The decisions parents make about feeding their infants have both immediate and longer-term consequences on the child’s growth and development. It has been shown that human milk confers advantages with respect to infants’ general health, especially reduced infectious disease and chronic digestive disease. The American Dietetic Association position statement on the promotion of breast-feeding advocates exclusive breast-feeding for 4 to 6 months, and breast-feeding with weaning foods for at least 12 months (1
). The American Academy of Pediatrics also recommends breastfeeding through the first year, stating: “Exclusive breastfeeding is ideal nutrition and sufficient to support optimal growth and development for approximately the first 6 months afterbirth…It is recommended that breastfeeding continue for at least 12 months, and thereafter for as long as mutually desired” (2
, p 1036). Furthermore, the decision to breast-feed or formula-feed initiates different trajectories with respect to longer-term growth, health, and development (1
Our research investigated whether breast-feeding through the first year predicted maternal control of infant feeding. We also considered whether toddler energy intakes at age 18 months were predicted by prolonged breast-feeding or maternal control in feeding. In particular, we investigated whether the association between breast-feeding at 12 or 13 months and toddler dietary outcomes during the second year were attributable, in part, to mothers’ infant-feeding practices and beliefs arising from the breast-feeding experience.
To our knowledge, the effects of mothers’ child-feeding practices on their children’s food intake during the first and second years of life have not been investigated. There is evidence, however, that by the preschool period, mothers’ child-feeding strategies serve as important determinants of food intake (5
). In particular, highly controlling feeding strategies are negatively associated with children’s ability to adjust intake in response to the energy content of foods (6
). There is also evidence that high levels of maternal control over what and how much children eat are associated with greater adiposity in children and with children’s heightened responsiveness to and increased intake of palatable foods (8
1. Children should always eat all the food on their plates.
2. Children should be strongly reprimanded for playing or fiddling with their food.
3. Parents have to be especially careful to make sure their children eat enough.
4. Generally children should only be permitted to eat at set mealtimes.
5. A child who doesn’t finish all of the rest of their dinner should not get dessert.
6. Children often have to be strongly encouraged to eat things they don’t like because those foods are often good for them.
7. A tasty snack is one of the best ways to reward children.
8. A child who eats something that is good for him, that he doesn’t like too much, should then be given something he likes in return.
9. Offering a tasty dessert after a meal is an especially good way to get children to eat foods that are good for them.
10. Parents have to be sure their children do not eat too much.
11. Does your child usually finish all the food they are given with no difficulty, even when they are not particularly full?
Child-feeding questionnaire given to assess maternal control in feeding (7
. Items 1 through 10 have a 7-point response scale where 1 =strongly disagree and 7=strongly agree; item 11 has a 7-point response scale where 1 =very rarely and 7=almost always. Item responses were expressed as standardized scores.
aItems 1–10 have a 7-point response scale, from strongly disagree to strongly agree; item 11 has a 7-point scale, from very rarely to almost always.
bItem responses were expressed as standardized scores.
Beginning in the first half of the second year of life, a dramatic transition from a predominately milk-based diet takes place. By age 18 months, a modified adult diet is consumed. Opportunities for parental control over children’s eating are altered during this transition period. Initially, when the child is consuming an exclusive milk diet, parents control whether the child is breast-fed or formula-fed, and whether human milk or cow’s milk formula is consumed; they can also control the timing of feedings. As the child makes the transition to a more adult diet, parents also determine what foods will be offered. During this same period, however, young children become more independent and strive for greater autonomy and control over a variety of areas in their lives, including eating. In general, as the child develops, the balance of control between parents and children begins to shift, with parents relinquishing control and children assuming increased control of their eating. At any point in development, however, there are large individual differences across mother-infant dyads in the balance of control, and the extent to which children control their own food intake, including the timing of meals and what and how much is eaten (see Satter [10
] for further discussion).
The choice to breast-feed may be an important factor affecting the balance of control in feeding across mother–infant pairs. Infants eat primarily to satisfy energy needs and are responsive to the energy density of their diet (11
). For example, infants will adjust the volume of milk consumed to maintain a relatively constant energy intake, consuming more diluted than concentrated formula preparations. Given infants’ ability to control their energy intake, Fomon (11
) argues that an advantage of breast-feeding is that the mother cannot readily assume control and intervene in infant feeding—the breast-feeding mother cannot monitor how much the infant is consuming. Therefore, the quantity of milk consumed by the breast-fed infant is primarily under the infants’ control. This observation was supported by subsequent research demonstrating that among breast-fed infants, the volume of a feeding was not limited by milk availability (12
). For the breast-fed infant, a feeding is likely to be terminated when the infant’s sucking rate slows or stops, and the mother assumes that the infant is satiated. For formula-fed infants, however, feeding duration and intake may be more closely aligned with maternal feeding decisions based on visual cues regarding the amount of milk remaining in the bottle. Formula-feeding mothers may have routine control over the volume of milk consumed by encouraging the infant to continue to feed until the bottle is empty.
Breast-feeding experience may also provide a basis for more lasting beliefs and attitudes regarding the extent to which infants can and should regulate intake. Fomon (13
) argues that breast-feeding may promote parenting that facilitates infants’ control and moderation of intake, where feeding occurs in response to internal cues signaling hunger and satiety. In contrast, formula-feeding may promote parenting that involves a greater degree of control over child feeding. Thus, mothers who breast-feed may adopt an approach to child-feeding that affords the child more opportunities for sharing control of food intake, whereas formula-feeding mothers may maintain a higher degree of control over children’s eating.
The purpose of this research was to determine associations among breast-feeding, maternal control of child-feeding, and toddlers’ dietary intake during the second year of life. In particular, we explored whether breast-feeding at 12 or 13 months of age predicted mothers’ control in infant feeding and ultimately toddlers’ energy intake at age 18 months. Maternal control of feeding was evaluated as a mediator of the relationship between breast-feeding through the first year and toddler energy intakes at age 18 months. National demographic data have revealed that both the choice of an infant-feeding method and parenting practices are confounded by socioeconomic status, especially maternal education (14
). Thus, we investigated these issues using a predominately white, middle class, well-educated sample. We also statistically controlled for maternal education and infant weight, length, and gender.