In the throes of managing toddler sleep, it’s understandable that some parents turn to bottle feeding their children before naps and at bedtime.
Often used to help calm an unsettled child or encourage them to drift off to sleep, new Australian research shows 30 per cent of kids are still bottle fed to sleep at two years of age.
But despite the practice being relatively common, the study also shows it comes with health risks, which parents may not be aware of.
Lead author Heilok Cheng said the researchers used data from a study that followed more than 700 children in Sydney from birth for up to four years, looking at their feeding habits, weight and dental health.
“Our research found that children who were bottle-fed at two years old were more likely to have overweight at three to four years of age,” Ms Cheng, a PhD student at the University of Sydney, said.
“Children who were bottle-fed to sleep at three years old had more teeth that were affected by tooth decay at the same age.“
In Australia, parents are recommended to wean their baby off the bottle by the time they’re 12 months old, at which point they can continue to breastfeed or drink from a cup instead.
This is because longer bottle use can lead a child to drink more milk than they need, and can increase the risk of dental cavities, especially if they’re settled in bed with a bottle.
Australian recommendations advise parents to start introducing cups at six months of age and stop using baby bottles at 12 months. (ABC News: Craig Hansen)
Ms Cheng said the study, published today in the Australian and New Zealand Journal of Public Health, provided robust evidence using local data — rather than international research — for Australia’s national dietary guidelines.
“Similar studies have been done overseas … but we have a different population in Australia: 89 per cent of people have access to fluoridated water, which helps protect teeth.”
But more needed to be done to support families and help them avoid getting into the habit of putting a child to bed with a bottle, she said.
“It’s important to make sure parents have this information.
“We need to understand what helps them to pick up this message so it becomes as routine as children brushing their teeth twice a day.”
Why bottle feeding isn’t recommended for toddlers
One reason parents are encouraged to help their baby learn to drink from a cup from six months is because prolonged bottle use can lead to overfeeding, especially when given to toddlers at bedtime.
“Because the bottle isn’t being offered in response to hunger, it can … [put] children at risk of unhealthy weight gain,” Ms Cheng said.
Drinking more fluids also means children tend to eat less solid food, which can result in them missing out on important nutrients like iron and zinc.
Harriet Hiscock, a paediatrician at Murdoch Children’s Research Institute not involved with the research, wasn’t surprised by the findings, and said that healthy children did not require bottle feeding after 12 months of age.
“They can be having cups of fluid during the day, and from a nutritional point of view, they also don’t need any milk overnight,” Professor Hiscock said.
Of the children in the study who were still bottle fed to sleep at two years of age (30 per cent) and three years of age (22 per cent), most were given cow’s milk or formula.
These often contain natural or added sugars, Ms Cheng said, increasing the risk of tooth decay.
But the recommendation against bottle feeding also applies to expressed breast milk, which contains natural sugars too.
This is because production of saliva, which helps protect teeth, is reduced during sleep. Putting children to bed with a bottle also means they go to sleep without clean teeth, Professor Hiscock said.
“The sugar in milk and in formula tends to bathe their teeth, so it increases their risk of developing dental caries.
“What can also happen … is that [parents] leave the bottle in the bed, so the toddler is sucking on it a lot more overnight, and they get prolonged exposure to the sugar.”
The risk of tooth decay is one reason why bottle feeding in bed is also not recommended for babies.
“What happens for some families is the baby learns to fall asleep on the bottle or the breast, so when they naturally wake up overnight … they can’t re-settle themselves without a bottle again or the breast again,” Professor Hiscock said.
Improving community knowledge and awareness
Despite the known health risks, Ms Cheng said some parents may not be receiving accurate information or advice about infant or toddler feeding.
“One challenge is that information is everywhere … and it can be hard to navigate, especially if it’s conflicting.”
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The study found that children whose mother was born overseas had a higher risk of tooth decay, which Ms Cheng said may be the result of newly arrived families being less familiar with the Australian healthcare system, including the availability of subsidised care though Child Dental Benefits Schedule.
“Based on the availability of dental services overseas, there may be different norms around, for example, preventative care or only seeing a dentist once you are experiencing symptoms from tooth decay.”
Professor Hiscock said more research was needed to “understand the cultural diversity in the [study] population” and work out why parents continued to bottle feed after 12 months, and how they could be supported to stop.
How to reduce bottle feeding after 12 months
To help wean children off night-time feeding, Professor Hiscock recommends taking a gradual approach over the course of seven days.
“It doesn’t work if you just stop cold turkey as your toddler has learnt to be hungry overnight, because they’re so used to it,” she said.
“What parents need to do is actually reduce the amount of milk in the bottle by say 20 to 30 millilitres every couple of nights, and once they get down to around 60ml — because that’s just a snack — they stop the bottles altogether.”
At the same time, it’s important to replace the bottle feed with another way of settling them, which could include a behavioural strategy such as the “checking method” or “camping out” method.
Ms Cheng recommends reading children a bedtime story or having them take bath “to get them settled into healthy routines that don’t require them to be fed”.
“A primary healthcare provider like a GP or child and family health nurse is the best person to help you set up those family routines,” she said.
Professor Hiscock added that it was important to help break the association that had developed in the child’s mind between bottle feeding and sleep.
“Ideally, they should get the last bottle of the night outside the bedroom … and wait 10 to 15 minutes before going into the bedroom,”
she said.
For parents who continue breastfeeding after 12 months, the same advice applies.
“Again, leave that period of time between the last feed and going into the bedroom, so the toddler is learning to re-settle overnight without a breastfeed.”
You can find free, independent parenting advice on the federal government’s Raising Children website, including guides on weaning children off the bottle and an upcoming webinar on helping toddlers sleep and settle.
