Bottle feeding a breastfed baby
For most of us breastfeeding moms, there comes a time when we want and/or need to introduce a bottle. Perhaps you are returning to work, going on a vacation, or taking a night away. Maybe you are planning to wean from the breast, or maybe complications are requiring you to wean. Even more, you could be looking to get a spouse or other caregiver more involved in your baby’s care (and give you some down time). Here are some things to consider when preparing to give your baby his or her first bottle.
Side note: If you are having trouble getting your baby to take a bottle, please read my post Breastfed baby refusing a bottle? Read these tips and tricks!
When to introduce a bottle.
Every baby and situation is different. There are no clear rules.
Waiting too long to introduce a bottle can make things challenging. As your baby gets older, he or she may grow less willing to accept milk from an artificial nipple.
On the contrary, some hypothesize that introducing the bottle too early can cause nipple confusion or flow-preference. I would like to note, however, that many breastfeeding mothers successfully bottle feed their infants in the first few weeks of life for supplementation or other reasons. Please read the pacing recommendations described later in this post, as they may help reduce the chance of your baby developing a bottle preference.
A general and common recommendation is to introduce the bottle after the first 2-4 weeks, but before the 6 week mark.During this time, your milk supply is likely well-established, you and your baby have developed a strong breastfeeding relationship, and hopefully your baby is still open to the idea of using a bottle as a food source.
After your baby has successfully taken a bottle, many lactation consultants and nurses recommend offering a bottle either every day or once every 2-3 days. If too many days or weeks pass between bottle feeds, your baby may decide to refuse the bottle. This happened to me, and it was a stressful 6 weeks before our daughter accepted another artificial nipple! Hopefully you can prevent this stressful period by consistently offering a bottle of pumped milk or formula every 1-3 days. I know pumping is hard and time consuming, but if you can pump enough to offer just an ounce or two per feed, this may be enough to keep your baby familiar with the bottle.
Choosing a Bottle.
There are so many different nipple shapes out there. Below is a list of bottles/nipples that tend to be recommended for breastfed babies.
- Evenflo (Best latch for my daughter, but every baby is different)
- Dr. Browns
- Munchkin Latch
- Laytex NaturaLatch
- Tommy Tippee
Some bottles claim to be more like a mother’s breast, which in theory may make the transition from breast to bottle a little easier. Be cautious, however, because I found my daughter latched poorly to many of these bottles. For example, she didn’t latch well to nipples shaped like the Nuk. Rather, her best latch was with round nipples that gradually widened to the base.
Because every baby is different, I recommend observing your baby’s latch and feeding with each nipple-type you try. A good bottle latch should have similar characteristics to a good breastfeeding latch: an open mouth and flanged, relaxed lips that rest on the base of the nipple (not just pinching the nipple teat).
If, after a few attempts, your baby is having difficulty, try something different. Some options are to try a different nipple shape and/or take steps to better pace the feed. Pacing the feed can be done by changing the nipple flow rate and/or adding pacing strategies. Read the rest of this post for more information.
Pacing the feed
Pacing your baby’s bottle feeding session is important. Not only does it support the breastfeeding relationship, but it also ensures your baby’s safety, improves your baby’s comfort, and builds a trusting/loving bond between your baby and her caregiver.
An ideal feed will have the following characteristics:
- Your baby will appear comfortable, calm, and relaxed while feeding (no tensed muscles).
- Your baby will make good eye contact with the feeder. She may smile and coo intermittently throughout the feeding.
- Your baby will repeat a cycle of sucking 1-2 times, swallowing, and breathing.
- The feeding session will last for about 15-20 minutes.
- Baby’s lips will be relaxed and flanged (like fish lips) onto a portion of the nipple’s base. Baby’s lips should not be tight and/or “pinching” the nipple.
These signs indicate that your baby is receiving milk at an appropriate pace. Your baby is not feeling inundated by a flow that is too-fast or frustrated by a flow that is too-slow.
Giving a bottle at a pace that is too fast (more common) raises concerns, as it can compromise your baby’s safety by increasing the chance of milk passing into the airway. A fast flow rate can also lead to over-eating, can cause baby to reject the bottle, and/or can increase baby’s risk of gassiness, discomfort, or reflux.
Signs of distress caused by a flow/pace that is too fast:
- Gulping without taking breaks
- Unable to catch breath while sucking
- Spilling milk down the chin
- Coughing/choking (could also be nipple shape/length)
- Looking worried
- Splayed fingers/toes, or tension in the arms/legs
- Having wet throat sounds/clearing throat
- Finishing a feed to quickly (<10 minutes).
- Turning head away from nipple, refusing to open mouth, or pushing the bottle away (if occurring only at the end of a feed, however, these may be signs that your baby is full)
Below are two general approaches to help avoid these signs of distress.
I always liked the idea of approaching bottle feeding in a way that is similar to breastfeeding. That is, following your baby’s cues and feeding at your baby’s pace. Bottle feeding in this way helps support the breastfeeding relationship you have already established. When the pace of bottle feeding matches that of breastfeeding, your baby is less likely to develop a preference for a faster flowing bottle. Here are some suggested pacing strategies:
Feed your baby based on their cues rather than a time schedule.
- Offer the bottle when your baby demonstrates early signs of hunger: licking lips, smacking lips, making sucking sounds, opening mouth, sucking on hands/toys. For younger babies, turning their head side-to-side is often a hunger cue.
- End feeding sessions when your baby shows signs of satiety: turning head, letting go of the nipple, opening fists, pushing bottle away.
- If your baby is showing signs that she is full, you don’t need to force the extra ounce of milk just to finish a bottle.
Hold your baby upright. Usually, at least a 45* angle is recommended, as this keeps the bottle at a preferable angle and prevents milk from flowing too quickly.
Let your baby accept the nipple, rather than forcing the nipple into her mouth.One approach that generally works well for a younger baby is to tickle her cheek with the nipple and wait for her to turn and latch. For an older baby, you can try tickling her top lip and waiting for a rooting response (opening wide) before placing the bottle into her mouth.
Bottle Position: Use gravity to help baby self pace.
- Hold the bottle in a mostly horizontal position. By doing so, you are making your baby work a bit to get his milk, like he does while breastfeeding. This also allows your baby to self-pace his feed. On the other hand, if you hold the bottle in a vertical position, you might unintentionally overwhelm your baby with fast milk flow. Personally, I like to keep the bottle tipped just enough to fill the nipple tip with milk.
- Tipping the bottle up or down a small degree during a feed causes an increase or decrease in flow rate. If you want to dig deep, you could use this information to get pretty specific with your bottle feeds. For example, some caregivers try using small changes in the tilt of the bottle to mimic a natural let-down rhythm. For me, doing too much up/down with the bottle during a feed seemed disruptive of the feeding rhythm. As always, observe and follow your baby’s cues.
Mimic the natural pauses of breastfeeding. Breastfed babies don’t generally drink nonstop until they finish a feed. Instead, a breastfeeding rhythm typically has many pauses, where the baby stops to take a break, look around, flash a toothless grin, etc. When giving a bottle, you can incorporate natural pauses, but try doing so at your baby’s initiation.
- When breastfeeding, sometimes a baby takes a break from sucking, but doesn’t come off the breast. If your baby naturally stops sucking during a bottle feed, try tipping the bottle down to stop the milk flow, without removing the nipple from baby’s mouth. Simply wait for the baby to start sucking again before tipping the bottle back up to reintroduce the milk supply.
- Other times in breastfeeding, the baby takes a break by pulling himself off the breast. If your baby naturally takes himself off the bottle during a feed, respect his desire to rest and take the opportunity to shift position, exchange smiles, have a little chat/coo interaction, etc.
Switching sides (caregiver holding baby in left or right arm) when bottle feeding supports breastfeeding and may reduce the risk of baby starting to prefer one breast over the other.
Nipple flow rate.
When offering your baby’s first bottle, you typically want to choose a slow-flow nipple. Different bottles label nipple flow rates in different ways. And, to further complicate things, the same flow rating doesn’t necessarily mean the same thing from one bottle to the next. Look for one of the following: preemie flow, extra-slow flow, slow-flow, 0+m, 1+m, or size/level/stage 1.
To me, it makes sense to avoid the level/stage 2 nipples or 3+m nipples until your baby is an established bottle-feeder. Babies suck differently from a bottle than a breast, and it can take some time before they figure the bottle out. You don’t want to flood your baby while they are learning.
Some babies progress through nipple flow rates as advertised (requiring a faster nipple about every 3 months). Not all babies follow this progression, however, and your baby may move through flow rates at a faster or slower pace. My baby, for instance, preferred a level 1 (0+m) nipple until she was over 6 months old. Watch your baby’s signs to know when to adjust the flow rate.
The signs of distress listed above may indicate that the flow rate is too fast.
On the other hand, these are signs that the flow may be too slow:
- Sucking more than 2 times before swallowing
- Pulling off the nipple after sucking a few times
- Sucking hard
- Biting/tugging on the nipple
- Appearing bored or angry/frustrated
- Taking >30 minutes per feed
- Showing hunger signs shortly after an unfinished bottle feed
- Not meeting weight gain expectations.
If you have tried multiple nipple flow rates for a particular bottle type, and the bottle feedings are not successful, observe your baby’s latch. You may need to consider a different shaped nipple. (see “choosing a bottle” section above)
Resources & Additional Information:
The importance of flow rate in infant feeding, by Allyson Goodwyn-Craine
Bottle feed a breastfed baby, by Philippa Pearson-Glaze, IBCLC
Baby-led Bottle Feeding, by Fleur Bickford BSc, RN, IBCLC
Bottle Feeding Breastfed Babies, by Tanya Lieberman, IBCLC, with Amy Peterson, IBCLC
Breast and Bottle Feeding Blog, by Amy Peterson, IBCLC
When to switch Nipple Flow & Size And How To Do It, by KidSimplified
Paced Bottle Feeding Video, by Jessica Barton
When Do Babies Start Holding Their Own Bottle? Reviewed by Michelle Roth, BA, IBCLC
Featured image background photo by rawpixel.com