Does paced bottle-feeding improve the quality and outcome of bottle-feeding interactions?

Background: Responsive feeding is recommended and occurs when caregivers use infants' behavioral cues to guide the timing, pacing, and duration of feeding. Paced bottle-feeding is an approach designed to promote responsive bottle-feeding by mimicking the behavioral benefits of breastfeeding. This study evaluates the efficacy of paced bottle-feeding compared to typical bottle-feeding and breastfeeding for promoting responsive feeding and other markers of healthy feeding outcomes, such as slower feeding rates and lower likelihood of spitting up.

Methods: This within-subject, experimental study involved 29 mothers and their typically developing full-term infants. Participants were observed during three feeding conditions: Breastfeeding, Typical bottle-feeding, and Paced bottle-feeding. Each feeding session was video-recorded and coded using the Nursing Child Assessment Caregiver-Child Interaction Feeding Scale. Outcome measures included maternal sensitivity to infant cues, infant clarity of cues, infant milk intake, meal duration, and feeding rate. Mixed linear models were used for data analysis.

Results: Maternal sensitivity to infant cues and infant clarity of cues were similar between paced bottle-feeding and typical bottle-feeding but lower than breastfeeding. Paced bottle-feeding led to significantly longer feeding durations and slower feeding rates than typical bottle-feeding, with no significant differences in milk intake. Infant clarity of cues moderated impacts of feeding condition on maternal sensitivity to infant cues; when infants exhibited lower clarity of cues, maternal sensitivity to infant cues was lowest during typical bottle-feeding compared to paced bottle-feeding and breastfeeding.

Conclusions: Paced bottle-feeding effectively slowed feeding rates and extended meal durations. Paced bottle-feeding was also associated with greater maternal sensitivity to infant cues compared to typical bottle-feeding when infants had lower clarity of cues. These findings provide preliminary evidence of the potential for paced bottle-feeding to promote responsive feeding.