Baby bottle

Use

Cleaning and sterilization

Sterilization is a standard practice to prevent development of bacteria and resulting illness, that is more effective than sanitization. The Australian government and the United Kingdom's National Health Service guidelines recommend sterilization of baby bottles and other equipment either by using a cold water sterilizing solution such as by Milton sterilizing fluid, by steam sterilizing, or by boiling. It is important to clean and sterilize all parts of a bottle including containers, teats, and screw caps. The United States Centers for Disease Control and Prevention, suggests that it may be sufficient to clean bottles with soap and water, in a dishwasher or by hand. This recommendation is based on the assumption that water supplies are clean and sanitation standards are high. Some states, such as Illinois, continue to recommend sterilization in addition to washing. Alberta, Canada recommends sterilizing bottles that are used with formula until an infant is at least 4 months old.

However, there is evidence that bacteria such as E. coli can thrive in biofilms which form on the interior walls of the bottles. Gentle rinsing is not enough to prevent this. Even in developed areas, contamination continues to be a concern. In 2009 in the United Kingdom, researchers found contamination with Staphylococcus aureus in 4% of the baby bottles that parents reported were ready to fill after cleaning and disinfecting.

In lower-resource settings, risks of exposure to dangerous respiratory and enteric infections are higher. A study of children admitted to hospital in Rawalpindi, Pakistan, found that 52.1% of the bottles their caregivers considered clean were actually contaminated. This occurred even though caregivers reportedly followed many of the recommended cleaning practices for cleaning and sterilizing bottles. The most common mistake was to boil the bottles for less than the minimum time recommended by WHO.

Research into the preparation of infant formula in South Korea indicates significant levels of contamination can be transmitted through the handling of spoons and other utensils. Spoons, after being touched, were often left in the formula container, allowing bacteria to spread to the formula in the container. C. sakazakii, S. enterica, and S. aureus, all of which are potentially fatal, were able to surviving for weeks in contaminated infant formula.

Understanding how recommendations are interpreted is important: in one study, leaving a bottle in water that had been previously boiled in a kettle was believed to be "boiling" the bottle. Researchers emphasize that health providers need to better educate caregivers; and that practical methods of bottle hygiene need to be suited to use in field settings. For example, in Peru, easy-to-adopt practices like using a bottle brush and detergent gave greater advantages than difficult-to-achieve procedures like boiling a bottle. WHO (which strongly recommends breastfeeding) notes that in cases where bottle feeding is to occur, much better education is needed on how to use bottles.

Age-appropriate use

Nipples (teats) are typically subdivided by flow rate, with the slowest flow rate recommended for premature infants and infants with feeding difficulties. However, flow rates are not standardised and vary considerably between brands.

When the infant is held in someone's arms while being bottle-fed, it receives physical contact, not as close as during breastfeeding, but more than when the bottle is given while lying in bed. Lying on its back, the infant is more likely to choke and misses out on the physical contact that is so important for its development.

The NHS recommends a sippy cup or beaker be introduced by 6 months and the use of bottles discontinued by 1 year. The AAP recommends that the cup be introduced by one year of age and that the use of the bottle by discontinued by 18 months. The use of bottles is discouraged beyond two years of age by most health organisations as prolonged use can cause tooth decay. Early childhood caries (ECC) is also a concern when considering how long breastfeeding should continue.

Regulation

While infant formula is highly regulated in many countries, baby bottles are not. Only the materials of the teat and bottle itself are specifically regulated in some countries (e.g. British Standards BS 7368:1990 "Specification for babies' elastomeric feeding bottle teats"). In the US, the Food and Drug Administration (FDA) regulates teats and the bottle materials.

In 1985 the FDA restricted allowable levels of nitrosamines (many of which are carcinogens) released from bottle teats. Tests of bottle nipples available in the US, Singapore, West Germany, England, Japan and Korea suggest that levels of nitrosamines in most rubber baby bottle teats are within recommended standards.

Another chemical that has been regulated is Bisphenol A (BPA), described as an endocrine disruptor in 1991. Ongoing research into the possible effects of BPA at levels of exposure far below the U.S. government's BPA safety standards has led to concerns about the safety of plastics, including baby bottles. A 1999 Consumer Reports study showed that some polycarbonate baby bottles released unsafe amounts of BPA. Concerns about BPA have been supported by further work. (Research into the effects of BPA has frequently been hotly contested and controversial and issues have been raised over research biases due to industry funding and conflicts of interest due to close ties between government consultants and BPA manufacturers.) One result has been proposals to change the testing paradigm for assessment of endocrine-disrupting chemicals.

Research and public pressure have led to bans on the use of Bisphenol A in bottles and cups to be used by children. In 2008 Walmart announced that it would stop selling baby bottles and food containers containing BPA. As of 2017, these were applied in at least 40 countries. Canada classified BPA as "toxic" in 2008 under the Canadian Environmental Protection Act. In 2011 use of bisphenol A in baby bottles was forbidden in all EU countries, in China, in Malaysia, and South Africa. In July 2012, the FDA stated that BPA would no longer used in baby bottles and sippy cups, in response to a petition from the American Chemistry Council stating that this was now in line with industry practice. Other countries such as Argentina and Brazil followed suit by prohibiting bisphenol A in baby bottles. Korea has extended its BPA ban to include all children's utensils, containers and packaging as of January 2020. There are calls for increased regulation of BPA in India.

History

Throughout most of human history, infant nutrition has primarily depended on the availability of the child's mother or a wet nurse to breastfeed the infant. Beliefs and behaviors relating to infant feeding also vary widely across countries, cultures and times. Mothers and caregivers have also sought additional ways to feed children, sometimes referred to as "hand feeding". As early as 1500 BCE, Egyptian pottery shows images of women breastfeeding their babies and also using animal horns to feed them.

Containers with hard spouts date to early in recorded time, as evidence by archeological finds (see image). The first vessels known to be used for feeding infants had an opening at one end for filling the bottle, and a second at the other to be put into the baby's mouth. Examination of the organic residues on ancient ceramic baby bottles shows that they were used as early as 1200 BCE to feed babies with animal milk.

Around 250 BCE to 300 BCE the Egyptians developed the ability to blow glass and the Romans blew clear feeding bottles of glass, but these did not obtain long-term popularity. Leather and wood were also used.

By the 1700s infant-feeding vessels such as the feeding-cups, bubby-pots, and sucking-pots were also being made from materials that included pewter, tin, and silver.

In the 19th century, artificial feeding begin to replace wet nursing, and by 1900, wet nursing no longer existed as an organized profession. Changes to the feeding of infants were both socially and technologically driven. With industrialization, more mothers worked outside the home and could less easily breastfeed their children. Technological changes including the design of artificial feeding methods and the preparation of animal milks and other milk substitutes supported a transition to artificial feeding, but with mixed success. Understanding of both nutrition and sanitation lagged behind the introduction of artificial feeding methods, contributing to extremely high infant mortality rates in the Victorian era.

In the United States, the first glass nursing bottle was patented by C.M. Windship in 1841. It was intentionally shaped like the mother's breast. In 1845 the Alexandra Feeder was marketed in England. In Paris, the "Biberon" was introduced by M. Darbo: it was reported to be quite popular in a review from 1851. As the group American Collectors of Infant Feeders notes, by "the late 1800s a large variety of glass nursing bottles were produced in the United States", and the U.S. Patent Office had issued more than 200 patents for various designs of nursing bottles by the 1940s—designed to lie flat or stand up straight, with openings on their sides or ends, with detachable or permanently attached nipples, etc.

The design of baby bottles and particularly the ease of cleaning them had potentially serious consequences for the health of the children using them. Estimates of infant mortality suggest that 20-30% of infants died in the first year of life during the late Victorian era. During the 1890s, at a time when England's childhood mortality rates (ages 1–5) were declining, infant mortality rates actually rose. A bottle with a long Indian rubber tube ending in a teat remained popular until the 1920s because even very young babies could feed independently. The feeding tubes could be bought separately and were sometimes used with empty whiskey or medicine bottles. Almost impossible to keep clean, this type has been nicknamed the "murder bottle".

In May of 1893, Wilmot Castle & Company began the production of modified versions of the Arnold Steam Sterilizer designed for the sterilization of baby bottles and pasteurization of cow's milk. The original sterilizer was based on William E, Arnold's Arnold Steam Cooker first patented in 1879. The Sterilizer and Pasteurizer began playing a significant role in pediatric hospital settings throughout the United States. In 1903, researchers documented the Arnold Sterilizer's effectiveness in battling Cholera Infantum. This was caused primarily by contaminated cow's milk resulting in summer-time infant mortality in Boston's slums and across the country. By 1914 the Castle Home Pasteurizer was available for families and written up in Good Housekeeping Magazine.

Allen and Hanbury introduced a new bottle design with a removable valve and teat on the two ends in 1894, and an improved model, the Allenbury, in 1900. This "banana" bottle was easier to clean. Sometimes referred to as the "hygienic bottle", it helped to improve survival rates. Similar bottles were introduced by other manufacturers and remained popular from the 1900s to the 1950s. Eventually increased understanding of the causes and transmission of disease and improvements in medicine and public health began to reduce infant mortality.

Heat-resistant Pyrex bottles were introduced to the American and British markets at different times. Pyrex bottles were first introduced in the United States by Corning Inc. in 1922. They were offered in three shapes (narrow neck, wide mouth, and flat) and multiple sizes, for a total of ten varieties. By 1925, the product line had been limited to a small subset of the original shapes and sizes. In the 1950s an upright Pyrex bottle with a narrow neck was introduced. In the 1960s a wide-neck version was finally introduced to the UK market. The design of upright bottles with a wider mouth meant that they could be more easily cleaned, and sterilized in batches.

Soft nipples of various materials were introduced early in the history of feeding (e.g., leather, cork, sponge, dried cow's teat filled with cloth). Many were very difficult to clean and when unsanitary could pose a serious threat to infant health. Although Elijah Pratt of New York patented the first rubber nipple in 1845, it took until the 20th century before materials and technology improved sufficiently to allow manufacture of a soft nipple that was practical for use. The invention of rubber (1840s) provided a material that was soft. Early black Indian rubber "had a very strong pungent smell", and did not survive repeated exposures to hot water. However, by the early 1900s more pleasing rubber nipples could be manufactured in volume and could withstand the heat of sterilization.

During the 1940s nurse Adda M. Allen filed for multiple patents relating to the design of baby bottles, including the first disposable collapsible liner for a baby bottle. Her patent was one of many attempts to design a bottle to limit swallowing of air during feeding, and reduce gastric upset and spitting up. A plastic bottle with a disposable liner was eventually tested at George Washington University Hospital and marketed by Playtex.

Innovations such as the introduction of a working check valve in the nipple (to provide unidirectional flow of the liquid food) appeared as early as 1948 in a patent to J.W. Less. This technology was picked up by others including Owens-Illinois Glass, eventually making its way into Gerber and all modern pressure-balancing bottle designs. It is also used for adult drinking cups and various other products requiring fluid flow under vacuum.

The modern business of producing bottles in the developed world is substantial. For 2018, the global baby bottle market was valued at US$2.6 billion. In 1999 it was reported that the UK "feeding and sterilising equipment sector ... stands at £49m… [where] [s]ales of feeding bottles account for 39%" or £19.1m of that market.

Controversy

The 2014 summary policy statement of the American Academy of Pediatrics (AAP) makes no specific mention of bottle feeding, but makes clear that "[b]reastfeeding and human milk are the normative standards for infant feeding and nutrition", and refers to decisions regarding the supply of infant nutrition as "a public health issue and not only a lifestyle choice… [g]iven the documented short- and long-term medical and neurodevelopmental advantages of breastfeeding". The AAP policy recommends breastfeeding exclusively for six months, continuing it with introduction of complementary foods, with an overall duration of "1 year or longer as mutually desired by mother and infant". The body of the policy statement notes and cites literature indicating that, in addition to the importance of mother's milk, the manner of the food delivery has implications: that "breastfed infants self-regulate intake volume", whereas bottle-fed infants receiving expressed breast milk or formula have "increased bottle emptying, poorer self-regulation, and excessive weight gain in late infancy", and that such early practice of self-regulation correlate with adult patterns of weight gain (ibid.).

The AAP policy notes that "[m]edical contraindications to breastfeeding are rare". The transmission of some viral diseases through breastfeeding is reportedly preventable, e.g., by expressing breast milk and subjecting it to Holder pasteurization.

In response to public pressure felt from policies de-emphasizing bottle- and formula-feeding, efforts have arisen to support mothers experiencing physiologic or other difficulties in breastfeeding, and sites include individual views that attempt to weaken the scientific case of the AAP policy; a book of the personal experiences and views of one mother committed to bottle/formula feeding, Bottled Up, by Suzanne Barston, has appeared.

In 2007, a group of 38 researchers examined 700 studies into the use of the chemical compound Bisphenol A in plastics manufacturing, and warned that very low levels of exposure to the chemical can potentially pose adverse health effects, especially to a developing fetus. In 2024, multiple baby bottle companies, including Nuk, Tommee Tippee, and Dr. Brown's, were involved in a class action lawsuit for their bottles leaching microplastics when heated.