Bottle-feeding beyond 16 months poses serious health risks

If your baby is more than 16 months old and you are still using a nursing bottle for feeding milk and other beverages, then this should serve as a wake-up call! The same mother will then complain that my toddler does not eat solids well and is a fussy eater. Well, the fact of the matter is that if you haven’t still moved forward from baby bottles to cups then how will the baby understand that she/he has to graduate from liquids to solids?

Even if your pediatrician did allow you to resort to bottles for some very critical medical reason from 6 month onwards, at least do not continue the malpractice once your infant has turned into a toddler. The harmful effects of bottle feeding go beyond just tooth decay and ear infections, it increases risk of growing into obese adult with poor sense of appetite regulation.

Firstly, we cannot emphasize the importance of breastfeeding enough beyond saying that “Breastfeeding is the birthright of every baby and a duty of every Mother” . But, in case, for whatever medical, personal or professional reasons you have intentionally or unintentionally put your baby on a bottle, it is extremely important to know when to stop!

Transition from baby bottles to sippy cups or straw bottles is quite a difficult one both for the mother and the child.

For the mother, baby bottles are convenient because

  • Infant completes the given quantity of milk without creating a mess
  • May fall asleep with suckling comfort of the bottle
  • Requires less vigil or guidance
  • Faster completion time

For the baby, feeding bottles provide

  • Replacement for mother’s breast
  • Some sweet liquid to fill stomach requiring very little effort

It is very essential for both to come out of that comfort zone soon, sooner the better! American Academy of Pediatrics recommends that bottle feeding should not continue beyond 12-16 months of age.

Bottle-feeding in bed is even more dangerous

Choking risks – Often babies fall asleep with bottle in their mouth which is a choking hazard as liquids can be drawn into the lungs

Sleep associations – Sleeping with bottle in mouth makes baby habituated to it and later they may find it difficult to sleep without it

Risk of tooth decay – Milk naturally contains sugars and also most mothers add some sugar or sweetening agent to the milk. Allowing this high amounts of sugar to remain in contact with baby’s teeth for overnight or longer time often leads to tooth decay . One can argue that baby teeth fall off and hence it does not matter. But experts have shown that decay in infancy can lay the foundation for dental problems later. Primary teeth or ‘baby teeth’ are associated with speech development, eating, and maintaining proper space for permanent teeth. Also, cavities in primary teeth increase likelihood of  cavities in permanent teeth

Risk of ear infections – Sometimes, though very rare, milk can flow through to the ear cavity when had lying down leading to ear infections.

Other long term health risks

Obesity- Longitudinal studies have shown that 25% toddlers using bottles beyond 24 months become obese by the time they reach 5 ½ years of age. There are multiple ways in which bottle feeding can promote obesity .

  1. Bottle feeding does not require conscious effort for the baby and so overdoing intake is easy (additional calories)
  2. Baby’s get used to finishing the given amount of milk or sweetened beverage irrespective of whether they need so much
  3. Delays introduction of semi solid or solid foods which provide a variety of micro nutrients along with different flavors and textures

Possible iron deficiency – Reliance on milk for most of the caloric needs can lead to iron deficiency in toddlers. Milk is not a good source of iron and too much milk leaves little appetite for solid foods

Overcoming the challenge

  • When baby reaches one year, start substituting a cup for midday bottle.
  • Offer only water in the baby bottle and gradually they will get bored of it
  • Try a training cup with a spout /sippy cup, or put small amounts of liquid in a regular cup. It takes a while for the toddler to get used to the new thing so lots of patience is required
  • Leave bedtime bottle for last because it is toughest but by the time your baby turns one, they do not need much to eat or drink through the night, so resistance to stopping it may be less

Bottle-feeding is not yet condemned by most pediatricians because they feel that modern-age mothers have too many other problems to deal with. But, feeding babies is becoming exceedingly challenging because these practices are being continued beyond specific age and time.  The earlier we start to build healthy habits, the easier it is for both, toddler and mother.


Author: drpoojachhawcharia

Dr Pooja Chhawcharia is the Senior Nutritionist at eKincare with over 7 years of experience in Nutrition education, diet counseling and research. She is a Registered Dietician with the Indian Dietetic Association and Certified Diabetes Educator recognized by the International Diabetes federation . She is also interested in ancillary sciences such as Yoga and Naturopathy.

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