Counterfeit Infant Feeding Bottles and Their Implications for Child Health: A Global Review of Chemical, Microbiological, Environmental, and Policy Evidence

Background: Infant feeding bottles are widely used globally; however, increasing evidence indicates that plastic food-contact materials are not chemically inert under realistic conditions involving heating, repeated sterilization, mechanical stress, and prolonged use. Early life, particularly the first 1,000 days, represents a critical developmental window during which low-dose environmental exposures may influence endocrine signalling, immune maturation, metabolic programming, and neurodevelopmental outcomes. Objective: This review synthesizes peer-reviewed evidence on chemical migration from infant feeding bottles, endocrine-disrupting mechanisms and “regrettable substitution” following bisphenol A (BPA) regulation, microplastic release during routine formula preparation, microbiological contamination risks, and emerging public health challenges associated with counterfeit feeding bottle markets. Methods: A structured narrative systematic approach was used to identify peer-reviewed literature from PubMed, Scopus, and Google Scholar. Included studies comprised experimental migration research, mechanistic toxicology reviews, epidemiological studies examining bisphenol exposure and child health outcomes, microplastic release investigations, and authoritative regulatory risk assessments. Grey literature and non-indexed sources were excluded to ensure methodological rigor. Results: Experimental evidence demonstrates increased migration of bisphenols under thermal and mechanical stress conditions. Although regulatory actions reduced BPA use in infant products, structurally related substitutes such as bisphenol S (BPS) and bisphenol F (BPF) exhibit comparable endocrine activity, raising concerns regarding class-based chemical risks. Polypropylene feeding bottles may release substantial quantities of microplastic particles during standard preparation practices, introducing an additional exposure pathway. Concurrently, bottle feeding practices may increase microbiological contamination risk, particularly where material degradation promotes biofilm formation. Counterfeit products further complicate safety assessment due to uncertain composition and regulatory oversight gaps. Conclusion: Infant feeding bottle safety should be conceptualized within an integrated exposure framework incorporating chemical migration, particulate release, microbiological hazards, and global market dynamics. Strengthening lifecycle-based testing, class-focused regulatory strategies, counterfeit surveillance, and culturally appropriate caregiver guidance may reduce early-life environmental exposures and improve child health protection. Key words: Infant feeding bottles; bisphenol A; bisphenol analogues; endocrine-disrupting chemicals; microplastics; polypropylene; polycarbonate; bottle hygiene; biofilms; counterfeit products; food-contact materials; infant exposure.