Concerns over giving breastfed babies a bottle

There used to be a lot of anxiety about breastfed babies being given a bottle, even if it contained expressed breastmilk, because after just a couple of feeds from a bottle, babies would often start rejecting the breast. It was believed this was due to nipple confusion, meaning that babies developed a preference for the teat of a bottle, because it is much firmer and longer than a mother’s nipple.

Paced bottle-feeding protects breastfeeding because it slows the flow

However, it is now believed that babies start to refuse the breast primarily because they get used to the fast flow of milk from a bottle and get frustrated when milk comes more slowly from the breast. It has been observed that when parents are shown a technique known as paced bottle-feeding, which slows down feeds considerably, babies are much less likely to reject the breast, even when given several bottles a day.

Paced bottle-feeding also helps prevent overfeeding

Paced bottle-feeding is also recommended for formula-fed babies because it helps to prevent overfeeding. If you bottle-feed a baby while holding them in the traditional reclined bottle-feeding position, a combination of gravity and the baby’s sucking reflex means it’s very likely they will drink more milk than their tummy can comfortably fit. Paced bottle-feeding allows the baby to drink at their own speed, respects the natural breaks that babies like to take, and makes it easier for parents to tell when their baby is full.

Babies are able to self-regulate

Babies have a natural ability to self-regulate: as long as they’re in control, they will stop feeding as soon as they are full. But when babies are regularly fed large volumes of milk, it stretches their stomach, which can affect their ability to self-regulate and puts them at risk of becoming overweight later on in life. At the moment, in the UK, more than 1 in 5 children are overweight or obese when they begin primary school. It has been estimated that in at least 20% of cases, this is due to being overfed via the bottle as babies.

How to practise paced bottle-feeding: 

There are several films online explaining paced bottle-feeding. Here are the recommended steps:

• Use the smallest and narrowest bottle you can buy. Avoid ‘fat’ bodied bottles as they will need to be tilted too soon.

• Hold your baby against your body, supporting their head either in the crook of your arm or with your hand at the base of their neck.

• Make sure your baby is sitting more or less upright and isn’t bent at the waist.

• Encourage your baby to gape their mouth wide by running the bottle teat from the tip of their nose to their bottom lip. Don’t force the teat into their mouth.

• Make sure your baby is taking a big mouthful of the teat, not just the tip.

• If your baby’s lips are curled in, gently use your finger to coax them out so they flange round the teat. Sometimes it can help to gently pull the baby’s chin down a bit to get a bigger gape.

• Hold the bottle horizontal with the floor, so that there is half milk, half air in the teat. Please don’t worry about your baby swallowing air: if they do, they can burb it out or pass wind just like adults do. (As Hannah Croft IBCLC explains here, contrary to popular belief this doesn’t make babies swallow air. In fact, paced feeding helps prevent this:

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• Every 30 seconds or so, or when you see your baby taking a natural break, tilt the bottle down so that you stop the flow of milk, but don’t pull the bottle out of your baby’s mouth. Pulling the bottle out of their mouth isn’t necessary and will probably upset the baby. 

• Count to about 30 seconds. When your baby starts sucking again, tilt the bottle back up.

• Repeat until your baby no longer starts sucking during breaks.

• Stop giving the bottle as soon as your baby no longer shows interest.

• Never try to persuade a baby to finish a bottle.

N.B. When breastfeeding is going well, the recommendation is to wait roughly 4-6 weeks before doing any pumping:

If you are breastfeeding your baby, and it’s going well, it’s recommended to wait until around 4 to 6 weeks before doing any pumping. This is because it takes approximately 6 weeks for a mother’s breasts to work out how much milk her baby needs. Pumping before her milk supply is established can put a mother at risk of developing blocked ducts and mastitis.

However, in certain circumstances, pumping earlier than 6 weeks can be very helpful: 

• If a baby is born early or premature

• If a baby isn’t able to latch

• If a mother can’t breastfeed due to pain and/or damage

• If a mother needs to increase her milk supply