Is bottle feeding easier than breastfeeding?

Disclaimer – I am talking about babies born with no ongoing medical issues that may affect their ability to feed or energy requirements.

“Bottle feeding is easier (uses less energy) than breastfeeding”

I have heard this from a few clients and colleagues recently so I thought I would post my thoughts and observations on the subject.

But there is no simple answer to this question, because there are a few more questions that need to be asked as well - such as easier for who? Why is the baby being bottle fed in the first place? How are we measuring 'easy'?

If we are saying that it is easier because it is quicker for them to drink from a bottle, then sure, for the caregiver it might easier. But why do they need to drink quickly? Who determines how quickly a baby should drink?

However, if we look at if from the baby's point of view, we may have a different understanding...

If breastfeeding is the biological norm, and our species has survived for millennia, why would a man-made invention be 'easier'? I have learned the truth to this over the last few years and the answer is it is not easier, but rather our perception of what is easier, and our interpretation of newborn behaviour, is wrong.

First let me ask you this – what is the most important substance an animal needs to survive? I imagine some of you may say something related to food or water….but the answer is actually oxygen. Body tissue can start to die within 3 minutes of being deprived of oxygen (even if you are a fish, you still need to filter oxygen from the water, which is done via the gills 😉).

Humans, like most land animals, breathe air into their lungs to get this oxygen. Only air can enter lungs – to get fluid or food into the lungs can cause major issues.

The second most important substance for animals is food (ie proteins, carbohydrates, fats, vitamins, minerals, etc) and water. Mammal babies get all this from milk, and the majority of mammal babies suck milk from a mammary gland (mammary gland = mammal).

In humans the tube that accepts air and food start out as one and the same - the pharynx. The pharynx then separates into the trachea, which leads to the lungs, and the oesophagus, which leads to the stomach. The epiglottis and larynx stop food or water from entering the lungs – these structures close over when we swallow to block off the trachea.

So, the 2 most important tasks a mammal baby needs to do well from birth are breathe and feed.

With me so far?

Now, picture feeding a baby with a bottle – how would you do this? I imagine most of you would lie the baby down in your arms, then place the bottle teat into the baby's mouth.

In human babies the reflex to suck on something placed in their mouth is very strong - because, apart from breathing, feeding is key to survival. When they suck on the bottle teat they get fluid, plus some ‘falls’ into their mouth by gravity.

Remember, what is the most important function of an animal? (Hint: oxygen is key to survival).

In order to protect their airway and not breathe the fluid in, they have to swallow it.

And swallowing causes more sucking, which in turn brings more fluid into their mouth, which they have to swallow, and so on and so forth.

And the more fluid they swallow, so the amount in the bottle goes down.

Society tells us that babies will only take milk when they want it - so if we think the baby is hungry and they have sucked and swallowed the milk from the bottle – they must have wanted it, right? But if it is a reflex to suck on something that is put in their mouth – are they actually hungry or are they just reacting to the stimulus…

Society also tells us that a ‘good baby’ is one who eats and sleeps - so if they have taken the milk in a relatively short period of time (5-10mins) and fallen asleep, then that’s good, isn’t it?

Frowning can be a sign that the baby is overwhelmed by the flow

Now let’s look at a baby breastfeeding looks:

A baby has to latch in a particular way to the breast in order to transfer a good amount of milk. They need to take enough breast into their mouth so that their tongue is well placed under the breast and the nipple stimulates the sucking reflex. The baby starts sucking to stimulates the mother to release oxytocin, which helps release milk from the ducts in the breast. The front part of the tongue lifts the breast to the hard palate to push milk out. The back portion of the tongue lowers and creates a vacuum to suck so milk out.

According to some, the volume of milk a baby receives from a 'letdown' is about 30mls. Then the flow slows down. The baby can choose to keep sucking and stimulate more milk flow, or pause, maybe even take a bit of a nap. They may start to suck again as they desire. And milk should flow according to that stimulation.

Babies may also suck on the breast for comfort, not just to get milk. Remember, sucking is the most finely honed skill a baby has – so it is the only skill they have to comfort themselves. They can suck at the breast in such a way that it is just for comfort, not to get out milk. But they can’t do this with a bottle, because chances are milk will flow out regardless of what they do.

Overall, a baby may 'feed' from the breast for a few minutes, 20 minutes, 30 minutes, or maybe they just want to hang out there because it's comforting, and they are there for up to an hour or more.

Plus, babies are usually breastfed in a side-lying or prone position (ie them lying on their front, on top of the mother). This means that even if milk is flowing out of the breast without the baby sucking, the milk can be held in their mouth while they take a breath, it doesn't 'shoot' to the back of the throat where it may flow down regardless of the baby swallowing or not.

Compare the positions of these babies - note how they are different

I know of studies and textbooks that say how many feeds in 24hrs is reasonable for a newborn (10.4 is the average, just FYI), but I don’t know of any that show how long each feed at the breast should take.

So, when we see babies take xx mls from a bottle in 5-10mins and then sleep vs a baby feeding/sleeping/comfort sucking at the breast for 30mins or more and you can’t see how much the baby has taken, it is understandable that parents (and caregivers) think bottle feeding must be easier.

But think about this – if I put a large meal in front of you and say “you have to finish this in 5 minutes” vs “you can take as long as you want to eat it”, which meal would you find more enjoyable, or ‘easier’ to eat….

So why do some babies seem to do better with bottle feeding (weight wise) than breastfeeding?

Basically because breastfeeding is a learned behaviour – babies learn to do this in the womb. If a baby is born before they are have had enough time to learn beastfeeding, then they may not know that what they have to do at the breast. But if you put a bottle teat in their mouth it will stimulate the sucking reflex and they will suck and swallow automatically. The breast does not stimulate sucking that hard, it also requires some effort from the baby to 'demand' the milk flows.

If they are given a bottle more than they are offered the breast, or they are given bottles before they have learned to breastfed (ie they were born prematurely and had not got to the point of learning to breastfeed in utero) they will ‘lose’ this ability – to what degree depends on what gestation they were born at, how soon they were given bottles, and how often before being ‘allowed’ to breastfeed. To then re-learn breastfeeding takes some time, if it can be done at all. And because the caregivers were controlling how much the baby took at each feed and now the baby has to figure out how much they need to take.

Now, in no way am I saying that you SHOULDN’T NEVER bottle feed – I am saying that you need to be discerning in your reasons for bottle feeding and understand ‘normal’ newborn behaviour to know if the baby really wants to be drinking the milk. If you choose to bottle feed, then that is your choice. If you want to breastfeed, then understanding the signs your baby gives you to know when they are hungry vs wanting to comfort suck, and knowing the signs of a well feed baby, is important. And if you want to breastfeed and are told that you need to give supplemental feeds (eg ‘top up’) there are other ways of doing this apart from bottle feeding - click here for an article on alternative methods to bottle feeding.

If you do decide to bottle feed, paced bottle feeding can prevent a baby from being overwhelmed by the milk flowing out - click here for an article that explains what this is. Also look for signs that baby has had enough - such as frowning or raising their eyebrows and/or raising their hands as if to say 'stop'.

If you need help with breastfeeding please get in touch