Objective: To compare the effect of traditional and ¿baby-led¿ breastfeeding advice on early infant weight gain and exclusive breastfeeding rates. Design: Longitudinal cohort study: part prospective, part retrospective. Setting: One UK general practice. Participants: 63 exclusively breastfed infants in two cohorts: 32 babies born before and 31 babies born after a change in breastfeeding advice. Intervention: A change from baby-led to traditional breastfeeding advice. Main outcome measures: Primary analysis: comparison of the effectiveness of the intervention (ie, weight gain expressed as standard deviation score gain (SDSG) between birth and 6¿8 weeks) and exclusive breastfeeding rates between babies whose mothers received traditional advice and those whose mothers received baby-led advice. Secondary analysis: relevance of feed length (ie, weight gain expressed as SDSG between birth and 6¿8 weeks in babies feeding for 10 min or less from the first breast and those feeding for longer than 10 min). Results: The two groups were equivalent with respect to birth weight, gestational age, and parity. Primary outcome: babies whose mothers received the traditional advice were more likely to be exclusively breast fed up to 12 weeks (log rank ¿2¿=¿9.68, p¿=¿0.002) and gained more weight up to 6¿8 weeks than those given baby-led advice (mean SDSG 0.41 (95% CI 0.13 to 0.69) vs ¿0.23 (95% CI ¿0.72 to 0.27)). Secondary outcome: irrespective of feeding advice given, babies feeding for 10 min or less from the first breast gained more weight by 6¿8 weeks than babies feeding for longer than 10 min (mean SDSG 0.42 (95% CI 0.11 to 0.73) vs ¿0.19 (95% CI ¿0.64 to 0.26)). Conclusions: In this study, traditional breastfeeding advice resulted in increased weight gain and increased exclusive breastfeeding rates compared with baby-led advice. Exclusively breastfed babies who had shorter feeds (10 min or less from the first breast) gained more weight.

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Rapid infant weight gain (RWG) in the first six months postpartum is a strong predictor for obesity during childhood and adolescence. Although biological factors can influence infant weight gain trajectories, the modifiable factor of parent feeding practices can also have an influence. The use of food to soothe (FTS), or the act of feeding a child when he/she is upset for reasons other than hunger, has been associated with unhealthy eating behaviors and less-favorable weight outcomes in children and older infants. However, limited studies have explored the use of FTS during early infancy before the introduction of solids foods. The present study was a secondary analysis of mothers who completed previous infant feeding studies (n = 134) and was aimed at exploring whether maternal-reported use of FTS was associated with greater infant weight gain during the first six months postpartum and whether feeding type (exclusive breastfeeding versus exclusive formula-feeding versus mixed feeding) or bottle-feeding intensity (percent of daily feedings from a bottle) moderated this association. Both maternal-reported and observational measures of maternal and infant characteristics and their associations with the use of FTS were also explored. Individual correlations as well as multiple and logistic regressions were used to assess whether FTS predicted change in weight-for-age, weight-for-length, and/or RWG from birth to study entry. One-way ANOVA tests were used to assess the differences in use of FTS by feeding type and/or bottle-feeding intensity. Individual correlations and multiple regressions were used to assess whether maternal feeding style and/or infant temperament, clarity of cues, and/or eating behavior predicted the use of FTS. The mean age for infants was 14.8 weeks (SD = 7.1, range = 1.7 - 31.0 weeks). The results showed that the use of FTS had a significant negative association with percent of daily feedings from a bottle (r = -0.20, p = 0.021), and a significantly higher association among mothers who reported mixed feeding (M = 2.87, SD = 0.20) versus exclusive formula feeding (M = 2.20, SD = 0.20). Greater pressuring feeding, greater infant negativity, and lower infant surgency were all significant predictors for the use of FTS (p < 0.05). FTS was not significantly associated with infant weight gain during the first 6 months postpartum. Neither feeding type or bottle-feeding intensity moderated the relationship between the use of FTS and infant weight gain. Future studies would benefit from recruiting a more diverse sample population, including measures of FTS that have been validated on infants younger than 3 months, and following the infants at more frequent time points from birth to 6 months postpartum.