Exploration of Responsive Feeding During Breastfeeding Versus Bottle Feeding of Human Milk: A Within-Subject Pilot Study

Background: Responsive feeding promotes optimal feeding patterns and growth trajectories. Breastfeeding is thought to facilitate responsive feeding, but research to date has been limited to comparing formula-feeding and breastfeeding dyads. Using a within-subject approach, we aimed to assess maternal responsiveness to infant cues during two human milk feeding sessions differing by feeding modality (breastfeeding versus bottle feeding). Materials and Methods: Nine mother-infant dyads (infants <= 6 months) were recruited from the Halifax Regional Municipality, Nova Scotia, from April to May 2018. Two human milk-feeding sessions, directly from the breast and from a bottle, were video-recorded in participants' homes, then scored using the validated Nursing Child Assessment Satellite Training (NCAST) Caregiver/Parent-Child Interaction Feeding Scale. The second half of feeding sessions were coded for infant satiation cues. Results: All women earned a college degree or higher, and were partnered. Mothers were aged mean +/- standard deviation 33.2 +/- 4.0 years; infants were 14.6 +/- 6.9 weeks old and six (67%) were female. Mothers were more sensitive to infant cues during breastfeeding (NCAST Maternal Sensitivity to Cues sub-scale score, 15.0 +/- 1.0) than bottle feeding (13.4 +/- 1.6; p = 0.016). There was a significantly longer latency from feeding session midpoint to the first satiation cue during breastfeeding (minutes:seconds; 3:00 +/- 1:53 versus 0:45 +/- 1:18 bottle feeding, p = 0.038). There was no difference in the number of infant cues by feeding modality. Conclusions: Despite the small sample with high socioeconomic status, this pilot study highlights differences in maternal responsiveness to infant cues by feeding modality with human milk, which warrants further investigation.