Bottlefeeding the Breastfed Baby

Every new mom has heard of dreaded "nipple confusion" - where a baby gets a bottle and then begins to have difficulty breastfeeding. In reality, there is a lot more going on than confusion over nipples. And babies can begin to experience difficulty transitioning between breast and bottle at any age, not just during the newborn period. Here are 5 tips to help the breastfed baby go back and forth between breast and bottle, and receive nutrition from a bottle in a nurturing, healthy way. Keep in mind, it is best to wait to introduce bottles until baby is 4-8 weeks old, after breastfeeding is established and going well unless a lactation consultant has recommended starting earlier. Beginning at 2 months of age, if mother will be returning to work eventually, baby should be offered a bottle once a day to keep baby familiar with bottles.

Our Top 5 Bottlefeeding Tips

  1. Encourage baby to latch around the wide base of the bottle nipple.

We don't call breastfeeding "nipple feeding" for a reason. When baby has a deep, wide latch at the breast it is more comfortable for mom and more effective for baby. Encouraging this same latch on a bottle will help avoid baby trying to nibble at mother's breast. Look for bottles with a wide, gradually sloped nipple base such as Lansinoh Natural Wave (this one can be picked up from our office) or Evenflo Balance. Although bottles with a wide rounded base (like the Comotomo or Tommee Tippee) might look breast like, its very difficult for infants to latch to the base/breast and wrap the tongue and lips around the base. With those bottles, babies tend to retract their tongue and to the protruding nipple tip and suck like a straw... and nipple confusion starts to set in.

Lansinoh Momma Bottle

2. Slow the flow down,

by holding baby upright or sidelying and bottle parallel to ground and using a slow flow nipple (all year). It should take baby the same amount of time to finish a bottle as it takes him to breastfeed. Or, another rule of thumb is it should take baby at least 5 minutes per ounce. If a baby gets used to the fast and effortless flow of the bottle, he will experience frustration at the slower flow of the breast. This frustration can surface at any age - even as late as 9 months old - and result in breast refusal. Holding the bottle parallel requires baby to exert healthy effort to draw the milk out. See video at top of page for a demonstration of these techniques. The video below also showcases the sidelying hold which is ideal for newborns.

Lansinoh Momma Bottle

3. Give baby an appropriate quantity of milk.

Most breastfed babies age 1-9 months consume a little over 1oz of breastmilk per hour, with a daily total of 27oz. So if baby is getting a bottle every 3 hours (day and night), expect baby to need around 3-4oz in each bottle. Older breastfed babies almost always maintain 3-5oz feeds at breast even when mother has more milk available. Tanking baby up on extra large bottles (5oz or more) puts baby at higher risk of obesity because it stretches out his/her stomach and disrupts appetite regulation. Big bottles result in baby breastfeeding less when you are together which will reduce your milk supply and make it hard to keep up with pumping. One of the most reliable ways to calculate your baby's bottlefeeding needs, is to divide 27oz by how many feedings your baby averages per day. For example, 27 oz ÷ 8 feedings = 3.4 oz per feed. If your baby is younger than one month old, reach out to your lactation consultant for specific guidance on your baby's breastmilk needs. This total volume (27 oz per day) does not change after the first few months because although baby is getting bigger, their rate of weight gain slows down.

4. Follow baby's cues to know when she is full.

While the above 27 oz divided by number of feeds guideline can set expectations for bottle volume, following your baby's individual cues will help you know when she is full. Respecting her hunger and fullness cues will help keep her appetite regulation in tact. Every few minutes, tip the bottle so that the nipple is empty (keeping it in her mouth) and watch to see how your baby responds. A hungry baby will continue to voraciously suck at the bottle, but a full baby will be very passive or allow the bottle to drop out of her mouth. These pauses also mimic the natural ebb and flow of breastfeeding. After burping, you can tap the bottle nipple on baby's top lip to see if she roots for it or if she keeps her lips closed.

5. Pump every time your baby gets a bottle,

as close to your baby's feeding time as possible. Pump about the same quantity of milk your baby takes in the bottle. This keeps your milk supply healthy by reminding your body to continue producing the amount of milk your baby needs. When you and baby are together, opt for frequent breastfeeding instead of bottles...then you can skip the hassle of pumping and bottle washing and enjoy the special closeness of nurturing your baby at the breast.

Mamas in the north Charlotte and Lake Norman area, we encourage you to setup a home visit so we can help you address these issues. If you are out of our travel area, you can setup a virtual consult with us or google "lactation consultant near me" to find local help.