The majority of parents who choose to breastfeed their newborn know that introducing a bottle (or artificial teat) can cause ‘nipple confusion’ or ‘bottle preference’. But what if you need to be giving expressed breast milk or formula (for whatever reason) as well. 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. 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 ideally bottles should be avoided.
If bottles can’t be avoided (eg baby is a special care nursery where the nurses may be giving some or most of the feeds), then paced feeding should be used.
What is 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’?
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, then over time they will 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).
The time this takes to happen can vary from baby to baby – some will take only a few days to develop a bottle preference, others may take a bit longer. And it can be quite difficult to get a baby who has a bottle preference to go back to 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.
The issue with a bottle is that the milk flows out with very little effort being made by the baby. When a baby starts suck at the breast, they do short, quick sucks to initiate the letdown and then once the milk is flowing, they suck, swallow, breathe (some babies do a few more sucks to 1 swallow). With a bottle the milk starts flowing from the first suck.
Also, since the teat is made of hard plastic, it is easy to push the teat into the baby’s mouth without them having to open it too wide. When a baby goes onto the breast, they have to open their mouth wide to allow a large mouthful of breast into their mouth. With a bottle, over time, they learn that they don’t have to open their mouth as wide, which can make it difficult for the them to take a large mouthful of breast. Which in turn causes a shallow latch, nipple damage, and less transfer of milk. I’ve even seen some babies start suck before something is even in their mouth, which makes things even more difficult
So, paced 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.