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Infant intake patterns vary by feeding method: results from a randomized controlled trial

Formula feeding is associated with greater intake and more rapid weight gain than breastfeeding. It is unclear if this is due to differences in composition of formula vs. human milk or the practice of feeding by bottle. We conducted a randomized controlled trial in which 231 infants whose mothers planned to provide at least some of the feeds (formula or human milk) by bottle were assigned to a novel bottle with a nipple allowing the infant more control over the flow of milk, or a conventional bottle. We also compared intake of human milk when consumed by bottle vs. at the breast. In infants who were fed only formula, intake per feed was lower with the novel vs. conventional bottle at both 3 mo (112 vs. 135 g, p=0.076) and 4 mo (129 vs. 152 g, p=0.039). However, the number of feeds/d was higher in the novel bottle group (15.2 vs 13.5, p=0.12 at 3 mo; 16.0 vs. 13.4, p=0.055 at 4 mo) and thus there was no significant difference between groups in 24‐h intake. In infants fed only human milk, intake per feed was greater when fed directly at the breast (87 g) than when fed by bottle (75 g, p=0.048) at 3 mo, but there were no differences in intake/feed or 24‐h intake between intervention groups at 3 or 4 mo. These results suggest that a novel bottle nipple that allows greater infant control over the rate of intake results in lower intake per feed, but that infants compensate over 24 hours by increasing feeding frequency.