Toddlers who continue to use bottles beyond
12 to 15 months of age tend to be overweight. But simply switching them to
sippy cups may not prevent extra weight gain, a new study finds.
Doctors recommend introducing sippy cups at
six months and weaning toddlers off bottles completely by the time they're 15
But 20% of two-year-olds and 10% of
three-year-olds in the US continue to use bottles, often drinking five bottles
of whole milk every day, researchers said.
"Bottles can become a vessel for
extra, or 'stealth' calories, because they are often used indiscriminately. For
example, while in a stroller, or to put a child to bed," Karen Bonuck told
led the new study at Albert Einstein College of Medicine in Bronx, New
York."Before you know it, a child can take in 150 calories of whole milk
in a bottle on top of their regular diet," Bonuck said.
researchers wanted to see if giving parents educational materials as part of a
programme called 'Proud to Be Bottle Free' and a sippy cup would reduce the
number of bottles kids used and the calories they consumed. They enrolled 300
pairs of parents and 12-month-olds at two Bronx Women, Infants, and Children
be eligible for the study, children had to be consuming more than two bottles
of milk or juice every day. The participants were randomly split into two
groups: a bottle-weaning group that received the materials and sippy cup and a
comparison group that did not. The research team checked in with parents over
the next year to find out how many bottles kids were consuming every day, as
well as what else they ate and drank.
104 parent and child pairs completed the study.
After three months, bottle usage had dropped from 4.6 bottles per day to two
bottles per day among kids in the bottle-weaning programme. There was a smaller
drop in the comparison group, from 4.4 bottles per day to 2.7, on average.
Sippy cup usage increased more in the
bottle-weaning group. Kids in the bottle-weaning programme consumed slightly
fewer calories – 1090 calories per day, on average, versus 1 186 among
comparison children. But the difference was small enough that it could have
been due to chance.
No effect upon overweight
The programme did not lower toddlers' chances
of being overweight, according to results published in The Journal of Paediatrics. "At
first we were surprised that there was no effect upon overweight status,"
Bonuck said, "but looking at the data more closely, this seems partially
attributable to the substitution of sippy cups for bottles in the intervention
"She thought the programme's benefits
might also have been clearer had fewer families left the study early. "Had
we achieved our optimal sample size, and included messages about sippy cups, I
would suspect this would have affected our overweight status outcomes,"
said the advice to wean toddlers off bottles by 15 months should be extended to
sippy cups. "They seem to just substitute for bottles well into the second
and third years of life. In addition, we need to develop guidelines for liquid
intake – including the proper balance of liquid versus solids during the second
year of life," she said.
"Around one year of age, a child
should be getting much of his/her nutrition through food," Angela Lemond
told Reuters Health in an email. A dietitian and spokesperson for the Academy
of Nutrition and Dietetics, she was not involved in the new research.
Lemond said breast milk, toddler formulas,
whole milk and four to six ounces of 100-percent juice each day are all good
choices for toddlers. Beverages not on the recommended list for toddlers
include low-fat milk or sweetened flavoured milks like chocolate or strawberry,
sport drinks, soda and other caffeinated beverages.
The World Health Organisation recommends
exclusive breastfeeding – without any formula, other milk or solid food – until
a baby is six months old, followed by breastfeeding with the addition of
appropriate foods through age two.