Baby-led Bottle Feeding

Unlike breastfeeding, we’ve all seen bottle feeding, and we all know how to do it. We’ve been surrounded by it growing up. If someone handed you a baby and a bottle you would know what to do right? Of course you would, but would you know how to do it without causing a stressful feeding? Despite the large number of parents who use bottles in today’s society (whether those bottles contain breastmilk or formula), there are very few who have actually been taught how to bottle feed their baby in a manner that is respectful of the baby’s airway and natural feeding rhythm.

Bottle feeding may seem like a strange topic for a lactation consultant to be blogging about, but I feel it’s an important one. Conventional bottle feeding methods can cause problems for both breastfed and bottle fed babies, and all babies deserve to be fed in a respectful manner. By “conventional” bottle feeding, I mean the method of bottle feeding that most of us are used to, which is baby more or less on his back, and the bottle being tipped up to ensure there are no air bubbles.

This baby is being overwhelmed with milk and is showing clear stress signs.

Although I work with breastfeeding moms and babies, I do a lot of teaching about bottle feeding. The moms  that come to me, are usually having difficulty with breastfeeding, and are sometimes supplementing breastfeeding with bottles of expressed milk or formula. There are of course alternate methods of supplementing (supplemental nursing system, finger, syringe or cup feeding) but many moms are either already using bottles when I see them, or find that bottles are simply easier to deal with because they are familiar.

I often hear from moms who are afraid that they aren’t producing enough milk because their baby will gulp down a bottle after breastfeeding. It’s important for parents to understand that with conventional bottle feeding methods, babies have no choice but to gulp down everything in their bottle in order to protect their airway. If you hold a bottle upside down (even one with a slow flow nipple), it drips. When a baby being given a bottle swallows, the negative pressure created draws more milk into the baby’s mouth, meaning the baby has to swallow again to avoid choking. This is stressful for the baby, and babies will often display stress cues such as splayed fingers or toes, milk running out of the corner of the baby’s mouth, trying to turn their head away, or trying to push the bottle away. The picture above is a good example of this.

It’s not normal for babies to gulp down their entire feeding in a few minutes. When you watch a baby breastfeeding, you see that they drink for a while then take a little break before drinking again (with the exception perhaps of oversupply/forceful let down, which is a different situation). Breastfeeding is the biological norm for infant feeding. This means that with any other feeding method used, care should be taken to mimic breastfeeding as much as possible.  I have seen conventional bottle feeding methods lead to overfeeding, spitting up, reflux, wheezing and  difficulty breathing while feeding, and even feeding refusal (due to feeding being so stressful). Bottles being given to a breastfed baby can also cause problems with breastfeeding. Babies suck differently from a bottle than they do at the breast, and babies can become accustomed to the faster flow of milk from a bottle, causing them to become impatient at the breast. The tips below can help to minimize some of the problems associated with bottle feeding.

Good positioning for bottle feeding, and a baby who is relaxed and enjoying feeding.

 

Tips for bottle feeding any baby (not just a breastfed one!)

1. Hold your baby sitting upright, and start by placing the nipple of the bottle against your baby’s top lip. Wait for your baby to open up before putting the bottle in his mouth. Never force a bottle into a baby’s mouth.

2. Your baby should be sitting up enough that the bottle is horizontal (parallel to the floor). Tip the bottle just enough to keep the tip of the nipple filled with milk (as the bottle empties, you will have to tip the bottle up more). It’s fine if there is an air bubble at the base of the nipple as long as the tip is filled with milk. This works much better with a straight bottle rather than an angled one.

3. If you are supplementing a breastfed baby, or pumping and bottle feeding in the hopes of getting baby back to nursing, it is beneficial to let your baby suck on the nipple for a minute or two without getting anything, and then tip the bottle so your baby is getting milk. When breastfeeding, babies have to wait a minute or so for mom’s milk to let down, and they have to suck to trigger that let down. Babies who have been bottle fed sometimes get used to the immediate reward from the bottle and then are impatient at the breast and don’t want to wait for let down. By letting baby suck for a short while without getting anything from the bottle, you are mimicking the process at the breast, and it can help with the transition. There is no need to worry about your baby taking in air, one end or the other it will come back out!

4. Watch your baby’s cues All babies, whether breast or bottle fed should be fed whenever they show signs of being hungry, and not according to any kind of schedule. During feeding, if your baby starts to show any signs of stress (splayed fingers and toes, milk spilling out of mouth, turning head away, pushing bottle away – see picture above) then your baby needs a break. Keep the bottle in your baby’s mouth, but tip the bottle so that the nipple is pointing towards the roof of the baby’s mouth. By doing this, your baby knows that the bottle is still there and will start sucking again when ready. At that point you can tip the bottle back up so that baby is again getting milk. It is frustrating for your baby if you take the bottle out of his mouth to give him a break because he doesn’t know where it has gone or if it’s coming back. If your baby is showing signs that he is done (turning head, trying to push bottle away etc), then respect those cues and end the feeding.

5. Alternate sides part way through the feeding to mimic breastfeeding and allow stimulation to both eyes and both sides of the body. This also helps to prevent the development of a side preference when feeding.

6. Find a nipple that works well for your baby. There are no black and white answers as to which bottle nipple is “best” for a breastfed baby, because all babies are different. For young babies, make sure you are using a slow flow nipple. Even with older babies a slow flow nipple may be best if your baby is struggling with the flow of milk. Don’t worry about the recommended ages on the bottle nipple packaging, watch your baby to determine what works best for them. Unfortunately, “slow flow” is not something that is standardized, and some “slow flow” nipples actually flow quite quickly, so again, watch your baby. I do not recommend the “Nuk” or orthodontic type nipples because mom’s nipples don’t look like that! (If mom’s nipples are pinched or flattened after baby feeds, it’s a sign that baby isn’t latched on properly, or some other issue is causing baby to compress the nipple). Your baby should be able to “latch” onto the base of  whichever nipple you use. Some bottle nipples that are advertised as having a wide base and being “more like mom’s breast”, are so wide that baby ends up being just on the nipple, which is something to be avoided. There are some good pictures of how your baby should look when latched onto a bottle nipple on this post from Best for Babes titled How to Bottle-feed as You’d Breastfeed, and more information at the website www.breastandbottlefeeding.com.

Things to avoid:

1. Never prop a bottle. It’s a dangerous practice that is stressful for your baby.

2. Don’t bottle feed your baby while he’s swaddled. You need to be able to see your baby’s hands to watch for stress signs, and your baby needs to have his hands free to participate in feeding.

3. Don’t feed your baby with him facing away from you. Feeding is an important time for the development of social interaction in babies. Make eye contact with your baby, talk to him and enjoy the feeding as a fun interaction with your baby rather than another task to get through as quickly as possible.

4. Don’t force your baby to finish a bottle by twisting it or moving it around in baby’s mouth. Let your baby decide when he’s done. Overfeeding can lead to an uncomfortable and unhappy baby!

 

More information about the baby-led method of bottle feeding can be found in Dee Kassing’s article Bottle-Feeding as a Tool to Reinforce Breastfeeding

 

Use of formula

Along with bottle feeding, I also do a lot of teaching about correct formula preparation because many parents are not informed about the dangers of giving powdered formula to young or ill babies, and haven’t been taught how to prepare powdered formula properly.

Powdered infant formula is not a sterile product and there have been cases of powdered formula being contaminated with the bacteria E. sakazakii which can easily be fatal for young children. Babies under the age of one year are at particular risk of infection with E. sakazakii, with the greatest risk being for those who are less than 28 days old, or who are preterm, low birth weight, or immunocompromised (have a weakened immune system). For these babies, liquid formula should be used because it is sterile.

If you are using  powdered formula it is very important for it to be properly prepared in order to kill any potential bacteria. Powdered formula needs to be mixed with water that is at least than 70 degrees Celsius (boil the water and let it cool for no more than 30 minutes before mixing it with the powder). It can then be cooled to an appropriate temperature for feeding or cooled and stored in the fridge for no more than 24hrs. You can read more detailed information about the proper preparation of powdered infant formula here.

If you are using liquid formula, make sure you follow the directions on the can closely. There are two types of liquid formula – ready to feed and liquid concentrate. The liquid concentrate must be mixed with the proper amount of water (as outlined on the can) before feeding. Failure to mix liquid concentrate formula with the right amount of water can have severe consequences for your baby.

 

 

Comments

  1. Spot on with this write-up, I really believe this web site needs much more attention. I’ll probably be back again to read through more, thanks for the info!

  2. Thank you thats an interesting post. We actually loved BreastFlow bottles with our first. We had no problems with leaking and it was easy to get the extra milk out of the by pinching it, It was nice to have a bottle that was as close to breast as possible while I had to work.

  3. Wonderful post, Melanie. Thanks so much for your perspective on responsive feeding, it warmed a dietitian’s heart :). I absolutely agree, regardless of the feeding approach the most important thing is to stay attuned to baby’s cues and enjoy mealtimes together.

  4. My husband and I found a new technique that worked when everything else failed so I offer it to anyone it might help–we used a video of a baby drinking a bottle. More on my blog post on this subject.
    artisanlyn.tumblr.com

  5. I thought this article was VERY helpful. We had been feeding out daughter all wrong. Wondering why her tummy was so upset after eating and why she was eating so much. We were WAY over feeding her! After reading this article, discovering she had all the stress cues listed, we changed the way we bottle feed her and she is doing great! Thanks so much for this article! We are making sure that anyone feeding her has been instructed.

  6. taylormae says:

    and she drinks her bottle rather quickly as well ! has a nice burp and is happy !

  7. taylormae says:

    my almost 7 month old will eat a whole 6-8 oz bottle every feeding and baby food , milk pours out the side of her mouth but that doesnt mean she doesnt want it because when i take it away to wipe her mouth she gets unhappy wanting her bottle back…. so this wasnt very helpful for me .. sorry

    • Article does say taking the bottle out is stressful for the baby b/c they don’t know where it went or if it is even coming back. So maybe the part about tilting it back so no milk comes out but nipple is still there could be helpful… Just sayin.. Take what you need and leave the rest…

  8. my baby is a breastfed he does.t use bottle fed.i wish he use bottle fed what can i do.

  9. The article is how to bottle feed your baby using their own cues, including WHEN they want to eat. No set schedule, however, the bit about preparing formula recommends a method that would take close to 40min to complete, in order to reduce the risk of E Sakazakii contamination. The linked WHO pamphlet then goes on to confirm that 70 degree water should be used, and feeds should be administered immediately, not mixed and then stored. I don’t see how these two concepts can coexist. If we are to safely prepare fresh bottles for each feed, but feed on demand, babies would have to wait over half an hour to eat? Sorry, I can’t do that to my child.

  10. Thanks so much for this! Do you have any thoughts on the Medela Calma nipple? Its supposed to control the flow and mimic the breast…

    • I used it and it is very expensive but my DD hated it around 3 mths. Tried again when she was a little older and she still hated it. I thought it would be great to be able to pump and feed in the same bottles, but it is very funky to take apart and assemble too. It is 4 different parts to get the nipple just right or it leaks.

  11. There is a lot of confusion out there about the safe storage and handling of expressed breastmilk, with some parents being wrongly advised to treat it exactly as formula. This would mean, for example, discarding any milk left in a bottle which the baby hadn’t finished.

    Even mothers who have little difficulty expressing enough milk for their baby will nevertheless have worked pretty hard at doing so, and are loath to waste their precious milk. I think this contributes to the temptation to urge their baby to finish the entire bottle whether he really wants it or not.

    When parents know just how safe expressed milk is, allowing the baby to adopt a more natural feeding pattern is more viable.

  12. For a new dad wanting to be able to share more in the feeding/bonding process, this article gives some great suggestions that I look forward to trying out. Thank you for posting this!

  13. Something about letting a baby suck an empty bottle for a few minutes seems just cruel. My son would have been hysterical if I did that,and then would have likely threw up his whole meal because he sucked in a gallon of air first! But I understand the theory behind it, my son was not interested in the breast at all after he had a bottle, it was easy for him.

    • It isn’t recommended that they suck the nipple of the bottle first. Put your knuckle up to his mouth and let him suck on that before handing him the bottle. Works wonders. My son is breastfed and we have avoided nipple confusion for when I have to pump by doing this!

  14. Thank you. This is so helpful. My 5month old prem son has been nil by mouth for 6 weeks. The drs want me bottle feeding when we reintroduced milk but I didn’t want to. I’ve been trying to cup feed but he’s been showing signs of frustration because he’s desperate to suck. I think these tips will help for that too – mum needs more practice! :)

  15. Yes great for the info but do you knoa a mothers breast milk can flow so fast and do the same as the bottle? It happend to me,when i was breast feeding my little one and she stoped to sack and my milk was not stopping..!! It is as the older people always said be aware at all times in what you do..!

  16. Thank you so much for this post! Our LC at the hospital where out son was born (5 weeks early) was recommended as a preemie paced-feeding expert, but other than holding the baby upright and keeping the bottle closer to horizontal, these tips are almost the exact opposite of the “tough-love” methods she taught us (which included twisting/moving the bottle to trigger our son to keep eating, forceful frequent burping to “keep him awake”, not noticing if he ate so quickly that he spilled out of the corners of his mouth/down his chin, and making sure he ate the prescribed amount (30ml each feeding to start, 45-60 each feeding, every 2-3 hours max, after a week) within 15 minutes or else he’d be “working too hard for his calories, thereby wasting them in the effort to consume them.”).

    …and here I’ve been so confused as to why he’s had difficulties taking to the breast after 4 weeks! Definitely going to take your tips to heart and give them a shot to see if it helps him transition into breastfeeding with less stress for all of us. :)

  17. This should be printed and put with every bottle&teat sold! Thank you, I am expecting our second in October and while I would prefer to feed exclusively from the breast for the first 6months or so and then cup feed, it is good to do some research in case we change our minds or have problems.

  18. Thank you! Excellent information! Even with no babies breast or bottle age in the house.. it’s good info to know.

  19. Christine says:

    I’ve made sure that my husband, my mother and my mother-in-law, as well as anyone else who gives my baby a bottle, is aware of this. I really appreciate you making them available. My daughter tends to gulp a bottle anyhow though, is that just her, or is it likely that we aren’t holding the bottle quite right? Does grabbing at the bottle necessarily mean that it’s a sign of too-fast flow? She is 7 weeks, and does the same with my breast sometimes (she’ll pat with her upper hand, and grab at the hand I’m supporting my breast with, and grip quite hard, with her lower one).

    • Fleur (Nurtured Child) says:

      Christine, you may need to check the nipple that you are using. There is no standardization of what “slow flow” means, so some slow flow nipples are actually quite fast. If your little one is grabbing the bottle and not pushing it away, and otherwise seems happy, then it’s likely not a problem.
      Warmly,
      Fleur

  20. Thank-you for the post. I am nursing my 6 week old baby with an SNS nurser and sometimes she has the same gulping response at the breast when the tubes are unclamped, do you have any advice for the proper use of the SNS? (I nursed my first daughter with the SNS as well, but she was about 8 weeks old when I first found out about how the device could help us and I don’t remember having the same issue).

  21. Jennifer S says:

    Thank you for this fantastic post! I often need to teach moms paced or baby-led bottlefeeding and I’m going to send them the link to your page because it explains everything so clearly. The pictures are great, too.

    I have been thinking a lot lately how formula feeding parents really need this information, because as you said, all babies should be fed in a gentle, respectful, non-overwhelming way.

    Thanks again.

  22. This is a GREAT article. We’ve all seen someone bottle-feed a baby, and most likely have done it ourselves at some time. Seems basic enough, right? There are all kinds of things you’ve mentioned that lots of people probably don’t know. I didn’t!

  23. What a great post! I shared it on our facebook page and Twitter feed. I think this is a subject that doesn’t get talked about nearly enough. It’s assumed everyone knows “how” to bottlefeed, and I think so often the way bottlefeeding is handled shows the assumption our culture has that infant feeding is simply about meeting nutritional needs.

  24. Thank you for this!! There is so much info out there about breastfeeding but so little about bottle feeding. And for those of us who end up on bottle feeding, this kind of article is a godsend!!!

  25. Angelena says:

    i ill be sharing this on my facebook so other moms can get this info.

  26. mommy2boys says:

    Thanks for sharing! My boys are past bottles now, but I wish I had this article to show my husband. I knew when our sons were showing the “distress” signs of too fast flow, but sometimes he didn’t belive me. Thanks!

  27. Fleur (Nurtured Child) says:

    Hi Amber,
    There are a number of possible reasons for a baby showing stress signs at the breast, ranging from forceful let down to tongue-tie or something such as tracheomalacia (there are other possibilities as well). A baby showing stress signs while breastfeeding really needs to be assessed by someone knowledgeable about suck-swallow-breathe issues in order to determine the cause, and come up with a plan to address the problem.
    Warmly,
    Fleur

  28. Thanks for the advice! I’m working with a mom right now and she says that her baby sometimes shows these stress cues while breastfeeding…what could be the issue there?
    Thanks!

  29. Thanks for this helpful information Fleur. Great insights, and seeing as my babies never had any bottles, only breast, this will be information that I will surely pass on.

  30. Another thing to think about when bottlefeeding is the size of the nipple. Even though my little one is four months old we are still using the slow (smaller hole) nipple. Does it take longer for her to eat? Yes, but she isnt gulping or struggling to keep up.

  31. pocketbuddha says:

    I remember trying to tell my parents (also our babysitters) that if he really was ‘gulping back’ his bottles at their house it was because they were doing it wrong. I wish I’d had this to print off & show them, you do a much better job explaining that I did, and you have much Moe helpful info about doing it right!

  32. Thanks or the interesting post! There’s a lot of information there that I didn’t know, and might explain why my son had such trouble after eating for the babysitters. :D

  33. Yahoo – thanks for this important info. hope all moms and caregiers are taught this.

Trackbacks

  1. […] lot of what we’d already been doing was intuitive and naturally right for him. We practised baby-led bottle feeding without even realising it, and we’d bedshared occasionally so we could all get some decent […]

  2. […]  Parents simply fill the bottles to the top and the baby just sucks it down.  Consider trying baby-led bottle feeding if you need to continue with bottles and here’s some information about bottle feeding the […]

  3. [...] (just the way she likes it… once in awhile), and we settle in together happily for feeding. She looks brightly, happily into my face as she eagerly sucks in some milk. Then she spits it into my face before screwing her mouth firmly shut and wiggling [...]

  4. [...] is a great article on how to imitate breastfeeding while using a bottle. Baby-led Bottle Feeding Hope it helps x Reply With [...]

  5. [...] be watching your little one to give it a go with these techniques while you're out of the room. Baby-led Bottle Feeding Reply With [...]

  6. [...] Baby-led Bottle Feeding Reply With Quote [...]

  7. [...] got much advice but thought this might help you, it's great for mums who breast and bottle feed Baby-led Bottle Feeding Reply With [...]

  8. [...] Bickford, of Nurtured Child, shares some excellent tips on this technique. Don’t forget to check out her post for more important [...]

  9. [...] Baby-led Bottle Feeding from NurturedChild.ca [...]

  10. [...] In that case, instead of purchasing the reportedly $15 a piece Calma, I would try Fleur at Nurtured Child’s method of baby-led bottlefeeding.  In fact, any time you are bottlefeeding, you should use this method.  It is the ideal way to [...]

  11. [...] bottles or formula might impact breastfeeding etc., however I also do a lot of teaching about safe formula preparation and how to bottle feed in a manner that respects a baby’s natural biological rhythms, and protects baby’s [...]

  12. [...] note: This post was originally published in December 2010 on the Nurtured Child blog by Fleur Bickford, RN, IBCLC, LLL.  We’re so grateful that she’s allowed us to repost [...]

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