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Doctors can influence when parents wean children from bottle

Prolonged bottle-feeding is linked to tooth decay, obesity and iron deficiency, and once children turn 2, they don't want to give it up

Family doctors and pediatricians can influence when parents wean their children from the bottle, thereby helping to reduce tooth decay, obesity and iron deficiency, according to a new study by researchers at St. Michael's Hospital and The Hospital for Sick Children (SickKids).

Only five minutes of advice at the nine-month "well baby" checkup about the dangers of prolonged bottle use resulted in a dramatic, 60-percent drop in the number of babies still using the bottle at age two, said Dr. Jonathon Maguire, a pediatrician at St. Michael's and lead author of the study.

Most of the babies whose parents received the advice stopped using the bottle by their first birthday, compared to 16 months for babies whose parents received no instruction, Maguire said. The American Academy of Pediatrics recommends complete bottle weaning for healthy children by 15 months, but Maguire said many doctors and parents are not aware of this. Many parents continue bottle feeding well past that time, even until their children are three or four years old.

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"If physicians counsel parents of young infants about the dangers of prolonged bottle use and when to stop using the bottle, the counseling actually works," said Maguire, whose research appears in the current issue of Pediatrics, the leading journal in the field.

"This shows it's possible for health professionals to positively influence the health behaviour of young children before they develop unhealthy habits and will hopefully lead to healthier children and healthier adults that they become."

Maguire and his colleagues from SickKids, Drs. Patricia Parkin and Catherine Birken, have created TARGet Kids!, an ongoing study of children's health and development in collaboration with community-based pediatricians and family physicians. It involves the largest database of inner-city children in Canada. Maguire is also an associate staff physician and adjunct scientist at SickKids.

"We and others have previously found an association between prolonged bottle feeding (beyond 16 months) and iron deficiency. Iron deficiency occurs in about 30 per cent of Ontario toddlers and is associated with developmental delays, behavioural problems and poorer school achievement, and, in rare cases, strokes," said Parkin, senior author of the study, staff physician and senior associate Scientist at SickKids, and associate professor in the department of paediatrics at the University of Toronto.

Eighty-six percent of parents whose children were still using the bottle after age two said it was because the child preferred the bottle over the sippy cup. Maguire said the older children are, the more difficult it becomes to modify their behaviour.

"By the time they reach two, it becomes very difficult for parents to transition their children away from the bottle," he said. "It needs to be done at a younger age when children's behaviour is more easily modified."

The research published in Pediatrics refers to children who drink milk and juice from bottles; most infant formula is fortified with iron. The families involved in the research were patients of three pediatricians in downtown Toronto.

About St. Michael's Hospital

St. Michael's Hospital provides compassionate care to all who walk through its doors. The Hospital also provides outstanding medical education to future health care professionals in more than 23 academic disciplines. Critical care and trauma, heart disease, neurosurgery, diabetes, cancer care, and care of the homeless are among the Hospital's recognized areas of expertise. Through the Keenan Research Centre and the Li Ka Shing Knowledge Institute, research at St. Michael's Hospital is recognized and put into practice around the world. Founded in 1892, the Hospital is fully affiliated with the University of Toronto.

About The Hospital for Sick Children

The Hospital for Sick Children (SickKids) is recognized as one of the world's foremost paediatric health-care institutions and is Canada's leading centre dedicated to advancing children's health through the integration of patient care, research and education. Founded in 1875 and affiliated with the University of Toronto, SickKids is one of Canada's most research-intensive hospitals and has generated discoveries that have helped children globally. Its mission is to provide the best in complex and specialized family-centred care; pioneer scientific and clinical advancements; share expertise; foster an academic environment that nurtures health-care professionals; and champion an accessible, comprehensive and sustainable child health system. SickKids is proud of its vision of Healthier Children. A Better World.™ For more information, please visit

Leslie Shepherd | EurekAlert!
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