This research studied breastfeeding and its relationship with a wide range of feeding styles during infancy and toddlerhood in an effort to advance scientific understanding of potential behavioral factors that underlie the protective effect of breastfeeding on child obesity risk. The main finding was that mothers who breastfed 3 months or longer reported higher levels of responsiveness to infant satiety and hunger cues than mothers who breastfed for less than 3 months, after taking into consideration potentially important covariates (maternal education, marital status, and ethnicity). These results suggest that mothers who breastfeed may show greater acknowledgement of infants’ ability to communicate fullness and responsiveness to those cues during infant feeding. This association was not observed among mothers of toddlers, suggesting that the relationship may be limited to infancy.
Our findings suggest that responsiveness is at the core of feeding style differences between mothers of varying breastfeeding duration, which augments past research on the positive relationship between breastfeeding and child-centered which focused on control [8, 36–38]. It is plausible that mothers who breastfed for a longer duration differ in attitudes and beliefs which influence level of responsiveness/pressuring feeding styles in a manner unexplained by the socio-demographic characteristics taken into account in this study. However, it could be that the more a mother engages in a behavior, the more likely she is to permanently adopt the behavior. In this case, longer breastfeeding duration would allow a mother to engage in infant-centered feeding interactions for a longer time, increasing the likelihood that these interaction patterns would continue, after initiation of complementary feeding . This possibility suggests that the infant-centered nature of breastfeeding, if of sufficient duration, results in greater responsiveness to infant feeding cues, which is consistent with prior research findings in this area [13, 15, 16]. While Brown and Lee  found a shorter duration of breastfeeding (6 weeks) was sufficient to predict satiety responsiveness among toddlers regardless of current feeding style, they did not report relationships between duration and feeding style. It is also interesting that a difference in maternal responsiveness was identified between mothers breastfeeding for less than three months and those breastfeeding for 3 or more months. Currently only 35% of mothers in the US are breastfeeding exclusively at three months , which suggests greater supports need to be put in place to extend duration beyond 3 months in order to maximize the benefits of breastfeeding in regards to responsive feeding.
Despite the inclusion of multiple dimensions of feeding styles in the current study, breastfeeding duration was largely unassociated with indulgent, restrictive, laissez-faire, and pressuring maternal feeding styles. Breastfeeding duration was associated with less maternal pressure among both infants and toddlers, but only in relation to early introduction of infant cereal. Thus mothers who breastfed for greater than 6 months were less likely to offer cereal in the bottle and/or to hold beliefs that the use of infant cereal in early infancy (<6 months) offers benefits (mainly infant fullness and sleeping through the night). Past research on pressuring has primarily relied on the Child Feeding Questionnaire, which focuses on pressuring a child to finish a meal, to eat without hunger, and to eat “enough” from the caregiver’s perspective . The measure used here dimensionalized pressuring feeding styles (pressure to finish, pressure to soothe, and pressure to eat supplementary foods early in infancy). That only aspects of pressuring related to complementary food introduction were associated with breastfeeding duration suggests dimensionalizing pressuring feeding styles offers more insight to their connection with breastfeeding duration. While responsiveness to satiety and hunger cues has been consistently linked to reduced obesity risk [20, 40, 41], there is less consistent evidence that early introduction of complementary foods increases obesity risk [42–46], particularly among breast-fed infants [47, 48].
Few associations of breastfeeding duration with feeding styles were observed among mothers of toddlers. It is possible that greater length of recall by mothers of toddlers could have increased the greater chance of recall bias and misclassification relative to mothers of infants. However, maternal self-reports of breastfeeding are considered to be fairly reliable in the first three years of life . It is also possible that the lack of association reflects a dynamic nature of feeding behaviors and interactions in toddlerhood. During toddlerhood, a number of intrinsic factors (within the developing child) are transacting with numerous extrinsic factors, including multiple caregivers responsible for feeding , modeling influences of siblings and peers , and the child’s increasing involvement in family meals, which are often determined by the family’s social clock rather than its individual members’ hunger cues. Because the design of this study was not longitudinal, causal inferences are not appropriate; however the findings encourage longitudinal inquiry. Longitudinal research that spans late infancy into toddlerhood would offer more insights on whether breastfeeding duration in early infancy continue to influence maternal responsiveness during feeding, particularly considering the increasing intrinsic and extrinsic factors described here.
This study had a number of strengths and limitations. While ethnically diverse, this sample of mothers was generally college educated, of middle income, and married. Also, mothers in this sample had higher rates of overweight/obesity (72.6%) than in the US adult population (64.1%) . However, weight was recorded in the postpartum period which likely inflated the rates for this sample. Results might be different in samples with more diversity in terms of these maternal characteristics, particularly for education level due to its positive association with breastfeeding duration . This study was not able to ascertain the extent to which breastfeeding duration involved feeding at the breast, referred to as “direct breastfeeding”, versus feeding human milk in a bottle. Direct breastfeeding has been linked to improved infant self-regulation of formula/human milk intake  and later satiety response , as well as reduced risk of accelerated weight gain ; thus future research in this area should differentiate between direct breastfeeding and feeding human milk in a bottle. Last, relative weight was included only as a potential covariate here. Future studies investigating breastfeeding behaviors and feeding styles would benefit from a longitudinal design which can assess relative weight at multiple time points into early childhood, particularly in larger samples which might identify even modest associations between breastfeeding behaviors, feeding styles, and child weight measures.