Comparing Alternative Breast Milk Feeding Questions to U.S. Breastfeeding Surveillance Questions

Area of Science:

• Pediatrics
• Public Health
• Nutrition

Background:

• Most U.S. mothers express milk for infant feeding.
• National surveys like the National Immunization Survey (NIS) assess breastfeeding prevalence.
• NIS data may conflate direct breastfeeding with expressed milk consumption from bottles.

Purpose of the Study:

• To investigate the hypothesis that a majority of infants classified as breastfed by NIS questions also consume expressed breast milk.
• To differentiate between at-the-breast feeding and expressed breast milk feeding in U.S. infants.
• To inform future national surveillance methods for infant feeding practices.

Main Methods:

• A convenience sample of 456 mothers of infants aged 19-35 months completed an online questionnaire.
• The questionnaire included NIS questions and detailed questions differentiating feeding modes (at-the-breast vs. bottle).
• Data analysis focused on comparing NIS-derived feeding classifications with actual feeding behaviors.

Main Results:

• NIS questions suggested high rates of at-the-breast feeding (74% at 3 months, 64% at 6 months, 39% at 12 months).
• However, most infants consumed expressed breast milk from bottles at all time points.
• The proportion of breast milk consumed from bottles increased with infant age.

Conclusions:

• The predominant U.S. infant feeding style involves a combination of direct breastfeeding and expressed breast milk.
• Current national surveillance may misinterpret feeding practices by not distinguishing expressed milk consumption.
• Future research and surveillance should separately measure milk expression and consumption to understand associated outcomes.