Breast- and bottle-feeding in preterm infants: A comparison of behavioral cues

Shih Chun Lin, Chen Hsiu Lin, Jia Wen Zhang, Siao Min Chen, Chih Ling Chen, Mei Chih Huang

Research output: Contribution to journalArticlepeer-review

1 Citation (Scopus)


Background: Developmental care has been broadly applied to identify the behavioral cues and care needs of preterm infants. Past studies indicate a significantly higher level of physical distress in bottle-fed preterm infants than in preterm infants who are breastfed. However, no evidence has yet been reported that supports the influence of feeding methods on behavioral cues. Purpose: This study compares differences in the type and frequency of behavioral cues between breast- and bottle- fed preterm infants. Methods: A comparison study design and secondary data analysis method were used to assess data from two previous research projects. Infant feeding behavioral cues were observed and compared between two groups: 7 preterm infants who were breastfed and 7 preterm infants who were bottle-fed. After cases were matched by infant gestational age, behavioral responses were coded according to the preterm feeding cues coding system (PFCCS) from 7 paired maternal-infant feeding videos that featured preterm infants of 25 to 32 weeks gestational age at birth. Results: The PFCCS classifies 24 feeding behavioral cues into hunger cues, self-regulatory cues, stress cues, and satiety cues. Infants in the breastfeeding group had a higher hunger cue frequency than their bottle-fed peers (p = .013), while bottle-fed infants had a higher stress cue frequency than their breastfed peers (p = .041). Other significant differences in behavioral cues between the two feeding methods included "fluid spillage" (bottle- > breast-, p = .008), "central cyanosis" (bottle- >breast-, p = .024) and "hand pushing" (breast- >bottle-, p = .034). Conclusions / Implications for Practice: Preterm infants in this study who breastfed showed significantly fewerstress cues than those who bottle fed. These findings support the importance of enhancing care provider sensitivity with regard to behavioral-cue observation. Findings further support breastfeeding rather than bottle-feeding forpreterm infants.

Original languageEnglish
Pages (from-to)27-34
Number of pages8
JournalJournal of Nursing
Issue number6
Publication statusPublished - 2013 Dec

All Science Journal Classification (ASJC) codes

  • Nursing(all)


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