There has been a lot of bad news about how junk food, sodas and other sugar-sweetened beverages are making children fat, but too often the discussion leaves out the role parents play in their children's weight problems.

A new study on how parents feed their infants finds that many parents engage in feeding practices that tend to promote overeating and excessive calorie consumption.

Over 25% of 2- to 5-year-olds in the U.S. are either overweight or obese. Children this young do not become overweight on their own. Something caregivers are doing, or not doing, must be contributing to these statistics.

Because overweight infants and toddlers often become overweight teens and adults, there is a new focus on how behaviors and eating habits from the earliest months can impact weight gain in the first few years of life.

Feeding Practices Parents Should Avoid

Certain feeding styles and practices have been suspected or definitively identified as being associated with obesity risk. On the positive side, when children are exclusively breastfed, they are generally protected against obesity as compared to their formula-fed peers.

Ninety percent of infants two months old were exposed to TV daily, and for an average of over 5 hours per day.

On the other hand, when families introduce solid foods such as cereal into their babies' diets very early (before 4 to 6 months), their children, who may not yet crawl and are far from learning to walk, consume too many calories for their physical activity level and often become overweight.

Similarly, children who are introduced to fruit juice and sweetened drinks at a young age also have an increased risk of becoming overweight or obesity.

Pressure to Eat
When infants are pressured to feed, either by being encouraged to finish a bottle even when they have lost interest and appear satisfied, or by propping the bottle so it remains in place for continual suckling, the risk of obesity increases.

Certain feeding styles and practices have been suspected or definitively identified as being associated with obesity risk.

It's better when parents and caregivers develop a more responsive feeding style in which they actively look for signals that their toddler or infant's hunger has been satisfied, and stop feeding at that point. Children fed this way are much less likely to develop weight problems.

Researchers at the University of North Carolina examined the feeding practices in 863 families when children were only 2 months old. Researchers wanted to know how common certain feeding practices were among parents at this young age, and whether they varied across racial/ethnic groups.

Their findings may help doctors counsel parents at well child visits about avoiding overfeeding their children, and they also identify the kinds of families likely to engage in high risk feeding behaviors.

Questions Parents Need to Consider
If you are parent interested in doing what you can to help your child maintain a healthy weight, here are some questions you should ask:

What did you feed your baby fed initially? Breastmilk exclusively, breastmilk and formula, or formula only? Breastfeeding tends to reduce the risk of overeating.

When did you introduce solid food (including the addition of cereal to the bottle)?

Did you encourage your baby to finish the whole serving in his or her bottle or did you let the baby decide how much to eat?

Do you often watch TV while feeding your infant? This practice can make parents less likely to notice their child's feeding cues. They may not notice when their baby or toddler is full or when they need to be burped.

How much time does your baby spend in front of the TV or video player? The American Academy of Pediatrics discourages any children under age two years from watching TV.

Is the television on as background in the room as you interact with your infant? Television tends to distract caregivers and prevent meaningful social and language-based interactions with infants.

How much time does your child spend in “tummy time?” When your infant lies on her belly and plays while supervised by an adult, it allows your baby to practice using different muscles to lift his head and move her arms and legs and chest than when lying on her back. Tummy time is especially important because it is recommended that infants be placed to sleep on their backs, not on their tummies, to avoid the risk of sudden infant death syndrome.

Propped With a Bottle in Front of the Television

Particularly striking was just how common non-recommended feeding and TV practices are in the lives of American 2-month-olds. “These results… — especially the high rates of television watching — teach us that we must begin obesity prevention even earlier,” said pediatrician Eliana M. Perrin, MD, MPH, lead author of the study and associate professor of pediatrics at the University of North Carolina School of Medicine in a statement.

Among the study's findings:

  • Feeding formula exclusively was more than twice as common as exclusive breastfeeding. By two months only 19% of babies in the study received breastmilk exclusively.
  • By the time babies were two months old, 12% of families had started their infants on solid food.
  • Babies were given bottles propped up in front of them in 23% of households.
  • Infants were fed whenever they cried in 20% of families.
  • Infants were encouraged to finish the whole bottle with every feeding in 38% of families.
  • Ninety percent of infants two months old were exposed to a television on in the background daily, and for an average of over 5 hours per day.
  • Half of the children in the study were placed in front of the TV to watch an average 25 minutes every day.
  • Sixty-six percent of infants spent less than 30 minutes a day of “tummy time,” depriving them of the added opportunity to exercise.

A few racial and ethnic differences emerged. African American parents were more likely than white parents to put their children to sleep with a bottle, and they reported more television watching.

Hispanic parents were less likely than whites to feed formula exclusively, less likely to start solids early, and less likely to report active and passive TV viewing. But they were more likely than white parents to encourage their children to finish a feeding, more likely to prop a bottle, and less likely to provide tummy time for their infants.


The researchers concluded that there is a high prevalence of infant feeding and activity practices in families of children as young as two months that can set the stage for future overweight and obesity in children, teens, and adults.

While further study is needed to broaden the understanding of the relationship between feeding in early infancy and becoming overweight later in life, it is clear from these results that parents and health care providers could make a number of beneficial changes immediately that would reduce infants' caloric intake and increase their activity levels.

It is not hard to keep your baby at a healthy weight. It may be as simple as realizing there is nothing to worry about when a healthy baby loses interest in her bottle before it's finished; or understanding that zoning out in front of the TV with food is as bad for your baby as it for you.

Making an effort to pay more attention as your baby nurses or bottle feeds can really pay off. So can encouraging “tummy time” and other activities, and introducing fruit juices and solids when it is developmentally appropriate and not before. If parents follow these tips, they can reduce their child's risk of obesity and set the stage for a healthier childhood, adolescence and adulthood.

Discuss your baby's diet, activity needs, and TV exposure with your health care provider. He or she can suggest ways to avoid the feeding pitfalls discovered here, and give you ideas that may start infants on the road toward good nutrition and good health.

The study is published in Pediatrics.