Paced bottle feeding

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 'topping up' or 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. 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 cannot be avoided (eg baby is a special care nursery where the nurses may be giving some or most of the feeds), then respectful or 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’? 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, 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).

I have sometimes seen babies who are being given top ups that are not necessary - 'but the baby took the milk, so they must have been hungry?', the parents say to me. Not necessarily so....

This can lead to overfeeding and a baby may start to think they *have* to have this volume to feel full.

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.

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.

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

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 - 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.

When choosing a teat please keep this in mind – NO bottle 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 hold 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 her business name

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