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Prolonged bottle feeding of young children may lead to childhood obesity and iron deficiency anemia

February 2003
Agency for Healthcare Research and Quality

The American Academy of Pediatrics recommends that infants be introduced to the cup around 6 months and be fully bottle-weaned by 15 months. Yet, 20 percent of 2-year-olds and 9 percent of 3-year-olds in the United States still use a bottle, with babies of poor, urban, less-educated, and minority parents more likely to continue bottle use for longer periods. A recent study warns that prolonged and/or excessive bottle use may increase a young child's risk of developing iron deficiency anemia (associated with delayed mental and psychomotor development) or becoming obese, both of which are on the rise among U.S. children.

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Children who are not weaned can become habituated to consuming milk (whose calcium blocks iron absorption) or other sweet liquids (versus water) throughout the day and night. This may displace their desire for a more balanced diet, according to Karen A. Bonuck, Ph.D., and Richard Kahn, M.S., of the Montefiore Medical Center/Albert Einstein College of Medicine. In the study supported by the Agency for Healthcare Research and Quality (HS10900), they surveyed caregivers of 95 predominantly Hispanic and black children aged 18-56 months (average age 36 months) about the children's bottle use. The survey was administered when the caregivers arrived for recertification in several Bronx Women's, Infant, and Children (WIC) supplemental feeding programs.

Half of the children were overweight (more than 85th percentile for body mass index, BMI), 36 percent were obese (more than 95th percentile for BMI), and 21 percent met Centers for Disease Control and Prevention criteria for anemia (based on their current blood test data). Two-thirds (63 percent) received daily bottles of milk or sweet liquids, with children receiving anywhere from 3 to 10 bottles a day. As noted, bottle use was significantly associated with iron-deficiency anemia and obesity but was not significantly associated with being overweight.

See "Prolonged bottle use and its association with iron deficiency anemia and overweight: A preliminary study," by Dr. Bonuck and Mr. Kahn, in the October 2002 Clinical Pediatrics 41, pp. 603-607.

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