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Acad Pediatr. 2009 Jan-Feb;9(1):17-25. doi: 10.1016/j.acap.2008.10.005.

Reasons for prolonged bottle-feeding and iron deficiency among Mexican-American toddlers: an ethnographic study.

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  • 1Division of General Pediatrics, Department of Pediatrics, UT Southwestern Medical Center, Dallas, 5323 Harry Hines Blvd, Dallas, TX 75390-9063, USA.



Several studies have shown that prolonged bottle-feeding is associated with iron deficiency. Mexican-American toddlers are the racial/ethnic group at greatest risk for prolonged bottle-feeding and iron deficiency, yet no studies have examined reasons for prolonged bottle-feeding in Mexican-American toddlers. The objective of this study was to assess infant feeding beliefs, knowledge, and behaviors among Mexican-American parents.


Ethnographic interviews were conducted of parents of Mexican-American toddlers 15 to 48 months old at 3 community sites. A 31-question moderator's guide addressed 4 domains: knowledge and cultural beliefs; sources of nutritional information; anticipatory guidance; and suggestions for ways to change infant feeding practices. Interviews were audiotaped, transcribed, and analyzed using grounded theory.


Thirty-nine parents were interviewed; the mean parental age was 29 years, and mean child age, 2.2 years. Parents cited convenience as a reason for prolonged bottle-feeding, and believed that they should give toddlers as much milk as they want. Many parents lacked essential knowledge regarding infant feeding practices and iron deficiency, including when to stop bottle-feeding, health problems caused by prolonged bottle-feeding, the quantity of milk to give a child >1 year old, and iron deficiency as a complication of prolonged bottle-feeding. Parents reported not receiving enough education from physicians, and they supported educational interventions on healthy infant feeding practices, including refrigerator magnet charts, videos, brochures, and teaching by physicians.


Parents of Mexican-American toddlers often are unaware of the adverse consequences of prolonged bottle-feeding and developmental problems associated with iron deficiency. Parents supported educational interventions, including videos, brochures, and refrigerator magnet charts on healthy infant feeding practices.

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