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Journal of Tropical Pediatrics 1984 30(3):159-164; doi:10.1093/tropej/30.3.159
© 1984 by Oxford University Press
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Bottle-Feeding and Malnutrition in a Developing Country: The ‘Bottle-Starved’ Baby

Clifford B. David, MD, MPH and Patricia Hallett David, MA

Department of Pediatrics, University of North Carolina Medical School Chapel Hill, N.C.

To measure the impact of bottle-feeding on nutrition, we studied 510 consecutive mothers and their infants under 3 attending an urban health center in North Yemen. Infants were weighed and their mothers interviewed on use of cow's milk and other foods and on demographic, educational and economic status.

Of those who bottle-fed, most (74 per cent) used powdered whole-milk products and not special infant formulas. Bottle-fed infants under 6 months had a markedly increased risk of severe malnutrition over those fully breast-fed (16.2 per cent vs. 2.2 per cent, P<0.01). Despite the inadequacy of local weaning foods, a regression model suggested nutritional advantage from early introduction of solids for bottlefed but not for fully breast-fed infants. Milk tended to be made dilute and feedings small. Only 21 per cent of all bottle-fed infants (27 per cent of those aged 3 to 9 months) received >60 kcal/kg body weight daily from milk. Use of dilute milk (<50 kcal/dl) appeared to double the risk of severe malnutrition in bottle-fed infants. Milk concentration was correlated with size of the measuring scoop supplied in the tin. Concentration and daily intake were both related more strongly to family income than to parental literacy or other socio-demographic measures.

Interim strategies to prevent the syndrome of the ‘bottle-starved’ infant should focus on early provision of additional calories from all possible sources, particularly breast milk and suitable solids. To affect feeding patterns, regulation of the infant-formula industry must control producers of other milk products as well.


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[Abstract]


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