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

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 1

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 2

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 newborns face 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. The problem presents when the nurses along with 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, ProQuest 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.


EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 3

Things to be considered while researching this topic were types of feeding: breastfeeding, bottle

feeding, or 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, p.1). 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, p.200). 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 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” (Hakimi, et al., 2018). 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 (Shoji, H. 2018) looked into how when a baby is born it goes from a

hypoxic environment in utero, to the normotoxic 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 extreme
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 4

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, p. 200) 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 that the significant advantages over of

breastfeeding might actually only be a short term effect (Eriksen, et. al., 2016). 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” (Eriksen, et. al. 2016, para. 16). This shows 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

lack of ability to latch, or more of a physical malformation preventing the infant from it. Bottle
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 5

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, p.1) 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, p. 1). 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 baby’s 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, p.11)”. 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 baby’s 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 6

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 one

study 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 and Koletzko, 2016, para. 3). This way the infant can still get

essential ingredients without being overwhelmed with everything that can be supplemented with

the mother’s breastmilk. During another 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, p. iv). This backs up the suggestion of the previously mentioned study 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

the study 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
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 7

their baby the different types of formula to supplement. There might also be a stigma to how they

should breastfeed their infant leading to the baby getting what they might need due to how the

mother’s feel about it socially.

Location

The problem that 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

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 stated that “EBF [exclusive breastfeeding] to age 6 mo has limited

benefit to the growth of rural Gambian infants” (Erikson, et. al, 2016, para.7). This finding
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 8

debunks the thought that breastfeeding is the single best way to feed the infant due to the 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, et. al., 2016,

para. 4). This 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 infant’s 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 compliance 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. Another study 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, including the benefits of
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 9

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 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” (Gartner, 2017). 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 and Koletzko, 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. Mothers 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). This is something that can be completely avoidable had

they had the availability of resources due to their lack of financial support.

Conclusion

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 have been many studies
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 10

performed 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. With all of these studies discussed in this research paper it was

found that there is many factors that come into play with what is the best feeding method to use

for infants. Some of these factors that were discussed are the mother, the infant, the environment

(location) if the mother and baby, and the socioeconomic factors that can play into feeding and

taking care of the infants. With all of these factors considered it was concluded that all forms of

feeding have both advantages and disadvantages. However, mixed feeding might be one of the

best ways to feed an infant because then the baby gets both the benefits from breastfeeding such

as antioxidants and the benefits of bottle feeding such as getting some more adequate nutrients.
EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 11

References

Busche, C. E. (2014). Infant Feeding Practices and Growth Performance in the First Year of

Life. Ann Arbor, MI: ProQuest LLC.

https://eps.cc.ysu.edu:2255/docview/1800026167?accountid=29141

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

years: ‘Children of 1997’.  Pokfulam, Hong Kong SAR, China.: Pediatric and

Perinatal Epidemiology.

https://eps.cc.ysu.edu:2608/doi/full/10.1111/ppe.12434

Eriksen, K. G., Johnson, W., Sonko, B., Prentice, A. M., Darboe, M. K., Moore, S. E.,

(December 21, 2016.) Following the World Health Organizations Recommendation of

Exclusive Breastfeeding to 6 Months of Age Does Not Impact the Growth of Rural

Gambian Infants.  London, United Kingdom: American Society for Nutrition.

http://dx.doi.org/10.3945/jn.116.241737

Hakimi, Danawi, & Ruggles, et al. (October, 2018). Views of Breastfeeding Versus Bottle

Feeding among Middle Eastern and Caucasian Women in Ontario, Canada. Ontario,

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EFFECTS OF BREAST AND BOTTLE FEEDING ON INFANT GROWTH 12

http://apjcn.nhri.org.tw/server/APJCN/27/6/1294.pdf

Prell, C., and Koletzko, B. (2016). Breastfeeding and Complementary Feeding. Munich,

Germany: Deutsches Ärzteblatt International.

https://www.ncbi.nlm.nih.gov/pubmed/27397020

Shinn, L. M. (2017). Infant Feeding Practices in the First Six Months of Life and Subsequent

Growth Performance.  Ann Arbor, MI: ProQuest LLC.

https://eps.cc.ysu.edu:2255/docview/1931361503?accountid=29141

Shoji, H., and Shimizu, T. (September 5, 2018) Effect of human breast milk on biological

metabolism in infants. Tokyo, Japan. Japan Pediatric Society.

https://onlinelibrary.wiley.com/doi/epdf/10.1111/ped.13693

Spalinger, J., Nydegger, A., Belli, D., Furlano, R. I., Yan, J., Tanguy, J.,  Pecquet, S., Destaillats,

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Weight Infants on Eating, Feeding Practices, and Subsequent Weight.  Cincinnati, OH:

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https://link.springer.com/article/10.1007%2Fs10995-018-2581-3

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