How to Bottle Feed
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Emma Pickett
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Board Certified Lactation Consultant (IBCLC) in London and author of “You’ve Got It In You: a positive guide to breastfeeding.”
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Formula feeding

Responsive bottle feeding by Emma Pickett

We know breastfeeding is about the milk inside the container but it’s also about a process – of holding your baby in a particular way; of feeding in response to cues; of encouraging certain oral skills; of focusing on the relationship between you and your baby.
In Short
Swap sides when you bottlefeed so that your baby gets to look out of both eyes during a feed. This is what happens during breastfeeding and helps to promote visual development and brain development evenly.

Look for bottles that allow your baby to open his mouth wide with a soft silicon teat.

Is it possible to bottle-feed in such a way so as to copy breastfeeding as closely as possible?

Breastfeeding supports brain development. However, it’s not all about the long-chain polyunsaturated fatty acids which help with brain growth, it’s also about skin-to-skin contact, holding baby close, providing the feeds yourself which helps you connect and bond with your baby.

If you need to bottle-feed, what’s the best way to do it? If you are mindful of the WAY you bottle-feed, it will make a difference to both yours and your baby’s experience.

Which bottle to use?

Every bottle manufacturer claims their bottle is ‘just like nature’ or ‘just like the breast’. They all seem to pick different features: texture, shape, sucking difficulty. The one that works best for your baby is the one they can feed from slowly and in a relaxed and calm way. It should be one that can be cleaned easily and one you can afford. When we are nervous new parents, we are vulnerable to messages from commercial companies so don’t be tempted to keep shopping for different brands. If we’re going to encourage good tongue placement and oral skills, ideally we’re going to use a bottle where a baby can gape and feed with a wide open mouth rather than just nipple-feed with pursed lips. Look for bottles which allow that wide gaping mouth on the soft silicone part of the bottle where the bottom lip can flange out like a fish-lip and which therefore gives a chance for the tongue to come over the gum ridge rather than be pushed back as it often is with artificial nipples. The tongue is holding the bottle in place rather than tight lip muscles.

How should my babysit or be held?

You don’t want your baby to be lying back and we certainly don’t want to give him a bottle when he is flat as this increases the risk of him choking and spitting out the milk. Your baby should be sitting fairly upright with his body close against yours. This is an opportunity for closeness allowing you to communicate with your baby and look into their eyes offering reassurance. It is not an aim to have a young baby hold their own bottle. It is also not recommended to have your baby remain in their pram or high chair or be turned away from you.

Think of it a cuddle which has milk as a side-benefit. This is not just about a transfer of nutrition. How about bottle-feeding skin-to-skin? Sounds a bit odd, doesn’t it? Try not to worry about what other people might think, it’s about your relationship with your baby. I’m not saying it’s something you’ll be doing in in a busy café but bottle-feeding skin-to-skin is a lovely way to get that closeness when you can. If you do have skin to skin contact while you bottlefeed your baby keep your baby covered with a blanket as they tend not to get in such close skin contact due to the positioning and the fact they are facing a bottle rather than a breast.

Swapping sides

Often bottle-feeding parents have their baby on the same arm and hold the bottle with their dominant hand. This means that, over many hours, one of the baby’s eyes looks at the world and the other is effectively blinkered. The newborn brain is doing a huge amount of development in the first year of life. Connections are being made and brain tissue forming. It seems wise to give the eye/ brain relationship equal chances on both sides so try and swap round and have a different eye on the outside. You might find it a bit awkward at first holding the bottle with your non-dominant hand but with a little practice, you will get better at this.

How do I hold the bottle?

The bottle stays horizontal as much as possible with just enough milk in the teat to ensure a slow and steady flow. Some brands make this very hard as the bottle has to be tipped up to allow milk to flow so watch out for these. Your baby needs to create negative pressure and needs to make an effort to take the milk out. When a baby is working hard, they are less likely to overfeed and they are also developing muscles that they are going to need later for speech and eating solid food. This technique of keeping the bottle horizontal is sometimes called ‘paced bottle-feeding’.

Start the feed by placing the bottle above your baby’s top lip and then encourage your baby to open their mouth to take the teat. Your baby will tip his head back very slightly and open his mouth wide. Don’t push the bottle in without an indication from him. Your baby is showing his is ready and accepting the bottle. Remember we’re encouraging the bottom lip to be flanged out and the tongue to be extended over the gum ridge if we can. Use a newborn size teat. This isn’t about the milk needing to flow out more quickly. We also want to take pauses during the feed so your baby can catch his breath. We should never feel as though your baby is overwhelmed by the flow which is why the paced feeding is important. Your baby should be able to breathe calmly and his hands and body relax as he feeds.

If your baby has tight little fists and is moving in an agitated way, he is asking for the feed to slow down. He may also arch backwards and try to push away with his hands or turn his head away.

If your baby falls asleep remove the bottle. When first teeth start to arrive after just a few months, we don’t want them to be washed in formula milk just as your baby starts to fall asleep and saliva production slows.

When a bottle feed finishes, you can burp your baby and then give them a close cuddle (in skin to skin contact if you like). Your baby could then fall asleep in your arms if that feels natural. At night, the safest place for your baby to sleep is close to you in the same room. Lots of mums have the Moses basket next to the bed and they can feed in a chair or sitting up in bed and return baby to the Moses basket or cot for sleeping.

How much milk to give?

The formula manufacturer will have recommendations on their packaging for amounts according to baby’s weight and age but these are a rough guide only and each baby will have individual needs. They may also have recommended times for feeding butYou don’t have to feed your baby according to a specific schedule. Ideally, respond to your baby’s cues. A baby who is beginning to be hungry will rustle while asleep, perhaps open their mouth or move their head from side to side as if they are looking for something. Your baby may show interest in his hands or something placed near his cheek. He may begin to make little noises. Feed in response to these early hunger cues rather than waiting for your baby to start or waiting until the clock says it is the right time. We don’t want to try and cram in as much as we can or force your baby to finish a certain number of mls or oz.

If you go slow and allow your baby to take control of flow and pause occasionally, hopefully, your baby has a better chance of receiving those fullness signals.

Babies suck to calm themselves and their sucking reflex is powerful. Your baby may keep on going feeding beyond the time when it’s best for him if the milk comes out too quickly or if we are too forceful. You’ll know you’re getting it right if your baby’s weight gain is going well and he has 6 or more wet nappies and at least 2 poos a day. If your baby has formula he will need to poo at least once a day as he gets older. Some babies exclusively receiving breastmilk may skip several days between poos and be quite happy.

If your baby has taken too much formula, they will usually bring up the excess. This isn’t necessarily ‘reflux’ that we worry about but a safety mechanism that prevents over-feeding and excessive weight gain.

If you are giving your baby formula it is possible to overfeed even when done responsively if you mistake other behaviour cues for feeding cues. This won’t happen if you are feeding expressed breastmilk however. Formula fed babies are sometimes admitted to hospital due to overfeeding so talk to your health visitor if you are concerned about your baby.

Please look at these guides from First Steps Nutrition on bottle feeding in a responsive way.

Who’s giving the bottle?

Feeding your baby is a special time where you both continue to develop that close bod. Your baby will feel safe and reassured if you and/or your partner are the main people providing feeds. If too many people are involved, using different techniques, holding baby in a different way it can make baby feel stressed and anxious especially when they are very young.

Grannies may want to help by giving a bottle but it’s better if they help with the winding and nappy changing and looking after you when a baby is younger, just as we would recommend during breastfeeding. A young baby may only be awake for feeds and you want those times to be in your arms, skin-to-skin with mum (or partner), looking at your face, using the techniques that feel familiar. When granny smells different, holds the bottle in a different way and you’re not there – it’s not ideal at the beginning.

What’s in the bottle?

Modern breast pumps make the option of exclusive pumping far more realistic than it was even just a few years ago.

You can read more about exclusive pumping here: http://www.exclusivelypumping.com

Mums with a low milk supply can still provide several feeds of expressed milk a day for their baby whether or not they choose to breastfeed. Even just one tablespoon of breastmilk contains a host of immunological benefits.

Some mums also choose to give their babies donor milk. Ideally, this is accessed from a milk bank where milk is screened and prepared carefully. Home pasteurisation is also sometimes used where this is not an option and the informal milk banking sites can tell you more.

If you are going to feed your baby formula, this is a useful guide. Although it is designed for use by healthcare professionals, it contains valuable information about types of formula available in the UK:

http://www.firststepsnutrition.org/pdfs/Infant_Milks_May_2015.pdf

This guide from UNICEF Baby Friendly is also useful:

Which formula milk?

It’s important to note that ‘first’ formula can be used up until 12 months of age and a family need not change onto follow-on formula (which is completely unnecessary and was created to get round the marketing rules in the UK). After 12 months, full-fat cow’s milk can be used.

When you practice responsive bottle-feeding, not everyone around you may appreciate what you’re doing. Friends and family might be a bit confused as it may not be familiar to them but have confidence that developing closeness and responding to your baby rather than the clock is the way to go. Your family will soon understand.

Further Resources:

The NHS guide to bottle feeding talks about making up formula safely and lots of other aspects of bottle feeding.

http://www.unicef.org.uk/Documents/Baby_Friendly/Leaflets/guide_to_bottle_feeding.pdf

If you are interested in re-starting breastfeeding, it can be done at any point. The Association of Breastfeeding Mothers leaflet on re-starting breastfeeding after a gap is a good place to begin:

http://abm.me.uk/restarting-breastfeeding-after-a-gap/

It is possible to supplement the baby while they are still attached to the breast using a supplementary nursing system. You can read more about that here:

http://www.expressyourselfmums.co.uk/Expressing-breastmilk/Medela-Supplemental-Nursing-System–#moreinfoEmma Pickett

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DISCLAIMER
This article is for information only and should not be used for the diagnosis or treatment of medical conditions. Essential Parent has used all reasonable care in compiling the information from leading experts and institutions but makes no warranty as to its accuracy. Consult a doctor or other health care professional for diagnosis and treatment of medical conditions. For details click here.