All about bottle feeding
Using a bottle to feed your baby can be a real game changer. Bottle feeding, in tandem with pumping, brings flexibility to how, when, and where your baby eats—not to mention who is able to help with the feeding.
Bottle feeding can be implemented in myriad ways, but it takes a little education, planning and, often, persistence. If strategically (and successfully) implemented, bottle feeding can support your efforts to continue breastfeeding. And if you find yourself in situations in which direct breastfeeding is difficult or even impossible, bottle feeding enables you to continue providing your baby breast milk.
To help guide you through this journey, check out our tactical tips on how to introduce a bottle, what to do if your baby refuses to take one, and best practices for managing bottle feeding, once established.
How to introduce a bottle
Dr. Jones
Pediatrician
Try these strategies to help your baby learn to take a bottle.
If you’re planning to return to work and want to leave breast milk and bottles with a caregiver, wait until your baby is 4 to 6 weeks old, if possible, after establishing breastfeeding. Then start with just one bottle, once a day, to reduce the risk of your baby refusing the breast in favor of the bottle’s regular (and typically faster) flow.
Babies can differentiate between a bottle and breast. Many initially prefer the breast and are more receptive to bottles offered by someone else—not least because they can smell you. Ask your partner or another caregiver to give the initial bottle. Set the expectation that your baby may refuse it, which can be very challenging to hear and manage. Then leave.
Try to have your caretaker offer the bottle while your baby is awake and alert, such as immediately after a nap.
Offer freshly pumped breast milk for this initial bottle. Your baby may initially refuse older (or colder) milk. To minimize waste, have your partner or caregiver offer that first bottle of milk in small, half-ounce increments.
Introduce just one type of nipple (ideally a slow-flow nipple) and bottle, and keep using them throughout your infant’s bottle-feeding journey. Consistency increases your odds for success—and reduces your costs and risks of gear frustration and confusion.
Just before introducing the bottle, have your caregiver place a few drops of your pumped milk on the bottle’s nipple. Offer the nipple so your baby can taste it, then rub the bottle’s nipple on your baby’s lips to prompt your baby to latch onto it.
It can take time for a baby who’s been exclusively breastfeeding to accept and adjust to bottle feeding. Don’t expect it to happen on the first try. The introduction process can be stressful—caregivers may find prolonged periods of crying or fussing challenging—but with patience and persistence, your baby will eventually take a bottle.
Once your baby is regularly bottle feeding from others, give it a try yourself. (This can also present time-consuming challenges.) Try feeding the bottle with your baby’s cheek in a location and position that your baby associates with breastfeeding. This may help your baby develop a positive association with bottle feeding from you.
How to handle bottle refusal
If you’ve heard of (or perhaps experienced) bottle refusal, pediatrician Dr. Laurie Jones, founder of Dr. MILK (Mothers Interested in Lactation Knowledge), has several tips to help manage it. She says your baby’s willingness to take a bottle is more about personality than timing—some babies just prefer the breast. Success, then, depends less on the type of bottle than on the caregiver’s patience, consistency, and persistence.
The good news? Even the most stubborn bottle refusers will eventually figure it out—or learn to use a cup.
Once your baby has learned to take a bottle, you’ll likely want to avoid both overfeeding and breast refusal. Maintaining breastfeeding while bottle feeding involves using a slow-flow nipple, pacing your feeds so they mimic that of direct breastfeeding, and keeping an eye on your daily ratio of bottle-feeding to breastfeeding sessions.
What’s the deal with nipple confusion?
One popular idea is that introducing a bottle early will cause “nipple confusion.” The term implies that your baby can become confused (and picky) about nipple types.
That’s not exactly accurate, Dr. Jones says. “We try not to say ‘nipple confusion’ anymore because it’s actually flow preference—and that’s the very real enemy of direct breastfeeding.
With anywhere from two to nine milk ejections and 1- to 2-minute pauses between each burst, a breast nipple typically has a lower, slower, and less consistent flow than a bottle nipple. Babies learn to stay on the breast until their needs are met, even through the lulls between bursts, because they know that more milk will come with persistence and patience. A bottle, on the other hand, is faster and easier: Your baby has to work much less to get the milk.
Be on the lookout for breast refusal
As your baby learns to alternate feedings between the breast and bottle, try to ensure that the number of daily breastfeeding sessions matches or exceeds the number of daily bottle-feeding sessions. This is important because every baby has a tipping point at which flow preference takes over, and many babies begin to prefer the regular, faster flow of the bottle to the breast.
“If the number of bottles is more than the number of direct feeds, the baby may self-wean and refuse the breast because it's just easier to bottle-feed,” Dr. Jones says. (If this happens to you, you may find yourself becoming an exclusive pumper. If you’d like to continue directly breastfeeding to some extent, check out Dr. Jones’ tips on how to avoid accidental exclusive pumping.)
Aim for paced feedings
Just as with breastfeeding, it’s important to pay attention to your baby when bottle feeding. Go slowly, make eye contact, closely hold your baby, and aim to match the pace of the bottle’s nipple flow to your own through a method called “paced bottle feeding,” Dr. Jones advises.
This involves using a slow-flow nipple and stopping periodically, bending and tugging the nipple gently to mimic the natural lulls between letdowns. Maintaining a slower and periodically interrupted flow can have a positive impact on a baby’s health.
“Paced feeding is always a good idea to prevent obesity and overfeeding, and to allow for breathing and coordination of swallowing for younger
A slow-flow nipple is crucial because it offers (and requires) the closest resemblance in flow and effort to direct breastfeeding. If you hope to continue direct breastfeeding, don’t be tempted to switch to a higher-flow nipple, despite what other people may recommend. And keep in mind that even older babies can learn to prefer a faster-flowing nipple to breastfeeding.
“Breasts don’t flow faster over time, so the slow flow-nipple is the one to stay with,” Dr. Jones says.
Dr. Jones says caregivers tend to have “volume norms,” from their own experiences. So it’s important, she says, to ensure that your baby’s caregivers will help give paced feedings.
“Many child care centers are not breastfeeding-friendly and just need some education to protect your feeding goals,” Dr. Jones says. “Have a conversation with them, and share with them how you’d like them to feed your baby.”
Watch out for overfeeding
When breastfeeding, babies tend to release their latch (or just stop sucking) when they aren’t hungry anymore, but the cues for satiety during bottle feeding aren’t quite as clear, Dr. Jones says. Babies are more likely to continue feeding beyond this point when being fed a bottle—even though the amount they need in a given feeding doesn’t actually change much as they grow.
One study of more than 16,000 babies found that 75 percent will demand more volume over time, if consistently fed bottles beyond satiation.
“Breast milk’s caloric density doesn’t change over time, but the number of calories your baby needs to grow over time goes down, the older they are,” Dr. Jones says. In other words, the caloric burn goes down while the volume stays roughly the same.
Keep in mind, Dr. Jones says, that a breastfed baby typically needs 3 to 4 ounces per feed. Don’t be confused by those larger bottles; your friend’s exclusively formula-fed baby may be consuming more volume than your baby. That’s because breast milk and formula are metabolized differently; formula-fed babies use the nutrients in formula less efficiently.
“Any feeding that is controlled by an adult creates potential for overfeeding,” Dr. Jones says. “We never know if they were lonely, thirsty, hungry, or just wanted to be picked up. Infants will take a bottle, even when they are not physiologically hungry.”
Treat the bottle as one tool in your toolkit
Just like the pump, the bottle is a tool. With patience and practice, and an awareness of the ways a bottle can change the course of your breastfeeding journey, you can use this tool to your advantage as you focus on accomplishing your feeding goals. Just remember to be patient with your baby and yourself. There are many learning curves, and you’re doing the best you can with the tools you have.