Your Complete Guide to Introducing a Bottle to Your Breastfed Baby

Whether you are headed back to work, want to have another caregiver feed your baby a bottle, or find yourself needing to supplement your feeds, introducing a bottle will be a part of your feeding tool kit. There are a few techniques you can use to move between boob and bottle with ease! I'm going to go through some tips to try today and some things to avoid to give you the best possible start.

When to introduce a bottle

I generally recommend starting a daily bottle between 3-4 weeks of age. This helps prevent bottle refusal by getting babies used to bottle feeding before their suck reflex begins to fade. Some parents will need to introduce a bottle sooner than this point and that is perfectly okay! 3-4 weeks is the point that I would aim for if you have not needed to introduce a bottle yet. 

Will the use of a bottle ruin my breastfeeding relationship?

First up, some myth-busting. You may have heard the term "nipple confusion," as a reason to not bottle feed early on in your nursing journey. I am not a fan of this phrase because it doesn't capture what is happening to most babies. 

I find that most babies are much more likely to have a flow preference than a nipple preference.

If feeding in one way gets you a lot of milk really quickly vs having to work for the milk in another way, your baby is likely to choose the path of least resistance. Babies are really smart! 

Why traditional bottle feeding is problematic

In traditional bottle feeding positions, think cradle hold with the bottle held at a sharp vertical angle, that milk is flowin' and your baby has to do very little beyond enjoying the good time and gulping it down. This is one reason a babe may seem to "need more" when bottle feeding or very quickly consume 3-4 ounces. 

It takes time for the gut and the brain to communicate, about 20 minutes, and if a baby is consuming an entire bottle in 5 minutes, they may appear to need more milk simply because their body has not registered that their stomach is actually full.

Human babies are very smart and will ALWAYS prefer the easiest way to feed. If your baby, who may have been eating quite well at the breast, suddenly is very fussy at the breast, pulling off a lot and generally letting you know they prefer that other option, you may have a case of flow preference.  

So how do you avoid your baby developing a bottle preference

• Introduce a bottle between 3-4 weeks while your baby's suck reflex is still present, this will help them take to a bottle more readily. 
• Feed a bottle EVERY DAY. I can't stress this one enough. I often will have a mom reach out in panic with a deadline of needing to go back to work.  A baby may refuse a bottle even when they were guzzling them like a champ in the beginning, if a bottle is not a regular part of their feeding routine. Bottle feeding is a skill like nursing is a skill, if the babe isn't using the skill, they may flat out refuse bottles later on. If you do not want to do one full bottle feed, you can always incorporate a “snack bottle” of around 1 oz to keep up the skill. 
• Nipple shape matters! While the market has been flooded with boob-lookalike nipples for bottles, they do not function the same way and often can lead to a shallow latch on the bottle which can translate to nursing. When the bottle nipple base is really wide, the baby tends to only latch to the tip of the nipple aka a shallow latch. 
• Choosing a nipple with a gradual slope like the Evenflo balance bottle is a great starting bottle. The Evenflo balance bottle promotes a wider latch for your baby and helps mimic the wide latch we want them to have at the breast. 
• Feeding position matters, just like when nursing! 
  

How to feed your baby a bottle 

We want to focus on paced bottle feeding.

1. First up, get babe in a comfy, stable position (don't forget foot stability!). I like to have my clients start with their babysitting on their lap, then lay them on the side on your legs so they are now horizontal and looking to the side. Another position I like to try is with you or another caregiver on the couch or in bed with your knees bent and the baby laying on the side of your thighs. 
2. Next, let's introduce that bottle like a boob. Don't simply stick the nipple in their mouth. Similar to how there is a lead-up to latching when you are breastfeeding. We want to go through similar steps with bottle feeding. As your baby gets older, these steps may not be necessary, just like breastfeeding, but in the beginning, we want to stimulate similar reflexes. Bring the nipple down over your baby’s lips landing on their chin. Press the nipple into your baby’s chin gently. Wait for your baby to open nice and wide, then put the nipple in their mouth. Keep the bottle down and don’t introduce milk into the nipple just yet!
3. Before tilting the bottle so milk will flow, let your baby take 4-5 practice sucks of the nipple. This is similar to the breast. Babies have to suck to stimulate a let-down and don’t immediately get lots of milk flowing at the breast.  This teaches the baby that the bottle is just like the breast; they have to work a little to get the milk to flow. 
   

Many parents worry that the baby will swallow this air and this will cause the baby to be gassy and uncomfortable. However, this is not true. Until the baby is swallowing liquid, they will exhale this excess air through their nose. Similar to if you sucked air through a straw with no liquid you would not swallow it,  you would simply exhale it through your nose. 

4. Take frequent pauses and breaks. Milk flow ebbs and flows at the breast. It is not constant. Taking frequent pauses from the bottle, it mimics feeding at the breast and also gives your baby’s body time to register as being full.  You don’t need to remove the bottle nipple from the baby’s mouth to take breaks, simply tilt the bottle down so no milk is in the nipple and then tip it back up.  Essentially we are trying to mimic your let-down pattern while bottle feeding. 
   

5. Many parents ask me “Do I need to increase the bottle nipple size/flow rate?” We always want to start with a slow-flow nipple and for many babies, this will not need to change ever. (Remember your breast flow stays the same) Also, there is no industry standard for flow rate and varies greatly by manufacturer.  
   

If your baby is getting frustrated with the bottle or collapsing the nipple as they suck it may be time to increase the flow rate. Also important to note is if you have a very strong or fast letdown your baby may be used to a quick flow at the breast and may expect the same thing with the bottle. 

Tips for bottle refusal

Whether your baby was taking a bottle like a champ and now refuses or has refused from the get-go, there are tips and strategies for getting through bottle refusal. First, bottle refusal, like latching, takes practice and patience. It is normal for there to be ups and downs. You may find one feeding session goes great only to have another be really tough. Progress isn’t a straight line. 

• My number one tip! If you are dealing with refusal, start by ditching the bottle and try nipple practice only. This takes a bit of the pressure off and helps to build a positive association with the bottle nipple without the pressure of managing a feeding. 

• Try to incorporate this throughout the day. We want this to be as fun as possible, incorporating movement, and happy, and big expressions from the caregiver. We never want to force your baby. Be respectful when they are not wanting to try. 

• Above all tips, we want to be sure to have bottle practice/nipple practice be positive. If your baby is very frustrated, it is best to move on and plan to come back at a later time. 
• Try having another caregiver or partner try to give the bottle.
• Attempt to bottle feed when your baby isn’t overly hungry. A snack bottle of 1 oz can be a good starting place. 
• Try bottle feeding for only part of a feeding session. You can try at the end of a feeding when your baby is likely to be content and may be more flexible. 
• Incorporate music, movement, and/or toys into the feeding session. Distraction can be helpful for babies. 
• Try different milk temperatures. 
• If you are already using a bottle with a gradual nipple slope, IT IS LIKELY NOT THE BOTTLE SHAPE. I would focus on practicing with just the bottle nipple before investing in 20 different bottle styles. 
• Reach out to an IBCLC experienced with bottle refusal or a pediatric speech-language pathologist (SLP). 

Need more help?

In Boob School we offer two modules devoted to how to blend breast and bottle. You can also bring your questions to our private Facebook group and our weekly live support group calls. This is a wonderful resource to watch with your partner if you want to share feeding responsibilities. I hope this helps you feel more confident blending breast and bottle. You can also bring your questions to our private Facebook group and our weekly live support group calls. 

I also recommend checking out the book Blending Breast and Bottle by Amy Peterson and M. Harmer. It is a great resource, packed with tips on navigating breast and bottle. 

Cheering you on, always!!

XOXO
Kelly

Boob School Founder and CEO

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