Paced Bottle Feeding – How to bottle feed a breastfed baby

Breastfed babies may be bottle fed for a variety of reasons

Breastfed babies may be fed with a bottle for many reasons; the most common of which are to supplement with extra milk or formula, or to provide breastmilk to the baby while the mother is away.

Some babies are supplemented with pumped breastmilk or formula

Babies sometimes need to be supplemented with breastmilk or formula. This need may happen right after birth or within the first few weeks of life. Supplementation can also happen when mom returns to work and someone else is caring for her baby. Often times, supplementing is meant to benefit the baby when they are struggling with excessive weight loss, refusal to nurse, low milk supply, excessive nipple trauma, separation and hospitalization.  There are alternatives to bottle feeding, including finger feeding, syringe feeding, and supplemental nursing systems. While these alternatives can work well, sometimes pediatricians, lactation consultants and parents prefer a bottle. If you are providing pumped milk to a daycare or in-home sitter,  they usually prefer to feed babies via bottle.

Supplementation does not need to hurt your breastfeeding relationship

Supplementing can disrupt many parents’ plans for feeding their baby, however there is a way to supplement your baby and reduce confusion with breastfeeding.  Babies often develop nipple confusion as the bottle nipple is so different than a mothers’ nipple. However, babies develop even more confusion with the fast flow of the milk from the bottle. Sometimes babies can deal with this fast flow, but over time they tend to overeat, become very gassy, and reject breastfeeding.  Babies learn to eat quickly as they get rewarded with a mouthful of milk with each suck. At the breast, babies then become impatient and frustrated with moms “slower” flow.

Breasts regulate flow naturally, but bottles don’t

When babies are at the breast, they can control the flow of the milk, pause when they need to breathe, and stop eating when they are truly full. When a baby receives a supplement via bottle, the flow of the milk is so fast, and many babies aren’t able to handle this flow. They appear to be taking the bottle “so well” or they were “so hungry” as they gulp the milk down.  The adult giving the supplement is in control of the flow and baby cannot take a break when needed. If baby doesn’t continue to swallow this fast flow, they could choke, so they instinctively gulp it down. This stressful way of eating can lead to a very gassy and spitty baby, as well as baby overeating and being impatient with breastfeeding.   Thus the breastfeeding problems are worsened.

You can mimic breastfeeding with paced bottle feeding

Supplementing and breastfeeding can co-exist if done correctly.  If you need to supplement, always use your own breast milk first, then any added formula needed to make up the right amount for your baby’s age and size.  It is vital that you are pumping to empty your breasts during supplementation, whether baby nursed first or didn’t nurse at all for this feed.

  1. Make sure you are using a slow flow nipple, such as a nipple with one hole in the top.  Prop your baby upright but keep close to you to provide warmth and comfort. It will be helpful to switch baby from one side of your body to the other side about half way through the bottle feed to assist with eye stimulation and coordination, as well as reduce the chances of side preference when breastfeeding.
  2. Tap your baby upper lip with the bottle nipple and wait for a wide open mouth. Don’t make the baby wait too long, but opening wide will help your baby remember to open wide when latching to the breast. It also helps to let the baby accept the nipple, rather than force the nipple in when baby is not ready.
  3. Watch how your baby is drinking. If baby is starting to gulp away, usually more than 5-10 sucks, gently tip the nipple up towards the roof of baby’s mouth while tipping the bottle down. Or gently twist and remove the nipple from baby’s mouth. This will prompt baby to pause, swallow, and breathe.  After you see baby has swallowed and taken a breath or two, tap baby’s upper lip to remind baby to open wide and continue eating. Keep on feeding baby in this manner until the supplement is gone or baby is not actively rooting for the nipple anymore and appears full.
  4. If baby is pacing him/herself and pausing to swallow and breathe after 5-10 sucks, then you don’t need to physically remove the bottle. The goal is to feed baby the adequate amount of food in an adequate amount of time – similar to breastfeeding. If baby is nursing 10-20 minutes, the bottle feed should take 10-20 minutes. Sometimes babies with excessive weight loss or jaundice are very sleepy and will eat too slow. It’s important to watch your baby to know if he/she is drinking within a reasonable amount of time, as you don’t want to exacerbate these problems.   These are times when you need to just focus on feeding baby and worry less about pacing.

Teach your caregivers how to do paced bottle feeding

When you return to work, it is important to encourage your babys caretaker, whether its a sitter, family member, or daycare, to pace your baby. If baby drinks the bottle too fast, they are often given more as they “still seemed hungry”. And the care providers want to make sure your baby is happy and well fed. However, this often leads to running out of pumped milk and moms are asked to provide more milk.  This perceived low milk supply can be very distressing to mothers as they are already stressed with the whole pumping routine, being away from baby, getting back into the swing of working, and the common milk supply decrease from returning to work. Some babies will take all the food, or more, if offered. Once your stash starts to get low, then parents worry about having to supplement with formula. This stress also affects milk supply.

Review with your baby’s care provider about paced bottle feeding and encourage them to only give the recommended amount you have provided. If baby has time to register that his/her tummy is full, they will take exactly what they need.

If you have problems

If your baby is experiencing problems with weight gain and good outputs, has to be hospitalized (NICU after birth or readmissions), or having continued latching problems, its important to follow up with an experienced lactation consultant. Sometimes problems can be fixed easily and quickly with advice, but other times it requires more in-depth help and follow
up care.  Remember you are doing your best for your baby and there is assistance when you become frustrated or plans change.

Video of paced bottle feeding:

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