There are several reasons that a breastfeeding mum might choose to introduce a bottle to her baby; for some it is because they simply want to combination feed, others like the freedom of leaving a bottle of expressed milk when they go out while still others may be headed back to the workplace. Whatever their reason for wanting to use a bottle, many mums are concerned that it might interfere with the breastfeeding relationship for the remainder of the time.
I’m often asked to help prevent their babies from developing “nipple confusion”. First thing that I say to mums is that babies are not “confused” they know right from birth that the mother’s breast and a silicon teat are not the same. They do however, sometimes get their expectations mismanaged regarding what eating should look and feel like.
To resolve this confusion for babies we must first consider how breastfeeding feels to babies, and then how we can mimic this (as far as possible) with a bottle. There are 5 key events and sequences that a baby experiences at the breast during a feed:
1. A baby is an active participant in latching to the breast – they cannot be forced onto the breast
2. When a baby latches to the breast they will rarely get milk on the first suck. They have to suck for anything up to a minute to cause a let-down of milk
3. The flow of milk to the breast is determined by the baby’s suck – if they passively sit on the breast without sucking they will not get milk flow
4. The rate of milk flow during a feed is changeable – there will be natural peaks and troughs to the flow, allowing babies to take breaks along the way
5. A breastfed baby is in control of their own appetite – they will continue to actively encourage milk flow until they are full before spontaneously unlatching from the breast
One very strong theme comes through this examination of breastfeeding, and this is that it is a baby-led experience. Mum sets up the environment to allow the baby to decide the pace, length and volume of a feed. Understanding that this is a baby-led process is vital to successfully introducing a bottle to a breastfed baby.
So now we know that we want our babies to lead the way in eating, whether they are on the breast or bottle, how can we set up a bottle feeding environment to support this? We simply take each step mentioned above, and mimic the events for the baby:
The baby actively latches to the bottle
Do rest the bottle on a baby’s chin with the teat pointing towards their nose to encourage a wide gape and active latching.
Don’t “screw” the bottle into a baby’s mouth (especially while they are sleeping)
Get the baby to cause a “let-down”
Do have them suck on an empty teat for 5-6 sucks before allowing milk to flow (yes they will swallow a little air, but not as much as traditional bottle feeding. See below).
Don’t have milk flowing at them on (or even before!) the first suck
Baby should be in control of milk flow
Do fill the pointed part of the teat with milk, but ensure that the wider “reservoir” is not full. The correct angle is one in which no milk drips out without active sucking from the baby. This puts baby in control of the flow, prevents spillages and allows them to comfortably manage their “suck, swallow, breathe” cycle. Babies fed like this will appear relaxed and will swallow little to no air.
Don’t angle the bottle such that milk drips in “free flow”. In traditional bottle feeding most caretakers have been taught to fill the whole teat and reservoir with milk so no air is sucked in during a feed. This often causes a milk flow so fast that they baby cannot manage their “suck, swallow, breathe” cycle appropriately. There is too much to swallow and not enough time to breathe. To accommodate this, the baby will allow some milk to spill out of their mouths by breaking the vacuum seal around the bottle. As soon as the vacuum seal is broken, air from the environment rushes in and baby swallows it along with the remaining milk in their mouth. This is one of the key causes of trapped wind in bottle fed babies.
Let there be an ebb and flow
Do lower the angle of the bottle when a baby takes a natural pause in their drinking. They will start sucking again when they are ready for more milk and the angle can be raised back up to the above feeding position.
Don’t shake and jiggle the bottle to encourage a baby back from their natural break
Allow the baby to end the feed
Do respect your baby’s natural instinctive appetite. Some babies like larger meals, while others prefer little and often – this is their natural pattern and their right to maintain it.
Don’t try to get your baby to take those last few ml of the bottle in the hope of a longer break – it’s more likely to result in spitting up and a sore tummy from eating beyond their natural appetite
When using these steps to give a bottle to your breastfed baby it makes it easier for them to switch back and forth between the breast and the bottle and also respects their natural instincts for eating.