feedings, along with the location of mother and

baby, and the mothers socioeconomic status, and how all of these factors can affect the baby.

There was evidence that suggested breastfeeding was a goo

d way for the infants to receive good antibodies, antioxidants, and nutrition in places where the

mother has optimal nutrition. Bottle feeding was reviewed and studies have backed up that bottle

feeding can help an infant grow quicker later on during the first year of life. There was some

significant evidence that suggested mixed feeding was one of the best methods for feeding an

infant due to the benefits to both breastfeeding and bottle feeding. Evidence has shown that a

mother’s socioeconomic factors can affect how they feed the baby and what type of prenatal care

they receive. Studies were also shown in regards to different feeding tactics from different

locations around the globe and how they can socially affect the way mothers feel about different

feeding tactics, along with the availability of resources the mothers may be able to get. Overall,

the research done suggested that a form of mixed feeding might help an infant get all available

nutrients to the infant within the first year of life.

EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 3

Effects of Breastfeeding Over Bottle Feeding on Infants During the First Year of Life.

During the first year of life infants are at risk for quite a bit, but one of the most prevalent

risks that a newborn faces is the danger of malnutrition. Studies have been done to investigate

which type of feeding can be most beneficial for the development of a newborn, and how much

of a difference the multiple types of feeding can have on a newborn during the first year of life.

While discharging a new mother after her delivery the nurse is responsible for teaching this new

mother about how to take care of the newborn, and one of the most important parts of this

teaching is making sure the baby is getting the food it needs, and that the food it is taking in is

benefiting the newborns growth. This presents an issue in the nursing profession due to the fact

that it is the nurse’s job to talk to the mother and teach her about her options as far as feeding her

baby. Problems present when the nurses, and the mothers might not understand how the different

types of feeding can affect the baby, along with which one is the most reliable way to help the

baby reach the recommended growth. Therefore, the following research question was addressed:

In infants, how does breastfeeding compared with bottle feeding affect infant growth rate over

first year of life?

Literature Review

Introduction

To research this issue in the nursing profession, sources were sought via OhioLINK

databases, specifically CINAHL Plus, MEDLINE, and Health Source: Nursing/Academic

Edition. Ten sources were reviewed for complete data collection regarding the best ways for

newborns to achieve an adequate nutrition, this is typically measured in weight-for-age (WAZ),

length-for-age (LAZ), and weight-for-length (WLZ) z score observations. Things to be

considered while researching this topic were types of feeding: breastfeeding, bottle feeding, or
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 4

mixed, along with where the mother and baby live, and what type of socioeconomic background

the mother and infant come from.

Breast Feeding

Most nurses and research journals look to human breast milk as the best method of feeding for a

newborn, stating that it is the “gold standard for infant nutrition and provides all nutrients to

support normal growth during the first six months of life (Spalinger, 2017)”. Studies have gone

into the depth of how breast milk can help a baby and how it’s the most natural form of feeding

for any newborn of any mammal species. In particular one study looked at breast feeding and

how it affected WAZ, or weight-for-age gains and discovered “Greater WAZ gains were

observed in BF [ breastfeeding] than FF [formula feeding] infants from 0 to 3 months but in FF

than BF infants from 3 to 9 months” (Cheng, 2018,) This being said, there leaves the question of

which type of feeding is better for the baby, or whether or not just one type of feeding is best.

The nurses caring for these new mothers are expected to know what to recommend and a

research study (Hakimi, Danawi, & Ruggles, et al. ,2018) stated that colostrum located in the

mother’s breast milk “contains all the nutrients their baby needs in the first few days of life as

well as important antibodies for development of their babies’ immune system” . The higher

weight gain along with the development of antibodies from the mother’s breast milk are just two

of the benefits that breastfeeding can have on an infant during the first three months of life.

Another research study completed by Shoji, H. (2018) looked into how when a baby is born it

goes from a hypoxic environment in utero, to the normoxic environment of the outside world; the

study showed results that the mother’s breast milk supplied the babies with antioxidants that

slowly adjusted the babies from the extreme hypoxic environment of the womb to the other
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 5

extreme environment of the external world. This study showed that the antioxidants from the

mother’s breast milk can give infants who are breast fed a bit of an advantage on adapting to

their new environment, pushing the idea that breastfeeding should be the top choice for new

mothers. Nurses all around the world along with “The American Academy of Pediatrics (AAP)

and the American Academy of Nutrition and Dietetics (AND) recommend exclusive

breastfeeding during the first six months of life and continued breastfeeding during the first year

of life” (Shinn, 2017, p.1). to new mothers, but some mothers might not be able or willing to

breastfeed, and in some studies its actually shown that perhaps bottle feeding is better for the

infant in the long spectrum of overall health. Evidence has been shown that “breastfeeding may

only have short-term effects on growth” (Cheng, 2018). In several cases, leading researchers to

question whether or not bottle feeding should be seriously considered to new mothers, along with

the nurses who take care of them. It has been discovered, specifically in a study done by Eriksen,

K. G (2016) that the significant advantages over of breastfeeding might actually only be a short

term effect. This study looked at breastfeeding infants and found that “Thirty-two percent of

infants were exclusively breastfed to age 6 [months,] The mean age of discontinuation of EBF

[ exclusive breast fed] was 5.2 mo, and growth faltering started at; 3.5 mo of age.” showing that

long term breastfeeding might not be the most reliable way to feed an infant for the entire first

year of life, and that bottle feeding might have a more reliable growth factor to take into

consideration after the first few month of life into the first year.

Bottle Feeding

Bottle feeding, while not necessarily the most recommended type of feeding has plenty of

advantages to newborns, especially those infants who cannot breastfeed; whether it be due to a
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 6

lack of ability to latch, or more of a physical malformation preventing the infant from it. Bottle

feeding also advantages the mothers who have busy schedules, or perhaps other people in the

infants lives that might want to be involved in the feedings, including the father, or other family

members. The stress is on these mothers and nurses because for the infant "undernutrition may

lead to failure to thrive, [and] the inability to maintain growth, (Shinn, 2017)” which is only one

end of the spectrum, because “ early introduction to complementary feeding and overfeeding

may lead to obesity later in life (Shinn, 2017)”. When considering exclusively bottle feeding

there is a fine balance that the mother must place into it because there are so many different

things that go into formula that can affect the babies growth specifically including sugars and

proteins. While researching the journal done by Erikson it was also found that exclusive formula

fed infants had greater WAZ (weight for age) gains, leading researchers to believe that formula

feeding might supply the baby with better nutrients from ages of three months to nine months.

The study researched by Spalinger, looked at different forms of formula and the how they

affected the babies WAZ, (LAZ), (WLZ) scores. Their study provided some insightful thought

into how protein in formula affects the infant’s growth; evidence from this study showed “the

conventional formulas may provide a more than adequate amount of protein, which is reflected

in high plasma amino acids, plasma insulin, and elevated blood urea nitrogen in formula-fed

infants, compared with breast-fed infants (Spalinger, 2017)”. This showed that there might be too

much sugar, and protein being placed into these formulas that might help the baby grow, but that

they might not be the healthiest nutrients to bring into the babies body. Formulas that contained

these types of feedings might eventually end up negatively impacting the infant over time, or it

could really benefit infants with lower growth rates that need to put on some calories.
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 7

Mixed Feedings

A large majority of mothers do end up mixed feeding their babies different types of

formulas along with their breast milk due to the time constraint that exclusively breastfeeding

places on their schedule, along with the availability of formula types found in stores. The only

real disadvantage to mixed feeding can lead to inconsistency in the types of nutrients mother can

give their baby, because different formulas contain all kinds of nutrient but they are not typically

regulated so that each and every formula is exactly the same. This can lead to problems, Prell, C.,

recommends that “infants who are no longer being breastfed, or no longer exclusively so, should

be given commercially available low-protein infant formula containing long-chain

polyunsaturated fatty acids.(Prell, 2016)” that way the infant can still get essential ingredients

without being overwhelmed with everything that can be supplemented with the mothers

breastmilk. Busche, C. E. noted that during the study there was a “ rapid weight gain was

observed in 53.8% of breastfed infants, 65.0% mixed fed infants, and 75.0% of formula fed

infants.(Busche 2014)” backing up Prell’s suggestion because of the rapid weight gain due to all

the nutrients found in exclusive formula fed infants. Not to say that a weight gain is not

necessarily a bad thing, but more so that a rapid weight gain can cause a large effect especially

when infants might not have a great deal of weight on them in the first place. This type of weight

gain can hormonally mess with the baby. Exclusive breast fed infants were discovered to only

have a 53.8% gain, which is a reasonable amount of weight gain but again it is a growing child

and we do want to see some improvement in weight gains; especially, because Prell looked at

infants from one, three, and six months of age. The only major downfall to mixed feedings is that

in some locations mothers might not have the availability of others to get their baby the different

types of formula to supplement. There might also be a stigma to how they should breastfeed their
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 8

infant leading to the baby getting what they might need due to how the mother’s feel about it

socially.

Location

The problems nurses and mothers face when feeding their children has to do with that in

certain places in the world there might not be the resources needed to get the infant which types

of formulas they might need. Mothers might be stuck with only breast feeding their children

because where they live might not have formulas available to them. A study done by Hakimi

(2018) looked at how women of Middle Eastern descent and Caucasian descent fed their children

based on a questionnaire given to the mothers during follow up care, and found that “of 60

mothers of Middle Eastern descent only 16 (26%) solely breastfed their infant, while 36 (60%)

used a combination of breastfeeding and formula and only 8 (13%) were solely formula feeding

(Hakimi, 2018) ” . This study showed that middle eastern women typically chose to feed their

children with a combination feeding of breastmilk and formula; whereas, “mothers of Caucasians

descent (n-73), 41 (56%) were solely breastfeeding, 24 (32%) used a combination of

breastfeeding and formula and 8 (11%) exclusively relied on formula feeding (Hakimi, 2018)”.

Now whether this was from the availability of resources, convenience, or just overall more of a

social normative needs to be further evaluated. Collectively speaking though, both of these areas

have a reasonable amount of resources made available to mothers along with a solid educational

background to show these mothers the importance of following standard. Another study looked

at a rural area in West Africa done by Eriksen (2016), and stated that “ EBF [exclusive

breastfeeding] to age 6 mo has limited benefit to the growth of rural Gambian infants”. This

finding debunks the thought that breastfeeding is the single best way to feed the infant due to the
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 9

lack of resources in the area made available to the mothers. The mother can only supply her baby

with nutrients through her breast milk, if she has the nutrients in her body available to give to the

baby. In Gambia, where this study was located at “food availability and nutritional status are

strongly influenced by seasonality, and a chronically marginal diet is exacerbated by a ‘‘hungry

season,’’ when food stocks from the previous harvest season are depleted (Eriksen, 2016)” which

leads to mothers and overall most of the population with malnutrition. This leads breastfeeding

infants even more difficult because not only are the mothers already low on nutrients, their

children are essentially removing almost all necessary nutrients from their body and both are left

malnourished. This leads to the problem of having to supplement feedings, and whether or not

the mothers can afford to supplement their infants feedings with formula because formula and

infant supplements can cost a great deal especially if specific types are needed.

Socioeconomic Background

The socioeconomic background of a mother and her baby plays a huge role in how well

the baby is taken care of because there’s so much that goes into taking care of an infant, starting

all the way up before the infant is even born. This plays a part in whether or not the mother goes

to her prenatal visits, if she takes prenatal vitamins, if she goes to the hospital when she delivers

and how she feeds her baby after delivery. Another problem that nurses and mothers face from

having a low socioeconomic background is the lack of noncompliance because they do not

understand the risks and or benefits to getting these treatments for their baby, and/ or, they

cannot afford to get the treatments for their children. A study done by Gartner (2017), looked at

this and found that “Participants who reported the intention to exclusively formula feed their

infant (n=142) were less likely to report having received information about breastfeeding,
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 10

including the benefits of breastfeeding, how to breastfeed, and information about pumps and

other related accessories (Gartner, 2017)”, this brings about the question of whether or not

supplying this information might help mothers come to the conclusion of how important

breastfeeding could be for their children. In that same study by Gartner (2017) it was found that “

two-thirds of the participants intended to breastfeed their infant, 72% of these participants

intended to breastfeed exclusively, while 28% intended to both breastfeed and use formula.

While 27% intended to exclusively formula feed their infant, 5% had not decided how they

intended to feed their infant” and this was found related to the women below the poverty line.

Plenty of other studies have been done to look at this and found that a reasonable amount of

people considered below poverty level are more commonly formula fed and they are at risk

being only formula fed for things like “acute otitis media twice as often as children who were

nourished only on mother’s milk for three to six months (Prell, 2016).” It can be considered the

nurses job to supply the mothers with the guidelines on breastfeeding, bottle feeding, mixed

feeding, and how they can best take care of their infants, but this is impossible if the mother’s do

not come in for prenatal visits or stay in the hospital after delivering. Mother’s who do not follow

these “guidelines may increase the risk of development of gastrointestinal and respiratory tract

infections, otitis media (middle ear infection), sudden infant death syndrome, and necrotizing

enterocolitis (death of tissue in the intestine) in infants (Gartner 2017)” and this is something that

can be completely avoidable had they had the availability of resources due to their lack of

financial support.

Conclusion
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 11

In conclusion there is quite a lot of considerations to think about for the mothers and the

nurses in charge of taking care of newborns, and how something as pertinent as feeding the baby

can have a large impact on the baby and their first year of life. There are a great many studies

done to see what is the best way to feed a baby and in the future there will more than likely be

more research done on this. All in all depending on the mother, the infant, the environment, and

the socioeconomic factors that can play into feeding and taking care of the infants, mixed feeding

might be one of the best ways to feed an infant because of all of the benefits from both bottle

feeding and breastfeeding.

EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 12

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Cheng, T. S., Kwok, M. K., Leung, G. M. Schooling, M. C., (March 1, 2018)

The Associations of Breast Feeding with Infant Growth and Body Mass Index to 16

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