Does breastfeeding method influence infant weight gain?

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 chi2 = 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.