Bye Bye Bottle:Why You Need to Ditch it Sooner Rather Than Later!

So you have a 1 year old and they are still drinking from the bottle. I have a simple question. Why?

Typically, if your toddler has reached between 6-12 months, the bottle has served its purpose and can be retired. Barring any medical reasons, of course, by the time your toddler is sitting up and reaching for table foods, it's safe to say they are physically ready. Are they attached to it? Maybe, but here are 3 reasons why ditching the bottle sooner rather than later is better for their overall development.

#1 - The bottle is an easy meal and it's keeping them full.

"But my toddler just isn't eating enough. I have to give the bottle before she eats just in case." "Sometimes my 3 year old will reach for food, but he just likes the bottle more, so I give it to him. Can you make him eat more?"

These are actual quotes from feeding sessions in the past. No, I can't MAKE your child eat anything. I can help you set up your mealtimes so they are more likely to choose food over the bottle. I'm not talking about sensory or skill based feeding deficits here. I'm referring to a child who is fully capable of safely eating solid foods but is opting for the bottle instead.

But, milk is just a liquid how can that keep my toddler from feeling hungry?!

Yes, it is, but it is a nutrient dense liquid. Milk has a combination of fat, carbohydrates, micronutrients and proteins which is what makes it so filling. There are nutrients in milk that support growth and development, and it is suggested to reduce the risk of childhood obesity (Thorning,2016). Milk has also been considered a complete food (Górska-Warsewicz,2019) for many cultures. However, if your goal is for your toddler to eat more solid food, then why present them with the option of a meal in a bottle so to speak? Especially, prior to meals. I absolutely understand the need to supplement the diet of a toddler who isn't consuming enough nutritious solid foods, but you also have to take a look at what you're enabling and hindering. What kid wants to stop playing and sit still to eat at a table when their is an option for a meal on the go! Pull a few ounces, drop the bottle right then and there, and go on with the fun!I've seen kids hold the nipple with their front teeth, and go about the business of play while the bottle dangles from their mouth. Ready for the next break to be tilted up for a minute, stop, play (or lay down and watch some toons on their tablet) and repeat. Now if the goal is survival, sure this is doing the trick. If it's self feeding solid foods...this is not going to get you there.

I'm not asking you to drop milk from their diet. No, no, no! BUT....use its nutritional powers wisely! Remember, if they are drinking in their nutrients, the variety of solid food intake will be decreased (Yeung, 2017).

Don't offer it before a meal, let them eat a bit and then offer a straw cup or an open mouth cup with a few ounces. Take it away though. Don't leave it out for them to reach for whenever they need it. I also understand that it is easier to measure how much milk they have had in the day with the bottle. Fill it, hide in the back of the fridge, and when they are busy playing get a cup ready with an ounce or two. Give them as little as necessary. Should they ask for more, go ahead and pour another ounce or two into the cup.Why is it ok now? If they sat down and had a tablespoon of cut strawberries, a quarter piece of toast and some chopped steamed broccoli from last night AND they are STILL HUNGRY, then give them a few sips. Toddlers have small stomachs and they will only eat what they can tolerate as long as we don't force it. An easy way to remember how much to give is tablespoon to age. So, a 1 year old can eat about 1 tablespoon of 3-4 food groups at a time where as a 2 year will be able to eat 2 tablespoons of 3-4 food groups, and so on. Since their tummies are so small make sure you're offering healthy nutritionally dense foods throughout the day. Typically 3 meals and 2 snacks are enough. This way if breakfast is light and they make up for it at snack, no harm no foul! A bonus tip, if you offer a little bit at a time during meals, it's a great opportunity to work on language and utterance length if you need to. Mealtimes are great for working on requesting, comments, responding to questions ("It's yummy." I don't like it, I want more, I'm mixing yogurt!) and of course getting that fine motor practice they need to use utensils. Talk to an OT about any fine motor questions.

Tip #2 - Their muscles stay weak. Impact on oral and overall health.

"Transitioning to a varied diet and using a cup at the appropriate time is important for natural developmental skills such as chewing. If chewing is not encouraged, this ability may not develop readily and teaching older infants to chew can be difficult." ( Yeung,2017).

Their oral musculature stays weak, that is. Babies have these little balls of fat, sucking pads, in their cheeks. It's not just about looks with these adorable layers of fat. Oh no! They serve a purpose. That is to allow babies to easily create and maintain pressure so they can extract milk from the nipple- the mechanics of the coordination and movements involved is a whole different blog post! For this one, it's important to note that those fat pads are not meant to be there forever. They start to slim out as we grow. An integral piece to this is moving from a liquid diet to one that incorporates solid foods and away from a bottle to a cup between 6 to 12 months. As your baby consumes solid foods more often, they move from munching (an up and down chew) to a rotary chew ( diagonal jaw movements). They hone chewing skills functionally, during mealtime. They also work on jaw stability and lip closure while cup drinking. The better they get, the easier it is for them and the stronger their oral musculature is. If they only drink from a bottle, guess what, none of those skills are worked on and the musculature remains the same. It's perfectly suited for bottle drinking, but do you want to send your toddler to preschool with a bottle? What will they do at snack time when their friends are eating apples and drinking water from an open mouth cup. There is also an emotional and social health aspect here as well. How will your toddler feel when they see are what they are drinking from looks different from their peers but the same as the babies in the other room?

Furthermore, there is something referred to as "bottle mouth syndrome", "nursing-bottle syndrome", or "nursing caries". It's not pretty and it can even be quite painful in severe cases. This occurs in those babies and toddlers who engage in prolonged use of bottel feeding or those who fall asleep with a bottle of milk. The sugars in the milk ( or any sugary drink for that matter) sit on their teeth and if it's a part of a daily routine, their baby teeth start to develop cavities and can rot or decay. It has also been noted that if your baby or toddler has a chronic respiratory illness, nighttime feeding with the bottle may be the culprit. Your child may accidentally inhale tiny amounts of milk as they are falling asleep. It can also cause gastro-esophageal reflux or GER (Kim, 2011). None of the information provided here is to scare you. Take it, and look at your child's routine, their abilities, and any concerns you have and use it to have an honest conversation with your child's doctor. If you have more information, you can ask more specific questions.

"It is therefore recommended to stop bedtime feeding at 6 months of age and to undergo complete weaning by 15 to 18 months of age. Inappropriately continued bottle feeding can affect the sleep cycle, cause the formation of dental caries due to increased oral flora, affect oro-facial development and affect respiratory diseases such as otitis media and wheezing".-American Academy of Pediatrics

Tip #3 - Speech and Language delays

I can't tell you how often I have gone into a new case and while I'm interviewing the parent the child is present, but is sitting with a bottle in their mouth. The parent will then ask the child to repeat some words to show me what they can do, and I have to remind them that the bottle is still in their mouth. It is a constant in their child's day and has almost become a part of them in a way. Beyond the fact that it is an obvious obstruction, look at how what has already been mentioned can apply. Weak oral musculature. Now, we have all laughed so hard that our cheeks hurt at some point in our lives! Why is that? It is because there are many muscles involved in opening your mouth, retracting your upper lip for that smile, and sustaining that airflow for all of the "HAHAHAs" and "HEHEHEHs". All of those muscles staying engaged can be exhausting, right?! I'm not suggesting we need herculean strength to converse, if we did, you better believe someone would be out there peddling a line of mini dumbbells! But think about it, if your , lips and tongue don't get practice retracting, elevating, or pursing ( rounding) and developing lip closure what sounds may be affected? Try it. Say "eeeeeee", now say "ohhhhhhh". How about "mmmmmmm". Think about all of the movements involved in saying one word. How about "happy". Sustained airflow, lip closure, lip retraction? You see where I'm going with this? Language, speech, feeding and overall motor development are not isolated skills. An infant coo's when they are laying down looking up at you. What's going on there? Since they are laying down, gravity is helping them out. Their tongues are pulled back slightly so when they phonate it sounds like the /k/+ ahh, or ohh, or whatever vowel they produce based on the shape of their mouth. Now your baby is sitting up and they can clearly see you face ( don't forget an infant's vision isn't exactly 20/20!) Let's say they are 6 months, you start to notice that they are imitating more /m/ and /b/ sound combinations, some ohhh's and ahh's because they can see your lips moving and what else should be happening? They are starting to eat soft solids so you see munching and their tongue is moving a bit more so it can elevate just enough for /dah/. I could go on and on. But I'll stop here because I need something to write about in the next post!

Bottom line...Prolonged bottle feeding may be easier, but it's definitely not helping them in the long run.

References:

Górska-Warsewicz H, Rejman K, Laskowski W, Czeczotko M.(2019) Milk and dairy products and their nutritional contribution to the average polish diet. Nutrients. Aug 1;11(8):1771. doi: 10.3390/nu11081771. PMID: 31374893; PMCID: PMC6723869. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6723869/

Kim HY, Han Y, Pyun Y, Kim J, Ahn K, Lee SI.(2011) Prolonged bedtime bottle feeding and respiratory symptoms in infants. Asia Pac Allergy. Apr;1(1):30-5. doi: 10.5415/apallergy.2011.1.1.30. Epub 2011 Apr 26. PMID: 22053294; PMCID: PMC3206237. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3206237/

Thorning TK, Raben A, Tholstrup T, Soedamah-Muthu SS, Givens I, Astrup A.(2016) Milk and dairy products: good or bad for human health? An assessment of the totality of scientific evidence. Food Nutr Res. Nov 22;60:32527. doi: 10.3402/fnr.v60.32527. PMID: 27882862; PMCID: PMC5122229. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5122229/

Yeung, S. , Chan, R. , Li, L. , Leung, S. , and Woo, J. (2017) Bottle milk feeding and its association with food group consumption, growth and socio‐demographic characteristics in Chinese young children. Maternal & Child Nutrition, 13: e12341. doi: 10.1111/mcn.12341.https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6866143/