Breast or Bottle: A Content Analysis of Infant Feeding Recommendation Videos on YouTube, Bilibili, and TikTok

Background Social media has become a primary source of infant feeding guidance, but content accuracy remains unverified. While World Health Organization(WHO) and American Academy of Pediatrics(AAP) endorse breastfeeding for its health benefits, formula feeding is frequently promoted as an alternative.This study evaluates the quality, engagement patterns, and feeding recommendations of infant-feeding videos on YouTube, Bilibili, and TikTok to inform platform content policies and viewer decision-making. Methods On November 1, 2024, searches were conducted with the terms “Breastfeeding” and “Formula Feeding” on YouTube, along with “母乳喂养” (breastfeeding) and “奶粉喂养” (formula feeding) on Bilibili and TikTok. The first 100 videos from each platform were collected based on the default sorting, with promotional and unrelated material excluded. Video details were documented, and their quality was measured using the Global Quality Score (GQS), the Video Information and Quality Index (VIQI), and a modified DISCERN (mDISCERN) tool. Results A total of 88 YouTube videos, 83 Bilibili videos, and 84 TikTok videos posted between September 2019 and November 2024 qualified for this study. TikTok clips drew the most audience interaction, while YouTube clips showed higher reliability based on mDISCERN ratings. No major differences emerged regarding feeding advice or the proportion of professional creators across platforms. However, professional content was of markedly higher quality and tended to favor breastfeeding, whereas non-professionals more often highlighted formula feeding. Additionally, formula-related videos generally attracted stronger engagement. Correlation tests revealed a clear positive association between engagement metrics and video quality on Bilibili, but this pattern was less pronounced on YouTube and TikTok. Conclusions Short-form platforms amplify formula-feeding narratives driven by algorithmic biases and unregulated commercial interests, often conflicting with WHO guidelines. Professional health entities predominantly share evidence-based breastfeeding guidance through less engaging long-form content. Systemic interventions are needed: Algorithmic prioritization of certified health content;WHO Code-compliant digital marketing regulations;AI-driven misinformation filters;Micro-influencer partnerships for breastfeeding advocacy. This multi-platform analysis highlights critical tensions between engagement-driven content ecosystems and public health priorities in infant nutrition.