Children's Health

Late bottle-weaning is associated with an increased risk of overweight

The American Academy of Pediatrics recommends introducing the cup to babies at 6 months and complete bottle weaning at 15 months of age. Yet 20 percent of 2 year olds and 9 percent of 3 years olds still use a bottle, according to a recent National Health Interview Survey-Childhood Supplement.

Prolonged bottle use in young children is associated with increased risk of overweight, according to a study supported by the Agency for Healthcare Research and Quality (HS10900). Infants who are overweight are more likely than those who are not to be overweight in the preschool years. Further, children who are overweight at 12 months and during the preschool years are at increased risk of obesity in later life, notes Karen Bonuck, Ph.D., of the Albert Einstein College of Medicine.

Dr. Bonuck and her colleagues examined the relationship between age at bottle-weaning and child body mass index (BMI, a ratio of weight to height) among a national probability sample of nearly 3,000 children aged 3 to 5 years reported in the National Health and Nutrition Examination Survey III (NHANES III). The mean age of bottle-weaning was 18.8 months. Slightly more than half of children in the sample (55 percent) had ever received breast milk. The mean age of first receiving cow's milk was 11.2 months and 5.8 months for solids (consistent with pediatric guidelines).

Children less than the 85th percentile BMI (normal weight) were weaned from a bottle, on average at 18 months, compared with 19 months for those in the 85th-95th percentile BMI (overweight) and over 22 months for children greater than the 95th percentile BMI (obese). After accounting for other factors affecting BMI such as mother's BMI and birth weight, bottle-weaning was significantly associated with a child's BMI level. Each additional month of bottle use corresponded to an approximate 3 percent increase in the odds of being in a higher BMI category.

See "Is late bottle-weaning associated with overweight in young children?" Analysis of NHANES III data," by Dr. Bonuck, Richard Kahn, M.S., R.D, and Clyde Schechter, M.D., M.A., in the July/August 2004 Clinical Pediatrics 43, pp. 535-540.

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