Background Infant feeding is often characterised in broad categories, such as exclusive breastfeeding, partial breastfeeding and formula feeding. However there is little information about detailed patterns of feeding within these groups. The purpose of this study was to examine patterns of breastfeeding from 3 day prospective feeding diaries to describe how women feed their babies.

Methods The APrON study is a prospective study of women during pregnancy and their children. At 3 months postpartum women completed a prospective breastfeeding diary which collected information on the number of feeds, and duration and method of every feed over 3 days. A total of 1080 women completed the breastfeeding diaries.

Results Women reported feeding their babies using combinations of up to 4 different methods (at breast, expressed breastmilk in a bottle, formula, mixed breastmilk and formula in the same bottle) in any one day. For the ongoing analyses women were categorised into 4 groups based on the number and type of feeds reported/day: 1) at breast only (n=622), 2) at breast and expressed breastmilk (n=223), 3) mixed feeding using 2 methods (n=123) and, 4) mixed feeding using 3 or 4 methods (n=112). The proportion of total feeds at breast was 80%, 75% and 64% for the mothers in the ‘at breast and expressed milk’, ‘mixed feeding using 2 methods’ and ‘mixed feeding of 3 using 4 methods’ groups, respectively. In turn the average daily duration of at breast feeds was longer in women who fed at breast only compared to those in any other method group. Women who fed ‘at breast and expressed milk’, ‘mixed feeding of 2 methods’ and ‘mixed feeding of 3 or 4 methods’ fed, on average, for 18 min, 17 min and 27 min less at breast per day, respectively, compared to women who fed at breast only (all p=<0.01). There were no differences in the average number of daily feeds between the 4 method groups.

Women use many different combinations of methods within a day to feed their 3 month old babies. Using fewer groups to classify women ignores the ‘real life’ complexity of feeding patterns. Our data showed that those who used a combination of methods to feed their babies fed had a lower a frequency and total duration of feeding at breast. This could be important to understanding variation in maternal energy expenditure and infant growth, development and health in the future.

In collaboration with the ENRICH team.