Bottle Feeding is a Risk Factor for Hypertrophic Pyloric Stenosis (HPS) in Infants

Could bottle feeding make your baby sick? Image by kamuelaboy

Could bottle feeding make your baby sick? Image by kamuelaboy

The power of breast milk, when moms feed it directly fed to infants, whether preemies or term babies, is indescribable, and the health benefits produced by its continued use only makes the case for breastfeeding stronger. New research finds that increased rates of breastfeeding has reduced overall cases of hypertrophic pyloric stenosis, which is great news for breastfed babies everywhere.

According to the latest CDC report, the number of moms that breastfeed has risen to 77% in 2010, and those that continue breastfeeding up to at least 6 months has increased to 49%. This is in good part due to the increased services provided at the hospitals, which now better encourage rooming-in and skin-to-skin time.

Breastfeeding: Secret to Good Health in Infants 

Every day, there are a multitude of reports attesting to the power of breast milk and its benefits to infants in providing them not only with nourishment, but also improving their chances to fight infections, and preventing prolonged hospital stays in preemies.

The latest study, published by Dr. Goldin’s group of researchers, demonstrated an inverse correlation in the decreased incidence of hypertrophic pyloric stenosis (HPS) in infants over the years to an increased prevalence of breastfeeding.

Causes of HPS

HPS is a thickening of the muscle layer of the pylorus (lower part of the stomach) that occurs in the crucial first weeks of life. When the pylorus muscles enlarge, the channel to empty food from the stomach to the intestine narrows and prevents gastric emptying (the ability of the stomach to empty its contents via digestion). This condition occurs in 2 out of every 1,000 births and manifests as forceful and recurrent vomiting of food that cannot pass into the infant’s intestines. In most cases, the obstruction of the outlet of the stomach makes surgery necessary. The risk factors of HPS are many, including being male, white, and a firstborn infant.

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In order to understand the association between increased breastfeeding rates and a decreased incidence of HPS, the authors studied 715 infants to assess the effects of maternal age, the smoking status of the mother, bottle-feeding, infant gender and maternal parity, or the number of babies the mom’s had. This study demonstrated that in older moms, there was a significant risk association between bottle-feeding and HPS.

Bottle-Feeding: A Risk Factor for HPS

It is interesting to note that although breast milk contains high levels of hormones, such as vasoactive intestinal peptide, that relax the pylorus and aid in emptying the stomach’s contents, infant formula possesses higher osmolarity (number of particles per litre of liquid) and decreases gastric emptying. According to previous studies, infants drink larger volumes when fed by bottle, so that could also account for the condition.

Overall, statistics show that children of young (<20 years) and nulliparous mothers (moms who have’t had any other babies) are at an increased risk of HPS; but, this study builds a strong case for an increased associative risk of HPS with bottle-feeding in older (>35 years) and multiparous mothers (moms who have had other babies.) This observation adds another factor for possible consideration: The increased estrogen present in older mothers also slows gastric emptying. It is also suspected that the fetus’ pyloric muscle could be primed, in utero, to the high estrogen levels in the older mother’s uterus, thereby making the infant more susceptible to the effects of bottle feeding after birth.

Bottle Feeding: What’s The Culprit Behind HPS?

Is it the larger volume of milk sucked in through bottle-feeding or the higher osmolarity of infant formulas that are to blame for the incidence of HPS in infants? Should we be cautious when feeding premature infants commercially-fortified human breast milk, since, in some cases, it causes a temporary delay in gastric emptying?

The authors caution that the results of this study, based on observation alone, are purely speculative at this point in time. A more detailed analysis, taking into consideration the multiple risk factors of the mother and infant, is necessary.

As for the breastfeeding advocates, this study adds a feather in their cap, and they can continue to push for this noble cause.


McAteer, JP, Ledbetter DJ and Goldin AB. 2013. Role of bottle-feeding in the etiology of HPS. JAMA Pediatrics.

Breastfeeding Report Card 2013. CDC.

Carlson S, Wojcik B, Barker A and Klein J. 2011. Guidelines for the use of human milk fortifier in neonatal Intensive care unit.

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