Association of Infant Child Care with Infant Feeding Practices and Weight Gain Among US Infants

Objective: To assess whether child care arrangements influence infant feeding practices and weight gain among US infants.

Design: Cross-sectional analysis of data collected by the US Department of Education, National Center for Education Statistics.

Setting: A nationally representative sample of infants enrolled in the Early Childhood Longitudinal Study, Birth Cohort at baseline.

Participants: A total of 8150 infants aged 9 months.

Main Exposures: Age (in months) at initiation and type and intensity of child care.

Outcome Measures: Breastfeeding initiation, early introduction of solid foods (<4 months), and weight gain (birth to 9 months).

Results: A total of 55.3% of infants received regular, nonparental child care and half of these infants were in full-time child care. Among infants in child care, 40.3% began at younger than 3 months, 39.3% began between 3 and 5.9 months of age, and 20.7% began at 6 months or older. Infants who initiated child care at younger than 3 months were less likely to have been breastfed (odds ratio, 0.58; 95% confidence interval [CI], 0.43-0.74) and were more likely to have received early introduction of solid foods (odds ratio, 1.73; 95% CI, 1.43-2.04) than those in parental care. Infants in part-time child care gained 175 g (95% CI, 100-250 g) more weight during 9 months than those in parental care. Infants being cared for by relatives had a lower rate of breastfeeding initiation, a higher rate of early introduction of solid foods, and greater weight gain compared with infants receiving parental care. The early introduction of solid foods was a risk factor for weight gain.

Conclusions: Child care factors were associated with unfavorable infant feeding practices and more weight gain during the first year of life in a nationally representative cohort. The effects of early child care on breastfeeding and introduction of solid foods warrant longer follow-up to determine subsequent risk of childhood overweight.