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Published on: December 14, 2020
Association Between Infant Feeding Modes and Gastroesophageal Reflux: A Repeated Measurement Analysis of the Infant
Pei-Lin Chen1, Nelís Soto-Ramírez2, Hongmei Zhang1
11 Division of Epidemiology, Biostatistics, and Environmental Health, School of Public Health, University of Memphis, Memphis, TN, USA.
Insights
Formula feeding increases infant reflux risk, while breastfeeding is protective. However, mothers may stop breastfeeding if their infant experiences reflux.
Area of Science:
- Pediatrics
- Infant Nutrition
- Gastroenterology
Background:
- Gastroesophageal reflux (GER) is common in neonates and may influence infant feeding practices.
- Parental reporting of reflux can lead to changes in infant diet, including modified feeding modes or introduction of solids.
Purpose of the Study:
- To prospectively analyze the association between infant feeding modes and gastroesophageal reflux.
- To investigate the relationship between repeated measurements of feeding patterns and reflux incidence over the first year of life.
Main Methods:
- Utilized data from the Infant Feeding Practices Study II (2005-2007) involving 2,841 infants.
- Assessed feeding modes (breastfeeding, formula, combination, solids) and reflux at nine time points (months 1-12).
- Employed 1-month delayed models to estimate risk ratios (RRs) and 95% confidence intervals (CIs) for feeding modes and reflux, including reverse associations.
Main Results:
- Formula feeding, whether exclusive or combined with human milk or breastfeeding, significantly increased reflux risk (RR 1.59-2.19).
- Direct breastfeeding was associated with a lower risk of reflux compared to formula-based feeding.
- Introduction of solid foods did not demonstrate a protective effect against reflux (RR 1.21).
Conclusions:
- Combining any form of formula feeding with infant feeding practices poses a risk for gastroesophageal reflux.
- Breastfeeding demonstrates a protective effect against reflux.
- Mothers experiencing infant reflux were more prone to discontinue breastfeeding, indicating a potential cycle of intervention and altered feeding.
Background:
Gastroesophageal reflux in neonates is frequently reported by parents, potentially motivating changes in infant feeding mode and/or addition of solid food.
Objective:
The authors prospectively analyzed associations between repeated measurement of feeding modes and reflux in infancy.
Methods:
The Infant Feeding Practices Study II, conducted between 2005 and 2007 (2,841 infants), provides data on reflux and feeding modes at nine time points from months 1 to 12. Feeding modes were defined based on direct breastfeeding, feeding of bottled human milk, formula feeding, their combinations, and use of solid food. Repeated measurements were investigated using 1-month delayed models to estimate risk ratios (RRs) and their 95% confidence intervals (CIs). Risk ratios of different feeding modes were estimated for reflux; addressing a reverse association, RRs for feeding mode were estimated as responses to prior reflux.
Results:
Compared to direct breastfeeding, combinations with formula feeding showed a statistically significant risk for reflux (bottled human milk plus formula feeding: RR = 2.19, 95% CI [1.11, 4.33]; formula feeding: RR = 1.95, 95% CI [1.39, 2.74]; and mixed breastfeeding plus formula feeding: RR = 1.59, 95% CI [1.40, 2.42]). Addition of solid food was not protective (RR = 1.21, 95% CI [0.86, 1.70]). Analyses of reverse association (reflux → feeding) showed fewer breastfed infants among those with reflux in the prior month.
Conclusion:
Any combination of infant feeding with formula seems to be a risk for reflux. Although breastfeeding was protective, mothers with a child with reflux were more likely to wean their child.
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