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How to bottle feed the breastfed baby

…paced bottle feeding tips for a breastfeeding supportive style of bottle feeding

PDF version (great for child care providers)

by Eva Lyford. Reprinted with permission from the author.

Often, as infant feeding specialists, lactation consultants and other experts in the field of human lactation are asked how to properly bottle-feed a baby. Direct breastmilk feedings from the mother’s breast are always preferred to any artificial source or substance. In addition, there are often alternatives to bottle-feeding, such as cup feeding, which should be explored. For the baby who has to be bottle-fed, following is some information to help make the experience a good one for the baby and also to make sure that breastfeeding is fully supported even when artificial feedings are used. This information can also be useful in evaluating infant care providers and for instructing them on how to bottle-feed a breastfed infant. Note that when working through any feeding difficulties with an infant, a lactation consultant is an excellent resource for evaluating methods for their appropriateness to the specific situation. While useful for any bottle-fed infant, this information is particularly targeted towards infants under 6 months of age. Babies should be bottle-fed:

  • When their cues indicate hunger, rather than on a schedule.
  • Held in an upright position; it is especially important to avoid letting the baby drink from a bottle when lying down. Such a position is associated with bottle caries and an increased frequency of ear infections. Note also that babies should be held often at times when they are not being fed, to avoid the baby being trained to eat in order to be held.
  • With a switch from one side to the other side midway through a feed; this provides for eye stimulation and development, and thwarts the development of a side preference which could impact the breastfeeding mother.
  • For 10-20 minutes at a time, to mimic the usual breastfeeding experience. Care providers should be encouraged to make appropriate quantities last the average length of a feeding, rather than trying to feed as much as they can in as short a time as possible. This time element is significant because the infant’s system needs time to recognize satiety, long before the stomach has a chance to get over-filled.
  • Gently, allowing the infant to draw nipple into mouth rather than pushing the nipple into the infant’s mouth, so that baby controls when the feed begins. Stroke baby’s lips from top to bottom with the nipple to illicit a rooting response of a wide open mouth, and then allow the baby to “accept” the nipple rather than poking it in.
  • Consistent with a breastfed rhythm; the caregiver should encourage frequent pauses while the baby drinks from the bottle to mimic the breastfeeding mother’s let-down patterns. This discourages the baby from guzzling the bottle and can mitigate nipple confusion or preference.
  • To satiation, so that baby is not aggressively encouraged to finish the last bit of milk in the bottle by such measures as forcing the nipple into the mouth, massaging the infant’s jaw or throat, or rattling the nipple around in the infant’s mouth. If baby is drowsing off and releasing the bottle nipple before the bottle is empty that means baby is done; don’t reawaken the baby to “finish.”

The benefits of bottle-feeding in this manner:

  • The infant will consume a volume appropriate to their size and age, rather than over- or under-eating. This can support the working and pumping mom who then has an increased likelihood of pumping a daily volume equivalent to the baby’s demand.
  • This can minimize colic-like symptoms in the baby whose stomach is distended or over-fed.
  • It supports the breastfeeding relationship, hopefully leading to longer durations and increased success at breastfeeding particularly for mothers who are separated from their nurslings either intermittently or recurrently.

Bottle feeding Myth 1: Bottle feeding lets me know how much nutrition the baby has had.

Moms who bottle-feed, whether using expressed breast milk or anything else, should be aware that while artificial feeding may seem to be a very accurate measure of volume consumed, in fact it is often not. Bottle-fed infants more often regurgitate some quantity of a feed, or get a less than perfect balance of fore and hind milk than they might if feeding directly from the breast. If a substance other than breastmilk is used, the increased metabolic workload for the baby, lower digestibility of nutrients and increased waste substantially dilute the benefit of a feed, although it is more easily measured.

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Bottle feeding Myth 2: It is simple to bottle-feed safely.

Bottle-feeding caregivers face certain challenges in feeding a baby safely.

  • Wash hands before handling bottles or feeding baby.
  • Wash bottles and nipples/teats with hot water and soap, and rinse well. Some sources recommend sterilization of all feeding equipment, particularly bottle nipples/teats.
  • If infant formula is used:
    • Wash, rinse, and dry the top of the formula can before you open it. Make sure that all equipment used has been thoroughly cleaned: can opener, measuring cups/spoons, mixing container, etc.
    • Lot numbers should be kept for any infant formula or bottled water fed to the baby, so that parents can determine whether the product was subject to a recall.
    • For powdered formula, a clean source of water must be available, free from bacteria. If tap water is used, the caregiver must decide whether to boil the water to eliminate bacteria (which may concentrate any heavy metals in the water), or to use unboiled water. Because powdered infant formula is not sterile, it should be mixed with water that is at least 70°C/158°F to kill any harmful bacteria that may be present in the formula (to reduce the risk of infection, do not mix with cooled water–even if it is bottled or has already been boiled). Cool formula before feeding to baby.
    • Quantities the baby will need should be carefully estimated, since unused formula must be discarded after the feed.
  • If you are using both breastmilk and infant formula during the same feed, it’s best not to mix them in the same bottle. This is simply to avoid wasting breastmilk when baby does not finish the bottle (since it contains formula, contents must be discarded at the end of the feed). Feed the breastmilk, then follow with formula.
  • More information here from the American Academy of Pediatrics and UNICEF UK

For more information on infant feeding myths, see Dr. Jack Newman’s Breastfeeding Myths

Additional resources

There are a number of options for feeding baby when you are unable to directly breastfeed – a bottle is only one of them. If your baby is older than 4-6 months old, consider going straight to a cup. If your baby is younger than 3-4 weeks old, consider alternative feeding methods for a couple of reasons:

  • Regular use of a bottle instead of breastfeeding can interfere with mom’s efforts to establish a good milk supply
  • Bottle use also increases baby’s risk of nipple or flow preference
  • One study has shown that babies fed by bottle (whether the contents are breastmilk or formula) tend to gain too much weight: Li R, Magadia J, Fein SB, Grummer-strawn LM. Risk of bottle-feeding for rapid weight gain during the first year of life. Arch Pediatr Adolesc Med. 2012;166(5):431-6. The paced, baby-led method of bottle feeding described here and in the resources below should help to prevent overfeeding.

Tips for bottle feeding the breastfed baby

Tips for encouraging your baby to accept a bottle

Tips for combining breast and bottle feeding