What it is
Giving a bottle to a nursing baby raises three worries: when to introduce a bottle, 'nipple confusion,' and bottle refusal. Paced bottle feeding answers most of them. The baby sits upright, the bottle is held nearly flat so milk does not pour, and the feed has pauses, the way a breast does. The baby works for the milk and can stop when full.
Nipple confusion is the idea that a baby who gets a bottle early will prefer it and refuse the breast. It happens for some babies, mostly in the first weeks, when a fast bottle makes the breast feel like hard work. Flow preference is the better name. Bottle refusal is the opposite: a baby who knows the breast and wants nothing else. It is common when the first bottle comes late, in a rush before a return to work.
What's typical
Most lactation consultants suggest a first bottle between 3 and 6 weeks, once nursing is settled. One bottle every day or two keeps the skill alive. Use the slowest nipple available and keep it slow for months. A paced feed takes 15 to 30 minutes, about as long as nursing. Many babies take a bottle more easily from someone other than the mother, with the mother out of the room, or when half awake. Refusal at 3 to 4 months is common and usually workable with a week or two of calm, low-pressure offers. Babies rarely let themselves go hungry for long. Some reverse-cycle instead: more feeding at night with the mother, less from the bottle by day.
What's known
The Academy of Breastfeeding Medicine notes that paced feeding and a slow nipple lower the chance of overfeeding and of the baby preferring the bottle. A Cochrane review found that cup feeding and bottle feeding of top-ups did not differ much in how long breastfeeding lasted. Research on nipple confusion is mixed. The effect is real for some babies and smaller than many parents fear.
What helps
- Hold the baby upright, bottle nearly level, nipple just filled. Tip the bottle down for a pause every few swallows.
- Start with an ounce or two of fresh milk, warm, when the baby is calm and a little hungry, not starving.
- If the baby refuses: someone else offers, mother out of the room, different time of day, different position. Change one thing at a time.
- Do not force. Offer, pause, try again later. A fight at the bottle makes the next one harder.
- A straw or open cup is fine from around 6 months if the bottle never wins. It does not have to.
When to call someone
- Nowthe baby chokes, turns blue, or stops breathing during a bottle.
- Todaythe baby refuses both breast and bottle for more than 6 to 8 hours, or has fewer wet diapers.
- At your next visitthe baby prefers the bottle and nursing is slipping, or you are returning to work and the baby still refuses every bottle.
Who helps
Tools: Feeding Prep · Birthworker Directory
Related
- Pumping: how, when, how oftenFeeding Your Baby
- Building and storing a milk stashFeeding Your Baby
- Combo feeding: breast and formulaFeeding Your Baby
- Returning to work and pumpingFeeding Your Baby
- Nursing strikes and refusalFeeding Your Baby
- PacifiersBaby Basics
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Sources
- Academy of Breastfeeding Medicine — Clinical protocol 3: supplementary feedings in the healthy term breastfed neonate
- Cochrane — Cup feeding versus other forms of supplemental enteral feeding for newborn infants unable to fully breastfeed
- La Leche League International — Introducing a bottle to a breastfed baby
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