Bottlefeeding for Breastfed Babies

Some babies are very opinionated about how they want to feed. A breastfed infant associates milk from mother and occasionally will refuse the bottle after several weeks of successful bottle-feeding. I always like to think of the things that may have caused this behavior.

The first, of course is the question: Is your baby feeling well? An infant with a mild viral illness or ear infection may have a change in feeding pattern. If breastfeeding is the feeding most often done, the baby may naturally want to nurse more and refuse a bottle in times of mild illness. So if the behavior persists and you see other signs of illness — fever, decreased wet diapers, irritability or vomiting — call Kids Plus, and we’ll see you in the office.

But there are occasional times when a baby refuses bottles for no apparent reason. Here are some tricks and tips for helping breastfed babies learn to accept milk from a bottle. If one approach doesn’t work, try another…

Some breastfed infants prefer breastmilk in the bottle over formula.

Always attempt mother’s milk in the bottle so the baby doesn’t have to get used to too many foreign things at once. Remember the baby is experiencing a different delivery system, and possibly a different care provider, so to experience a different milk may be too many changes at once. If possible, put expressed mother’s milk in the bottle rather than formula.

The amount you offer varies according to the baby’s age. A baby who is a month old may need 4 ounces of milk per feed and an older baby more. If the baby always empties the bottle with feeding it may be an indication your baby needs more milk. Allow the baby to leave about a 1/4 of an inch in the bottom of the bottle.That way you know you offered an appropriate amount. Never force the baby to take the last bit or more. You also don’t want to overfeed.

Warm the bottle in warm water.

Warm the nipple separately, then attach it to the bottle. Drip the milk on the underside of your wrist to make sure it’s pleasantly warm but not too hot for your baby. Don’t over heat the milk, and never warm in a microwave. Microwaves can cause hot spots in the milk which can burn your baby.

Breastfed babies may not accept bottles from their mothers, since the sweet breastmilk and her heart beat are only a few layers away!

Some babies, when bottle feeding, may even fuss if mother is in the same room. So it may be best if father or a substitute caregiver is the one to introduce the bottle. Fathers are the logical choice to offer a bottle. Try it and see what happens.

Always avoid frustration and excessive crying. The old adage, she’ll eat if she gets hungry enough, is not necessarily true, so don’t hold out forever; feed at the breast then try again later. (A calm baby is always easier to feed than a crying one!) For babies, as well as adults, new experiences are easier to handle when they are well-rested and not feeling anxious. A grandmother, a substitute caregiver, or a friend with bottle-feeding experience may be very helpful in coaching you and your baby through these bottle-feeds. After baby has learned to take a bottle, then any caregiver can do these feedings.

Experiment with different positions for bottle-feeding.

Some babies respond well when the bottle-feeding experience is made to seem almost like breastfeeding: a familiar setting, the cradle hold, skin contact, lots of social interaction. Mother can begin by offering the breast, then unlatch the infant and slide the bottle nipple in the baby’s mouth while still maintaining the breastfeeding position.

Try holding the baby perpendicular to your body, so the caregiver is face-to-face with the baby.

Tip the baby’s head slightly so the nose points to the ceiling. This will open the baby’s airway and allow the baby to coordinate sucking while swallowing and breathing. If you have been holding the baby in a cradle position with the infant’s chin on his/her chest while offering the bottle, this may be the cause of the baby’s bottle refusal. It’s just harder for the baby to breath with the chin on the chest (try it yourself!), and harder to feed! The care-giver can try walking around while offering the bottle. Use a baby sling and feed while walking; some babies find comfort in the swaying of the body while feeding.

Try a nipple that has a wide base that gradually tapers down to the tip of the nipple.

If baby is unhappy with one type of nipple, try another. No matter what the packaging claims, slow flow, fast flow, or breast flow, no nipple is just like mother’s. The feeding should be relaxed for the infant, with the milk flowing steadily but not overwhelming the infant. Finishing the bottle in 3 minutes flat with lots of gulping is not a comfortable rate of feeding.

Conversely,bottle-feeding should not take 45 minutes either. Babies should take 10-15 minutes to bottle-feed with a steady suck-swallow-pause pattern. No need to stop every 30-60cc to burp, unless you’re directed to do so by a health care provider. Watch your baby during the feeding. As he/she slows down with the feeding, that’s a natural time to stop and burp. If your baby is consistently crying through burping, you may be stopping or interrupting the feeding too soon.

Instead of inserting the artificial nipple into the baby’s mouth, place the nipple under the baby’s nose or stroke his lips from nose to chin, encouraging him to open wide.

Your baby may take the nipple on his own, with a wide-open mouth. Be sure he latches onto the wide base and not just the tip of the nipple. You want the bottle-feeding to mimic what he does at the breast.

Don’t prop the bottle.

Leaving a baby unattended during a feeding is unsafe and may cause your baby  to choke or breath milk into the lungs. This can be dangerous. Also, sucking from a bottle while lying down allows milk to enter the middle ear through the eustachian tube, This is a cause of middle ear infections.

Remember, feeding time is a social interaction no matter how you feed. Feeding time is a time of nurturing and nourishing, whether by bottle or breast. Always put a person at both ends of the bottle. And remember that there are alternative ways to feed a breastfed baby other than bottle-feeding. Babies can also be cup- fed, finger-fed with a nursing supplementer, or they can take milk from a spoon or dropper.

To find out more, call the Breastfeeding Center of Pittsburgh at 412.246.4726.

Beverly Curtis is a former Kids Plus provider.