Bottle Feeding Expressed Milk: When to Introduce the Bottle?
So, an LC walks into a bar and asks for a bottle…
Oh, wait…wrong blog…
What is the best approach for offering a bottle of expressed breastmilk to baby? Parents are concerned about the potential to confuse baby with the process, fearing that once baby takes the bottle, she may become lazy at, or even outright refuse the breast. Many feel under the gun for baby to perform as they face the reality of mom returning to work outside the home and the need to keep baby well fed during prolonged periods of mother-baby separation. Sometimes supplementation is medically necessary. In any case, parents wonder about the best way to go about the process of introducing and maintaining the bottle-feeding skill so as to not undermine the breastfeeding experience.
Just as in breastfeeding, baby is driving the bus with this process as well. And while there is no right or wrong way about it, there are some things worth bearing in mind when getting things off the ground. I like to conceptualize these into 3 basic parameters:
Maybe you’re thinking about offering an occasional relief bottle or facing down the end of your unpaid leave and you’re wondering when to enter this process of teaching baby to take a bottle. Is there a better time, worse time? For this question, I’ll give an uncharacteristic direct answer: Yes, there is a better time to start. If possible, wait to introduce a bottle (or a pacifier or any other artificial nipple) until baby is between 3.5 and 4 weeks of age. Why? Because we want any suckling that your baby may be doing prior to this point to happen only at the breast, as to best establish your milk supply. During the first 2-3 weeks postpartum, your milk supply is under endocrine control. You are literally laying down the foundation for your milk supply in the form of prolactin receptor sites. This ground work is successfully completed by baby going to breast, early and often. In the case of mother-baby separation or other concerns, a hospital grade pump can be used as a stand-in for baby. Studies suggest that approximately 140 minutes of active suckling per 24 hours in the early weeks is required to establish a full supply. So think twice about offering a bottle sooner than this 3.5-4 week threshold and do so only with guided support from your friendly neighborhood IBCLC and pediatrician.
So that may be satisfactory for a big picture kind of person, but what about taking it a bit deeper? You’ve waited the recommended 3.5 weeks, now what? Or, more to point, when is the best time of day or night to offer a bottle? Here’s where I’ll throw out a vague and unsatisfying answer: the best time to offer a bottle is at a time when all parties involved can handle it. So now you’re rolling your eyes and saying to yourself, “Cha? Whatever!” and sighing in a sleep-deprived, exasperated way, as only a new parent can. Let me explain: Conceptualize bottle feeding as a new skill, one that is certainly new to baby and possibly new to you too. Chances are that integrating a new skill won’t go as well if either party is: over-tired, really hungry, over-stimulated, sick, grumpy or generally tweaked out. Sometimes offering a small amount in a bottle as a “dessert course” or even a “snack” can be a useful approach. Timed this way, baby has had her needs and expectations met and may be more willing to try something new. Kind of similar to how you may be more willing to try your Aunt Betty’s infamous tripe goulash after you’ve already had a satisfying portion of your favorite mac’ and cheese. Catch my drift? Waiting to offer a bottle until a time that baby is ravenously hungry and mom has stepped out to run an errand at the mall may not be setting your selves up for success.
How often? One practice session a day is generally adequate for teaching the bottle feeding skill and to maintain the skill over time.
The What: Equipment Selection
No bottle feeding system is inherently evil, but some definitely mirror the breastfeeding experience more closely than others. When choosing a bottle system, I think it can be helpful to think about the mechanics of feeding at the breast and seek out gear that asks baby to mimic what she is already doing. This minimizes the amount of newness that she has to deal with. Some babies can go back and forth from breast to bottle without any problem. Babies struggling to feed at the breast can be offered a bottle and still learn to feed at the breast. There’s no reason for concern that breastfeeding and bottle feeding need be mutually exclusive enterprises. Given that, some types of bottles and teats may be easier for babies and caregivers to find success with.
Some things to look for:
- A nipple with a broad base requires baby to flange out his lips in the same fashion she would when at the breast. Conversely, a narrow teat forces baby to purse his lips to feed with a bottle. Pursed lips latching onto a breast = ouch!
- A truly slow flow nipple. Baby controls the flow of milk out of the breast. A too fast flow from a bottle can overwhelm baby or worse yet, lead to fluid aspiration in the lungs. A baby repeatedly exposed to a too-fast flow may bunch her tongue as a way to staunch the flow or all-out refuse take the bottle in her mouth. A bunched tongue at the breast results in a painful latch. We’ve seen wild variations in the flow rates from “slow flow” nipples. It’s important to know that Slow Flow, Medium Flow and Fast Flow are marketing terms. These are not regulated by any authority. See for yourself by testing some out with water and you just might be shocked. Some babies will be able to keep up with a faster flow from the bottle and then grow frustrated by the slower rate of flow from the breast. A slow flow nipple even for an older baby can make sense. An artificially accelerated pace to the feed as a result of a medium or fast flow nipple can shorten the length of the feed. Baby satisfies more than her need for calories at the breast. She satisfies her need to be held close and to suck. A short feed can result in a fussy baby even though her hunger has been satisfied. For more on how to lengthen the feed, see the section below on “How”. We highly recommend the Playtex Slow Flow Premium Nursing System. Is that a mouthful or what? It’s the only bottle feeding system we sell and is available for sale through our website: Playtex Bottle System
So you’ve selected your gear with care, you’ve set the stage for a time when you and baby are open to learning a new skill…now what? Let’s think about offering the bottle in a way that puts baby in control, much the way she is when she’s at the breast. We refer to this as a “Paced Feed Technique”. This is what it might look like:
Step 1. Plan to offer just a small amount of milk at first. 1 Tbsp. is about right to allow you to see what’s happening for the first few offerings and not have to worry about wasting a large volume of your precious milk. Load up your system.
Step 2. Place baby in a position with his head higher than his butt. Maintain a straight ear, shoulder and hip alignment. Just like you don’t like sipping your lattes with your neck twisted or torqued, neither will your baby, so make sure baby is comfy, well supported, and well-aligned.
Step 3. Tickle the ridge of baby’s upper lip, the philtrum, with the end of the bottle nipple. Very important: wait for baby to open her mouth before inserting the bottle. Never jam a bottle into a baby’s closed mouth.
Step 4. Should baby take the bottle in her mouth, angle the bottle in such a way as to only just allow milk into the tip of the bottle teat. The flow rate is greatly affected by the angle at which the caregiver holds the bottle. Try to maintain as gravity-neutral a position as possible. This is really important in order to give baby proper control over the flow rate. You will need to increase the pitch of the angle as baby drains the bottle.
Step 5. Follow your baby’s cues. If baby is showing signs of stress (grimacing, fussing) turning head away)or is resisting the process(arching away, turning head away), back off and don’t force the issue. Praise baby when she welcomes the bottle teat into her mouth. Allow baby to take breaks as needed, as she would at the breast. Be aware of how you are doing as well. If you are feeling frustrated or agitated, think about trying again at a better time.
If things aren’t going well…
- Think about taking a holiday from the process. Take a break for a few days. Forcing the issue is unlikely to yield positive results.
- Keep it light and fun. Cuddles and patience are required in large doses. This will be a process not an event. Build on teachable moments and keep your expectations realistic.
- Some babies may require distraction. Singing, making funny faces, keeping baby in motion safely in your arms may take some of the stress out of the process.
- Consider asking for help from an experienced bottle giver. Their confidence and experience may prove helpful.
- Try a different brand of bottle or a different shaped teat.
- Remember, the bottle is simply one way to get your milk from point A to point B. Other vehicles are available to do the same job: medicine droppers, spoons, periodontal syringes, medicine spoons, training cups and other small cups can all do the trick.
- Call your pediatrician if you are concerned that your baby may not be taking in enough nutrition.
Remember, breastfeeding and bottle feeding can be compatible. With love and patience and flexibility many babies can go back and forth without issue. We’d love to hear your comments and experiences about what has worked for your family.