When to Offer the Baby a Bottle
One of the many concerns facing a new mother is whether to feed her new infant from the breast or the bottle. When the tradition of breastfeeding in America was lost during the last century, bottle-feeding became the norm. Today many women are choosing to breastfeed, but with busy and demanding lifestyles they often find it necessary for their babies to accept a bottle (hopefully filled with breastmilk). Occasionally a breastfed baby balks at accepting an artificial nipple for feeding. The following suggestions may help when offering a bottle to a resisting baby. However, none of these are necessarily an absolute 'fix'. Encouraging your breastfed baby to accept a bottle is a process that may require your practice and patience for several weeks.
When to Start
o Suggestions for the best time to start bottle-feeding a breastfed infant varies in the current research from two weeks to six weeks of age. Two helpful markers are that the mother's milk supply is well established and breastfeeding is going well. When these criteria are met, we suggest starting at two to four weeks of age since an older baby may strongly refuse the bottle.
The Approach
o Sometimes a breastfed baby will take a bottle from the mother. But many breasted babies refuse to take a bottle from their mothers since they instinctually know she provides milk and are confused and upset by the different, less familiar option. It can be helpful to have someone other than the mother offer a breastfed baby a bottle. Mothers may want to step out of the room, or leave the house during the bottle-feeding. Or, sometimes the exact opposite approach works and the mother is the best person to offer the bottle.
o Have the father/caregiver mimic the nursing mother's feeding ritual and practice respect for the baby's newly learned breastfeeding cues. Mom might wish to breastfeed for a few minutes before offering the bottle. Then, have the father or caregiver cuddle the baby as the bottle is given, just as the mother cuddles the baby while nursing.
o If the baby resists being cuddled, have the father/caregiver hold the baby with his or her back against their chest with the baby facing out. Looking out into the room provides a distraction, which may be helpful.
o As a last resort, the father/caregiver can try feeding the baby seated in an infant seat, if the baby still resists being cuddled.
o Try short, frequent trials until the baby takes the artificial nipple without difficulty. It's better to try several short trials than to have a major bout of screaming.
o Instruct the father/caregiver to give the baby a bottle after a nap, before the baby is fully awake, or before the baby is overly hungry. The more mellow the baby, the greater the possibility of accepting something new. The old adage "if the baby is hungry enough he or she will take it" really doesn't work.
o Don't let the father always be the "bad guy." The baby and father need to develop a positive relationship, so don't allow dad to be the only one who tries to bottle-feed the baby. Have other family members and caregivers offer a bottle to the baby.
Helpful Tips
o Try starting with an eyedropper or spoon, then go to a nipple. When using a spoon, have the baby seated in an infant seat, put the spoon to his lips and simply tip the milk in. Do not try to put the spoon in the baby's mouth.
o Gently stimulate baby's mouth with the artificial nipple in the same pattern as with mother's nipple at the breast. Let the baby "mouth" the bottle nipple and become familiar with it. Sometimes playing with the nipple with the baby eases the tension.
o Since breastmilk tastes different once it is frozen, try fresh or refrigerated breastmilk when feeding from a bottle. Only offer a little at a time so you are not wasting precious pumped breastmilk.
o Let the baby suck a clean finger first, then slip the nipple into the baby's mouth alongside the finger. Once the infant is sucking, slip the finger out.
o Dip the nipple in warm breastmilk.
o Some babies prefer the fluid to be warm, like breastmilk, while others like it cold.
o Some babies prefer the nipple be warmed under warm water, although a teething child may prefer the nipple chilled in the refrigerator.
o Try a nipple that most closely resembles the mother's nipple or one with a soft "hilt" such as a Munchkin nipple.
o If the flow of milk from the nipple is too fast, try a slow flow nipple. If your own milk flows very quickly, try a medium or fast flow nipple.
o If the baby rejects the taste of latex nipples, try clear silicone nipples.
o Getting the baby to accept a pacifier often helps but may take as long as 8 to 12 weeks.
o If the baby is old enough, let baby play with an empty bottle for a day or two to become familiar with it.
Feeding Expectations
o A word about volume: your baby's stomach is the size of its curled fist. Full feedings vary from one and one/half ounces to three ounces for a very young infant. Four to six ounces are appropriate for the older baby who has mastered the art of feeding.
o Knowing how to recognize when your baby is satisfied can enhance your success with the bottle.
o It is not uncommon for some breastfed babies to gulp ounces from the bottle. They are swallowing in response to the milk on their tongues, and the fast, constant flow of the bottle, just as they do during your letdown. Slow the feed; give one or two ounces, then withdraw the nipple and burp the baby, to mimic the breastfeeding pattern.
o When sucking needs are satisfied at the breast, some breastfed babies never take bottles. They may transition to a sippy cup with a little help at four or six months and skip taking bottles altogether.
Remember that your attitude is important. Stay happy and positive - even playful - and make it a game. Don't let your child sense your frustration. Try practicing with a bottle and nipple a little each day.
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