Starting Bottles For The Breastfed Baby

Lactation professionals advise breastfeeding moms to avoid bottles. This is to help establish mom's milk supply and help the baby learn how to breastfed efficiently. Moms who are returning to work for several hours a day will have to introduce a bottle to their baby at some point. Contrary to what you may have heard, breastfeeding dos not cause a baby (at six weeks) to have a harder time with the transition from sole breastfeeding to mixed feedings (meaning both breast and bottle feedings). And problems starting a bottle aren't because breastfeeding has caused the baby to be "over-dependant on mom." This a learning experience for the baby, like any other learning experience. Babies need time to adjust to any change. They have spent the past six weeks in "mother-care," the change to "other-care" can be a challenge, regardless of feeding method.

The goal is that the baby is happy and fed during mom's absence.

I've collected hints on how to start a breastfed baby on bottles for quite a few years. Here are a few of the suggestions lactation consultants and parents make most often.

1.     Begin trying bottles at least 2 weeks before returning to work.  So mom is comfortable knowing how things will go and it gives baby needed time to adjust.

2.     Choose a nipple with the slowest flow. Fill the bottle with water and turn it upside down, the bottle should barely form a drop and then actually drip.

1. A baby who has been breastfed from birth probably has a much stronger suck than a baby who has always been bottle-fed.
2. Baby may object to strong tastes and smells.
   1. Clear silicone nipples normally have no taste or smell.
   2. If you aren't sure taste the nipple yourself.
3. Boiling the nipple in water with a little bit of vinegar added to the water can sometimes take away the taste.

The nipple should have a raised, rounded, base for baby to latch on to. Avoid nipples that are short and stubby, with little or no base.

3.     If possible, mom should never give a bottle to the baby. 

1. Holding your baby in the nursing position and offering something totally foreign, like a hard nipple and bottle, when baby is expecting the breast, may cause baby to fight taking the bottle.  It?s not a good experience for either of you. 
2. A baby can literally smell his mother up to 50 feet away, so during the first few bottle feedings, it is better if mom is out of the house.
3. Some babies won't take a bottle from Dad either. If he's around, baby thinks mom is close too.
4. On the other hand, some babies will only take the bottle from Mom and refuse it from others.  She may be the best one to introduce the bottle and then transfer baby to the future caregiver.  This requires more gentle work if Mom has to go back to work soon.

2.    When starting bottle feedings, baby should not be overly hungry. Give the first few bottles between feedings.  When he's hungry he automatically thinks of mom's breast.

3.     Instruct the person feeding the baby to hold the baby against their chest, facing away from them, in as close to a sitting position as possible. Making sure the while baby is still comfortable.

1. The nursing position reminds them too much of nursing.
2. Some babies do better if placed in an infant seat and adult is not holding them.

4.     Offer the bottle like a toy or game (that has a surprise it -- mom's milk)

5.     "Latch" the baby on to the bottle nipple.

Stroke babies lips with the nipple, using a light touch, to elicit a wide-open mouth, as if the baby were going to breast.

When baby opens wide, then direct the nipple tipped slightly upward into the mouth, slowly and gently.

1. Don't force the nipple into the baby's mouth.
2. Let the baby draw the nipple into their mouth. 
3. Avoid forcing the nipple between closed lips.

7.     Encourage baby to take as much of the bottle nipple as possible into the mouth.

1. Generally babies lips should look nicely flanged out and be touching the base of the bottle nipple
2. Avoid allowing baby to suck only on the tip of the bottle nipple; like sucking from a straw or slurping spaghetti noodles. We don't want baby to try this on his mom.

8.     Avoid any possiblity choking.

1. Hold the bottle tipped just enough to fill the nipple with milk. 
2. With the bottle at roughly a 90-degree angle to the mouth the milk must work AGAINST gravity, so the bottle doesn't flow too fast for the baby to handle.
3. If the nipple isn't filled with milk, the baby could swallow large amounts of air.
4. Baby may need to be burped more often when first learning.

9.     For these first few attempts at bottle-feeding, a few sips is a victory.

a.      Don't expect the baby to guzzle down everything in the bottle at this early stage. (So start out with an ounce or less in the bottle)

b.      Remember:

i.       This is a process,

ii.       Realize baby IS learning about the bottle during every attempt.

10. NEVER, NEVER, EVER force the baby to take the bottle.

a. If it doesn't work, wait a day and try bottle-feeding again.

b.     Don't pressure the baby for long sessions. 5 or 10 minutes is enough. Babies have no sense of time.

11.      Even if it seems difficult at first, it will get easier with time. Baby will transition back and forth without too much difficulty once he learns how to bottle-feed.

Some additional gems

•  Run the nipple under warm water or cold water-- works for some babies.

• Use something that really smells like mom to wrap around bottle or snuggle baby close, across sitter's chest while offering bottle--her nightgown or cloth that she has expressed some milk on usually works.

• Baby may be confused about what he sees

• The feeder may need to cover their face or the baby's face (Use caution if you need to cover baby's face. Use only a very light cloth and not directly on their face, much like using a baby blanket around the feeder's shoulder).

• Sometimes it can help to look like mom. There was a newspaper snippet about a dad who put on his wife's fuzzy bath robe, and strapped on her nursing pillow; the baby took the bottle no problem after refusing loudly just minutes before.

• Have the feeder carry baby in a sling in such a way that baby can't see the caregiver/bottle-giver's face.  (It helps a lot if the caregiver is already very comfortable using a sling.)

• One sitter put a paper grocery bag over her head because it seemed that the baby did not like seeing a face other than mom's when he was feeding and it worked!

• The sitter may have to stick the bottle under his/her arm. Some babies will accept the bottle if they are held in the nursing position on their side, with the feeder using the bottle this way. Sounds odd but it does work sometimes

• Some babies will choose to "reverse cycle" breastfeed, rather than bottle feeding while mom is away, this is normal. Baby waits and "makes up" the missed feedings when mom is home.

• If mom is back at work and truly unavailable, be sure the sitter has the time and is willing to offer the bottle very frequently if the baby is only taking "snacks" of milk.

• Cup, spoon, dropper, and syringe are all feeding methods. 

o    You may need someone to teach you how to do this. 

o    These methods can be used for entire feedings instead of a bottle.

In conclusion, thousands of mothers work and continue to breastfeed. There are several ways to manage working and breastfeeding. Here are a few suggestions. Each mother has to decide what is best for her and her baby.

1. Work at home or work part-time.
2. Pump milk or have the baby brought to you for feedings. There are a number of good breast pumps available for purchase or rental.
3. Reverse cycle nursing. Mom deliberately reverses the baby's nursing pattern, so he nurses when she is home and sleeps while she is gone. (Babies sometimes to do this without any prompting from mom.
4. Partially wean the baby, giving formula during the hours that you would be away at work and nursing only during the hours that you will be home. (That includes using formula at those times even when you are home.) This eliminates the need for pumping in most mothers. It will take several days for your milk supply to adjust. In many ways, this schedule is like nursing a toddler two or three times per day. For the child who must be in daycare with other children, even partial breastfeeding has been shown to provide protection against illness.