by Amy Spangler
August 26, 2010

It is such a simple solution—the fact that it works may surprise many—a five-minute conversation between a health care provider and a parent during their baby’s 9-month checkup increases the likelihood of bottle-weaning. Why is this important? Because prolonged bottle-feeding (beyond 15 to 18 months) has been shown to increase a child’s risk for iron deficiency—a condition that is common in children whose diet is primarily milk rather than a wide variety of healthy foods. And bedtime bottle use also increases the risk of tooth decay—another reason for why the American Academy of Pediatrics (AAP) recommends complete bottle weaning around 12 months of age.

The goal of this particular study was to see if a short conversation about the risks of prolonged bottle-feeding would prevent prolonged bottle use and reduce the incidence of iron deficiency. In the end, what the researchers found was no effect on rates of iron deficiency but a significant effect on prolonged bottle use.

Babies were enrolled in the study when they were 9 months old and followed until they were 2 years old. Each child was randomly assigned to one of two groups—parents of children in group one were given instructions on weaning their babies from the bottle including introduction of a sippy cup; no discussion of bottle weaning took place with parents of children in the second group.

Rates of iron deficiency were not significantly different between the two groups of children at 2 years of age. However, only 14 percent of children in this study (versus 37 percent in a previous study by the same authors) developed iron deficiency, which suggests that a much larger sample might be needed in order to detect a difference between the two groups of children.

What was significant was the fact that bottle-weaning occurred at a much earlier age. An important finding given the established link between prolonged bottle-feeding and early childhood tooth decay. Children in the discussion group used a cup three months earlier (9 months versus 12 months) and were weaned from the bottle four months earlier (12 months versus 16 months) compared to those in the non-discussion group. Children in the discussion group were also half as likely to be using a bottle at 2 years of age. The effect of early bottle-weaning on the incidence of tooth decay at 2 years was not measured in this particular study, but previous data clearly show that prolonged bottle-feeding increases the risk of tooth decay in babies and young children.

Knowing that something as simple as a small investment of time can produce significant benefits, the take-home message for health care providers is clear—talk to parents about the importance of bottle-weaning their baby by the time he is 1 year old. The older the child, the more difficult it is to bottle-wean. Among the children in this study who were still using a bottle at age 2, 83 percent of their parents reported that the main reason for prolonged bottle use was that the child “likes the bottle better than the cup.” This supports the recommendation that children should be bottle-weaned sooner (starting around 9 months) rather than later.

Depending on your baby’s age and ability, bottle-weaning can take anywhere from several weeks to several months. Tips for weaning your baby from a bottle to a cup include:

• Offer a cup early and often. Don’t wait until your baby is spill-proof. Many babies will show an interest in drinking from a cup as early as 6 months. Follow your baby’s lead, but know that like any new skill, cup-drinking requires practice on the part of babies and patience on the part of parents.

• Replace a single bottle-feeding every 5-7 days with a cup.

• Involve your baby in the process by allowing him to choose his own cup.

• Put a familiar liquid in the cup—either expressed breast milk or formula.

• Offer the cup first. If your baby refuses the cup, offer the bottle, but for increasingly shorter periods of time.

• Keep your baby from becoming too attached to the bottle by not allowing him to crawl or walk around with a bottle or take it to bed.

• Replace bedtime bottles with a new routine such as reading a book, doing a puzzle, or counting the stars.

• Offer a wide variety of solid foods. Many babies lose interest in the bottle once they are eating three meals and two snacks a day.

• Avoid bottle-weaning during periods of illness or stress.

• Distract your active toddler with outside play.

• Remember that weaning can be a slow process, so start early and be patient.