Maternal control of milk feeding: the role of attitudes, intentions and experiences

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Levels of childhood obesity are increasing in the UK placing children at risk of current and future health problems with a significant impact upon NHS resources. Children from lower socioeconomic backgrounds are at increased risk. Childhood nutrition is a major risk factor for overweight and therefore early interventions to reduce obesity risk are needed. Individuals who recognise when they are full and do not overeat are more likely to be a healthy weight. Differences in this ability can be recognised from childhood. One influence upon this ability is the amount of control a mother exerts over her child's eating. Children have an innate ability to regulate intake of food but behaviours such as restricting intake or pressurising the child to consume more may lead to issues with eating style and overweight. Mothers who breastfeed use lower levels of control over their child's later diet. It has been hypothesised (but not examined) that differences in the feeding style of breast and formula fed infants may explain this. Breastfeeding is more 'baby-led' than formula feeding. The amount of milk consumed cannot be easily measured and feeds are frequent and irregular to stimulate milk supply. Conversely formula feeding is more visible and usually performed to a schedule. It is much easier to track amount of milk consumed. Whilst mothers who breastfeed need to follow their baby's cues to feed, formula feeding mothers have greater control and opportunity to manipulate intake. These differences may follow through into later feeding style. Alternatively mothers who desire a high level of control over feeding in general may choose to formula feed due to greater opportunity to manipulate feeding and go on to exert higher levels of control over later diet. My PhD research explored this relationship examining whether differences in maternal control could be identified during milk feeding and why any relationship might occur. In a longitudinal study, mothers who breastfed were more likely to feed to infant demand whilst mothers who formula fed were more likely to feed to a schedule and manipulate intake. Importantly, maternal control was associated with attitudes towards breastfeeding. Mothers who believed breastfeeding was inconvenient or difficult were more likely to control feeding patterns and to formula feed. These attitudes were present prenatally and predicted breastfeeding duration. Notably, mothers who started breastfeeding but held high concerns about feeding frequency and milk intake were more likely to stop breastfeeding and increase control. Formula feeding allowed greater control and routine. Potentially this is having an adverse effect upon infant health, through a shorter breastfeeding duration and impact upon ability to self regulate intake of energy leading to overweight. The research has important consequences for understanding influences upon breastfeeding duration and child overweight which are key public health concerns. The aim of the fellowship is to disseminate findings, through publications, conference presentations and study days for both academics and health professionals. This will allow further research into the area to be conducted and ensure findings are given directly to those working to increase breastfeeding rates. Key messages could be used to directly develop interventions to support pregnant and new mothers, particularly working antenatally to increase knowledge and confidence of the normality and need for baby-led breastfeeding. Findings could be used to inform evidence based policy in supporting breastfeeding. Beneficiaries of the fellowship would therefore include not only Academics but Health Professionals, Mothers and Infants and the General Public through potential increases in breastfeeding rates which in turn have a positive impact upon Public Health and thus NHS costs and resources. Overall the research is highly relevant, potentially improving both infant and maternal health.