U.S. states adding rules for feeding babies in daycare

(Reuters Health) - Most U.S. states have added new rules over the past decade designed to improve feeding practices for babies in daycare, a study suggests.

Babies who don’t learn to eat only when they’re hungry can have an increased risk of obesity, and excessive weight gain during infancy is also associated with a higher risk of chronic diseases like diabetes and high blood pressure later in life, researchers note in Pediatrics. Practices like too many feedings, oversize bottles, or what’s known as bottle propping, or giving a baby a bottle by leaning it on a pillow or support instead of holding it, can all encourage babies to eat too much.

As of 2008, the majority of states required child care providers to hold babies during feedings and to follow plans for giving infants bottles, but the rules often didn’t apply to family-based child care and few states had other infant feeding regulations, researchers report.

By 2016, however, nearly all states had updated their regulations to encourage feeding practices that do things like support breastfeeding and discourage over-feeding, the study found.

“Most parents share the responsibility for feeding their infants with another caregiver – the child care provider,” said lead study author Sara Benjamin-Neelon of the Johns Hopkins Bloomberg School of Public Health in Baltimore.

“In our review, we found that more states now require a feeding plan for infants from the parent or a physician,” Benjamin-Neelon said by email. “A feeding plan ensures that parents and providers are on the same page about what to feed and when to feed infants in care.”

Good communication between parents and child care providers can, for example, prevent breastfed babies from receiving a bottle right before they’re picked up at the end of the day. If babies are hungry when they’re picked up, it’s easier for mothers to breastfeed their infants, Benjamin-Neelon said.

“Child care providers can help ensure that mothers and infants continue to breastfeed successfully,” Benjamin-Neelon added. “State regulations can help make sure that happens by guiding infant feeding practices.”

Pediatricians recommend that mothers exclusively breastfeed infants until they’re at least six months of age because it can reduce babies’ risk of SIDS as well as ear and respiratory infections, allergies, childhood obesity and diabetes.

In addition, pediatricians advise parents to feed babies on demand in response to crying or other hunger cues. This practice can help parents avoid giving infants too much to eat and can encourage babies to eat only when hungry. The advice is harder to follow at daycare, however, when providers may struggle to have a routine for all of the kids while feeding individual infants at different times.

For the study, researchers looked at changes over time in state regulations covering 10 infant feeding standards at daycare centers. These include supporting breastfeeding and having a feeding plan as well as things like avoiding solid foods before 6 months of age and cow’s milk before 12 months, holding babies while they eat, and not permitting babies to carry or sleep with bottles.

Delaware was the only state with regulations meeting 9 of the 10 standards for daycare providers in 2008.

By 2016, all but one state required babies to be held during feedings, 41 states required feeding plans, 31 states didn’t allow babies to carry or sleep with bottles, and 25 states required feeding on demand.

One limitation of the study is the lack of data on how rigorously these regulations are followed or enforced, researchers note.

Even so, parents should be aware that most states have rules in place and do their homework, said Myles Faith, a researcher at the University at Buffalo in New York who wasn’t involved in the study.

“Many parents might not know expert feeding guidelines exist for early care and education (ECE) settings and that facilities are expected to be compliant,” Faith said by email.

“Parents can also ask if they or physicians can provide a feeding plan for their own infant, which is one of the recommended guidelines,” Faith added. “These can be empowering conversations for caregivers making such important decisions.”

SOURCE: Pediatrics, online November 1, 2017.