FEEDING BREASTMILK FROM A BOTTLE
When the nursing parent is away from baby or cannot nurse at the breast, it is important that the baby will take breastmilk by another method. These tips assume that your baby is being fed expressed breastmilk. If this is not available, ask your baby’s health care provider for advice.
The Womanly Art of Breastfeeding, the La Leche League guide for nursing parents, suggests that the introduction of a bottle wait until the baby is three to four weeks old and nursing well, in order to lessen the risk of nipple confusion. You may want to try once or twice per day to introduce the bottle, using a couple of “tricks” that experienced working/breastfeeding mothers have tried:
It may be best to try to give a baby a bottle before he’s really hungry. If he’s gone a long time between feedings and is very hungry, he may be less likely to try something other than the breast.
Have someone else give the bottle. Many breastfeeding babies won’t take a bottle from mother, since her smell and presence remind the baby of breastfeeding. One of the best people to give a bottle to a reluctant baby is someone who can convey confidence to the baby, reassuring baby of the care given to nourish him.
Offer the bottle in a horizontal position, so the baby can suck actively to get the milk as he does at the breast. This is often called “paced bottle feeding.” It should take about 15-20 minutes to finish a bottle, as you are mimicking the breastfeeding experience with active sucking of the artificial nipple and baby controls the intake. A tilted bottle is not recommended as baby has little opportunity to control of the milk flow. After all, he can’t yet say, “Stop! That’s too fast!” and may drink the entire bottle quickly. This can lead to tummy trouble, as well as frustration when the baby returns to the breast and does not have that fast stream of milk entering his mouth. Slow bottle feeding is good bottle feeding.
Gently stimulate the mouth with the artificial nipple, as is done for the first nursing at the breast. Let the baby “mouth” it and become familiar with it.
Use lots of cuddling by the person feeding the baby.
Some babies take a bottle better in their favorite breastfeeding position. Others do better in a totally different position. Try propping the baby in your lap with the baby’s back to your chest. The baby will see the room while drinking from the bottle. Or prop the baby on your slanted forelegs, like in an infant seat, and give the bottle while looking at him.
Try to feed while moving rhythmically, calming the baby, and distracting him from the different nipple.
If all else fails, try doing without a rubber or silicone nipple. For a tiny infant, alternative choices include an eyedropper, spoon, periodontal syringe, medicine spoon, special cup for infant feeding, tiny paper cup (as in the kind given out to hold condiments in restaurants), training cup, or a regular cup.
To cup feed, place the rim of the cup on baby’s lower lip and tilt the cup until the milk approaches the baby’s lip. The baby’s tongue will explore and find the liquid. On the first few attempts, this may take a few minutes. He will then lap or sip the milk.
Do NOT pour the milk into the baby’s mouth. Keep the level constantly by his lower lip and allow the baby to rest and pause while drinking, but do not remove the cup. When the baby has finished, he will let you know by turning his head away, or by other obvious cues.
Babies who can sit up may prefer to feed themselves (well supervised) from a regular cup or a covered “sippy cup.”
When the baby is fed by one of these methods, be sure to breastfeed often when mother and baby are together, to satisfy the baby’s sucking need.
Something to remember is most breastfed babies only take in 3 ounces of breastmilk in a “serving” during her first 6 months of life. The quality of the breastmilk changes, not the quantity. This is different from artificial milk, where more volume is often needed to satisfy baby.
Often family members express a desire to bottle feed a breastfed baby as a way of “bonding” with the new baby. What facilitates bonding is touch, not feeding. Babies also bond in a hierarchal manner, with mother or the primary caregiver at the top of the pyramid. There shouldn’t be a rush to force the baby to expand his circle of importance. This can be confusing and diminish the baby’s feeling of security if he’s constantly having to adapt to different situations, such as different people feeding him in different ways.
The answer is: there are many ways a loved one can bond – and help you and baby at the same time! They can love, listen and support the breastfeeding parent. They can change a diaper. They can bathe the baby. They can hold and soothe the baby when baby is not hungry, especially in those evening witching hours. They can baby wear and do skin-to-skin. They can play with baby. They can bring mom a glass of water, snack, phone, television remote, or anything else she needs after sitting down to nurse. They can contact a La Leche League leader for help. They can take care of housework, errands and meals. They can defend mom to others who may not support breastfeeding or other parenting choices. They can be right there next to mom when she breastfeeds in public, helping her feel confident. In short, family members are able to develop a close bond with the baby without a bottle.
BABY IS REFUSING A BOTTLE
It can be so stressful when your baby will not take a bottle. You may have already tried some of the “usual” hints in the prior section to try to encourage a breastfed baby to take the bottle. Here are a few more:
Try offering the bottle before the baby is likely to be very hungry. This is very important, as a hungry baby is less likely to be satisfied with something different from his routine. If baby is rooting or sucking his fingers, he’s hungry. Crying is a late cue of hunger.
Hold the baby lovingly while giving the bottle. This seems obvious, but if the adult is frustrated or in a hurry about it, the baby may sense the tension and refuse.
Wrap the baby in some of mother’s clothing that has her smell on it while offering the bottle.
Try different kinds of nipples. Some babies like a nipple designed for premature infants, because it is so soft. Consult a health care provider for ideas about artificial nipples to try.
Try varying the nipple temperature. Put it in the refrigerator (teething babies like this) or run warm (not hot) water over it.
Try varying the milk temperature. Breastmilk “at the tap” is lukewarm. Some babies prefer that temperature, while others will take it fine cold from the refrigerator.
Instead of pushing the bottle nipple into the baby’s mouth, try laying it near his mouth and allow him to pull it in, or tickle the baby’s mouth with nipple as many mothers do with the breast.
Try to feed the baby while moving. Try rocking, swaying, or walking, wearing the baby, sitting in a rollered office chair, or even sitting in a car seat.
Insert the bottle nipple into the baby’s mouth when he’s sleeping.
Try different positions. Some babies will refuse to bottle feed in the “nursing” position that mom uses. Some don’t like to look at the caregiver while taking a bottle.
Cup feeding or syringe feeding can also be an option.
Please know it’s common for breastfed babies to refuse a bottle initially, especially when returning to employment or in times of stress when there are so many changes in the home occurring! As you know, breastfeeding is not only about food. Baby can be looking for the warmth and comfort he gets naturally at the breast. It’s common for a baby to “reverse cycle,” which means refusing a bottle or taking in less milk than normal when away from mom, then nursing a lot when reunited with mom. Often baby may want to be latched to mother – or at last be skin-to-skin – after experiencing a separation, especially in those early weeks and months. Allow yourself a week or two for you and baby to adjust to this new schedule and environment. As long as wet and dirty diaper output in adequate, he’s getting enough milk.
If baby continues to refuse a bottle, consult your health care professional to rule out any sickness or teething discomfort.
Before long, he will be able to take some solid foods during separations from you. (Keeping in mind that breastmilk is the primary source of nutrition for baby throughout the first year.) And soon after that, your baby will begin to use a cup very well, or handle his bottle on his own.
DIFFERENCES BETWEEN NURSING AT THE BREAST AND BEING BOTTLE-FED
There are some differences between the benefits of being bottle fed breastmilk and being breastfed directly.
For example, your milk has the highest level of antibodies when your baby takes it directly from your breast, and is second-best when it is freshly pumped. Your body actually responds to your baby’s saliva to make milk that is just right for him. If your baby is exposed to something that he needs antibodies for, this is how your body “learns” to make those antibodies for him. The longer it is stored, the more of these antibodies are deactivated. Freezing destroys even more antibodies. (Your frozen milk still provides excellent nutrition and protection for your baby, just not as good as directly from the breast or freshly pumped.)
When breastfeeding directly, babies also benefit from appropriate jaw, teeth and speech development as well as overall facial development. The activity of breastfeeding helps exercise the facial muscles. This promotes the development of strong jaws and balanced facial structure. Several studies have shown breastfeeding to enhance speech development and speech clarity.
Increasing duration of breastfeeding is associated with decreasing risk of later need for braces or other orthodontic treatment. One study showed that overbites (malocclusion) requiring orthodontia could be cut in half if infants were breastfed for one year.
Breastfeeding directly is also less time consuming – no parts to wash, no pumping time plus feeding time. When baby is hungry or needs to be comforted, you simply put your baby to the breast. When exclusively bottle feeding breastmilk, you have to prepare a bottle first.
Skin on skin contact with your baby is an important part of their development. When you are breastfeeding, you have to be in skin on skin contact with your baby. Whether breastfeeding or bottle feeding, make sure you spend some time in skin-to-skin contact with your baby. Carry your baby a lot, skin-to-skin whenever possible. It increases mother’s milk supply. It helps to “organize” the baby’s behavior so that he learns to feed more easily. Babies who are held skin-to-skin and carried a lot cry less, save their calories for growing (they aren’t spent crying), and it actually makes them grow better! It stabilizes breathing, heart rate, blood sugar, and temperature.
We at La Leche League understand there are medical conditions and other challenges that may prevent baby from nursing directly at the breast. Those who are exclusively pumping breastmilk are doing valiant work to provide for your babies! We salute you! Your baby is deriving the benefits of breastmilk through your hard work. You may consider offering breastmilk through an at-breast supplementation system to derive some of the physical developmental benefits, and of course you can go skin-to-skin whenever you – or your partner or caregiver – desires! Baby is the ultimate beneficiary of your focused determination. You are always welcome at any LLL meeting for support on your journey!