Giving a bottle to a breastfed baby when baby is under six months of age*
Many times a breastfed baby’s
parents will want or need to use a bottle as well. This is not a bad thing. It may be that the dyad is separated by illness, mom is going back to work, that weaning is planned or so the
couple can go to the movies while grandma watches the
bub. Whatever the reason there are certain things to keep in mind to facilitate the process.
Bottle feeding any infant should imitate the natural rhythms of breastfeeding. The nipple used is best if slow flow, soft, round, has a wide base and is latex free. The infant should be held supported in a sitting position with the bottle held more or less parallel to the floor. This will minimize the forces of gravity pushing the milk too fast into the baby's mouth. Some air may be in the nipple, this is not a problem, it will vent through the baby's nose. In fact, babies fed this way typically burp less loudly that babies forced to guzzle from a fast flowing, downward pointing nipple. The infant who is fed in this manner will typically suck in a burst, pause mode just like a breastfeeding infant. S/he will also typically have less spitting and perhaps less reflux.
When it comes to giving a bottle to a breastfed baby I think in terms of 4 phases:
These are for the well baby who is home with his or her mother.
Phase 1:
Learn to breastfeed well. When mom and the baby no longer feel like they are using “
training wheels”, when breastfeeding has begun to feel easy learning a new
skill like
bottle-feeding is not likely to interfere.
Trying to learn to bottle feed while simultaneously learning to breastfeed is risky to the success of breastfeeding. This is not because bottle-feeding is easier; it is just more obvious. Physiologically
breastfeeding is easier on the baby but an artificial nipple and a dripping bottle give the baby a “super signal” that s/he may look for and not find at the breast. Give mom and baby both a chance to get good at breastfeeding before introducing the bottle. For most couples this takes about a month.
Phase 2:
Teach the baby to take a bottle before s/he gets too old to accept it. The
window of opportunity is wide open until about 3 months of age. One way to approach this is to
pump one
breast just before an anticipated
feeding and use that
milk for the early practice bottles. This allows mom’s first pumping sessions to be on a fuller
breast and to more likely be a positive experience yielding impressive quantities of milk. This also allows the baby to go to the “other” breast if the early bottle-feeding lessons do not go well. This allows significant others in the baby’s life to feed while still using the
gold standard of breastmilk.
Phase 3:
Build a little
inventory of frozen
breastmilk for use in the future. This phase may overlap with phase 2 as some of those early pumped bottles may be divided and a part used to feed while a part is frozen.
This phase is a bit like “
robbing Peter to pay Paul” in that the baby is usually breastfeeding full time while the mom is trying to stash away a bit of milk now and then. It is realistic to expect about 1 ounce a day for most moms during this phase. More than that is possible but shouldn’t be expected. If too much is pumped and baby is fussy for more food s/he can be given an unplanned practice bottle of expressed breastmilk, no big deal!
Mom can pump a bit before or after a regular breastfeeding, she can pump in between 2 breastfeeding sessions, she can pump the “other side” while or after baby takes the first side. Often pumping is easiest in the morning hours when the breast is generally fuller for most women.
Milk pumped for later use can be frozen in layers; just cool the newest milk in the refrigerator before pouring it over the frozen milk. It’s a bit like making a
parfait.
Phase 4:
This is when
mom actually leaves the baby in someone else’s care. Baby is fed previously pumped breastmilk and mom pumps while she is away. Most babies eat about an ounce per hour when under 6 months of age. Plan to have about 2 ounces of milk stashed per hour that mom will be absent, including transportation time. This allows a bit of a buffer in case baby is extra hungry or some milk is wasted.
Mom should pump approximately as often as baby usually eats because this will keep her milk supply up to baby’s needs and prevent her breasts from becoming
engorged. She doesn’t have to pump at exactly the same time as baby feeds.
Variations:
Some moms may not be able to
pump as often as baby eats but will want to pump as often as she is able to do so. She may be able to pump some when home, after or between direct breastfeeding sessions. Or she may not and some formula may be used to make up the difference.
If a mom pumps at least every 4 to 5 hours most can continue to breastfeed directly when home with the baby. If longer times go by without pumping, and especially if baby is still quite young, the overall
milk supply may suffer and baby may begin to need
formula even when mom is available for breastfeeding at home. Even so, any breastmilk is better than none and mom can continue to breastfeed first and follow up with a bottle of formula if it is needed as long as she and the baby wish to do so.
FOOTNOTE
* It is generally recommended that infants be fed just breastmilk(or formula if breastmilk is not available) until about 6 months of age when solid foods should also be added. AAP recommends breastfeeding continue (with appropriate solid foods added) until at least 12 months of age. WHO recommends at least 2 years.