Doctoral Dissertations
Date of Award
8-2025
Degree Type
Dissertation
Degree Name
Doctor of Philosophy
Major
Nutrition
Major Professor
Katie Kavanagh
Committee Members
Sarah Colby, Samantha Ehrlich, Kristen Johnson
Abstract
Background: Infant-led bottle-feeding (ILBF) techniques are widely recommended to support healthy infant intake and to promote feeding autonomy, yet little research has explored how caregivers understand and implement these approaches in real-world settings. Despite the wide availability of infant-led feeding information, families often encounter inconsistent guidance, unclear terminology, and limited practical support.
Objectives: This dissertation examined caregiver knowledge, experiences, and perceptions related to ILBF, focusing on how families interpret, adopt, and sustain infant-led feeding practices and what barriers or supports influence their choices.
Methods: A two-phase study was conducted. First, a cross-sectional web-based survey of U.S. caregivers (N = 312) assessed feeding practices, term recognition, and sources of learning about ILBF. Second, in-depth, semi-structured interviews were conducted with 18 survey participants, purposively selected to represent a range of infant-led feeding experiences. Thematic analysis was used to explore caregivers lived experiences, support needs, and perceived barriers.
Results: Despite being highly educated and well-resourced, participants reported notable gaps in guidance and inconsistent understanding of bottle-feeding terminology and practices, highlighting systemic shortcomings in infant feeding education. Most caregivers reported using elements of infant-led feeding, but their interpretations and implementation varied widely and were not associated with differences in infant weight change. Interviews revealed that caregivers often lacked meaningful support, felt uncertain about technique and bottle choice, and faced social and logistical barriers to implementation. Emotional support, practical guidance, and clear, accessible resources were identified as critical for building confidence in feeding choices.
Conclusions: Persistent gaps in bottle-feeding support and education exist, even among families with considerable resources. Findings underscore the need for standardized, widely accessible resources and consistent, evidence-based guidance from both clinical and community sources to help caregivers adopt ILBF in alignment with responsive feeding principles. Future research should clarify which ILBF elements caregivers are most likely to adopt, what influences those choices, and how implementation affects feeding outcomes. Addressing these issues is essential for designing effective interventions and reducing disparities in infant nutrition support.
Recommended Citation
Wojtowicz, Emily, "Exploring caregiver experiences and perceptions of infant-led bottle-feeding. " PhD diss., University of Tennessee, 2025.
https://trace.tennessee.edu/utk_graddiss/12787