P2.K210: Bye Bye Bottles: A Quality Improvement Project Targeting Bottle Weaning in Early Toddlerhood

Purpose/Objectives: Prolonged bottle use is linked to significant negative health outcomes including early childhood caries (ECC), nutritional deficiencies and overweight. The American Academy of Pediatrics (AAP) recommends bottle cessation by age 18 months. The pediatrician offers one of the most important opportunities for families to receive counseling and anticipatory guidance on this and many other issues, but weaning from the bottle is often challenging for families. The objective of this project is to provide consistent messaging and tangible resources for successful toddler bottle weaning and subsequently assess the impact of this intervention on parent-reported success.

Design/Methods: In this quality improvement (QI) project in an urban federally qualified health center in Denver, CO, pediatric providers presented bottle weaning messaging as well as a sippy cup and children's book at 100 twelve-month-old well child visits conducted during the summer 2023.
Families received specific messaging about weaning and were provided with a children's book entitled Bye Bye Bottles, Zebra by Michael Dahl and an EzPz silicone Mini Cup + Straw Training System. Those children who were breastfeeding received messaging about weaning directly to a cup.
To assess the effectiveness of the QI activity on successful bottle weaning, a medical assistant (MA) made follow-up calls 4-6 weeks after the visit to assess the family's bottle-weaning success. For those who were not successfully weaned, a follow-up call was made by one pediatrician to provide additional input about weaning.

Results: Upon the initial follow up call, 61% of the patients were successfully contacted by the MA. Of these, 52% reported bottle-weaning success and 14% reported not having received the bottle weaning intervention and messaging. The medical assistant made two attempts to call families, but 39% of the patients were not reachable. For the families that had not weaned from the bottle, the physician follow-up call centered on identifying the biggest barriers and offering input on steps toward the goal.

Conclusion/Discussion: This pragmatic QI intervention has encouraging potential to help families with this bottle weaning transition in early toddlerhood. This project also promoted goal-oriented physician counseling. The primary factor that affected success in this project was the number of families unable to be reached in follow-up as this provided an additional touch point in promoting the health goal. Despite this challenge, the same intervention described in this project is easily reproducible across a variety of pediatric practices and can be implemented to support this positive health outcome.