Paced bottle feeding

The majority of parents who choose to breastfeed their baby know that introducing a bottle (or artificial teat) can cause ‘nipple confusion’ or ‘bottle preference’. But what if you need to be 'topping up' or are separated from the baby and cannot feed directly? There are other methods of feeding – such as finger feeding or a supply line – but this may not always be practical or available.

Ideally you should avoid giving bottles to newborns before about 6 weeks.

Side note - this also goes for expressing. A very common line I hear is ‘I want to express so that dad can do the 2am feeding’. A lot of parents are very shocked when I say ‘you know you’ll need to wake up at 2am to express then’. If you want to breastfeed your baby then you need to develop a full supply, and this usually takes 6-8 weeks to happen. If you sleep for long periods overnight (ie skip the ‘2am’ feed) then you are telling your body that your baby isn’t feeding overnight and it doesn’t need to make that much milk. Very few baby’s will drop their night feedings in the first 6 to 8 weeks – if your baby is feeding then you should be feeding them directly or expressing to tell you body baby is feeding. Skipping feeds can have a long term, detrimental effect on your supply, and also cause mastitis.

But if you need to be giving expressed breast milk or formula, such as in the case of the baby not gaining weight well, or the baby needing to be separated from the mother, then bottles may need to be used and 'respectful', 'responsive', or paced feeding should be used.

What is responsive or paced feeding?

Let’s go back a step and ask ‘why is bottle feeding not a good thing for a baby I want to breastfed’? This will help you understand why this needed.

Babies are not lazy – they are opportunistic. The vast majority of them want to eat, sleep, and poo for the first 6-8 weeks of their life. If they don’t have to work very hard to get fed, over time they could develop a preference for that (this is not to say that breastfeeding that takes a long time is a bad thing – biologically this is normal).

Also the way a baby sucks on a bottle is vastly different to the way they suck at the breast. Please do not believe any teat manufacturer who says their teat is 'just like the breast' or 'closest to the breast' or 'best for breastfeeding' - there is no teat that is just like the breast, only a breast is like a breast. The way a baby sucks on the bottle can impact how the baby sucks at the breast.

No bottle teat is 'just like the breast'

For the first 6-8 weeks babies use reflexes and instincts to help them find the breast, latch on, and suck. The majority of parents know that a baby needs to open their mouth wide to take a large mouthful of the breast, but when we put a bottle teat in their mouth we often don't wait for that same wide open mouth. Over time, if we use bottles too often (or for some babies it may only take a handful of times) babies 'forget' how to open their mouth and latch onto the breast, and this can lead to a shallow attachment on the breast, which leads to poor transfer and/or nipple damage, which prolongs the need for top ups - and so the cycle goes on and on

Also, babies have a strong desire to suck. If you put something in your baby's mouth, even if they are asleep, chances are they will start to suck on it. Then, if they get fluid while they are sucking, they will most likely swallow it, in order to protect their airway (breathing is another very strong desire). It is therefore very easy to overfeed a baby with a bottle - the instinct to suck and swallow may have overridden the 'I'm full' feeling. And because milk continues to flow from a teat regardless of a baby sucking they have to swallow it.

This can lead to a bottle or flow preference. And it can be quite difficult to get a baby who has a bottle or flow preference to go back to direct breastfeeding.

Of course there are always exceptions to this – some babies will take a bottle and go back to the breast with no issue. But you probably won’t know what type of baby you have until you try, by which time it could be too late.

So, paced or responsive bottle feeding. This is where we use a bottle to feed the baby, but make it as close to breastfeeding as possible.

Traditionally a baby is laid down almost flat in the caregiver’s arms and the bottle is put almost over the top of the baby. By doing this milk will drip out and the baby doesn’t have to make much effort to get the milk out.

This is the 'traditional' position for bottle feeding a baby - but it is not ideal

Instead, sit the baby up on your lap. If you want to keep the baby close to you so you can do skin to skin, you can hug the baby into you. Hold the baby behind the neck, with your finger and thumb at the baby’s jaw with their head titled back slightly (think about you taking a drink from a glass), not the behind the head

Now take the teat and tease it around the baby's lips, if possible put the base of the teat to the baby's chin (this is how breastfeeding should start - nipple to nose, chin on breast)

When the baby opens his or her mouth put the teat in, but only tip it far enough so that milk is in the teat.

Let the baby take a few sucks and then take it away. Repeat the process.

Depending on how much you need to give the baby the feed should take as long as a breastfed would – 20mins would be ideal

Keep a close eye on the baby, be present while feeding your baby - if they are sleeping more than sucking, or only sucking intermittently, take the teat out of their mouth. If they wake up and look for more, then start again. If they sleep, let them sleep (the only exception to this is if there is a concern that baby needs a certain amount for a top up or have been born early or with a medical condition that could limit their energy).

If they gag or cough, take the teat out of their mouth. If they pull away or turn their head, wait a bit before offering it again. If they continue they may be telling you they don't want it. If they raise their eyebrows or put their hand up in a 'stop' sign, stop.

Watch your baby while they are feeding - be present and mindful

How to choose a teat for a breastfed baby

As I said before NO bottle teat is ‘just like a breast’, which some manufacturers will claim. Only a breast is ‘just like a breast’. Ideally the teat won’t leak when held upside down, and is long enough to reach the junction of the soft and hard palate (this is where the nipple will rest when breastfeeding) – you can put your finger in your baby’s mouth (nail on the baby’s tongue) to judge how far this is.

If you are told early on that you need to ‘top the baby up’ – ie give expressed breast milk or formula - make sure you have a clear plan on how much the baby should have, and for how long. See an International Board Certified Lactation Consultant (IBCLC) as soon as possible, to assess breastfeeding, and make a good plan for the long term feeding.

Justine is a midwife, nurse with NICU experience, an IBCLC, and HypnoBirthing practitioner. She owns Cherished Parenting Services. If you are in Perth and would like to see about booking a lactation consult appointment please click here or to see what other services and products she offers click on logo at the top of the page