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Best way to feed baby


How should I feed my baby? | Baby Feeding Methods

In this series Breastfeeding Your Baby Mastitis and Breast Abscess Bottle-feeding Your Baby Weaning Your Baby Feeding Your Toddler

How should I feed my baby?

One of the first decisions you will make, after your baby is born, is how to feed him or her. Most mums will have the choice of either breastfeeding or bottle-feeding from the start.

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Should I breastfeed or bottle-feed?

The benefits of breastfeeding for you and your baby are so great that experts recommend that, in almost every circumstance, breastfeeding your baby for the first six months is the best option for both your health and your baby's health, even in countries where infant formula is easily obtained and water supplies are clean and safe. Nevertheless, deciding whether to do this is a personal decision and you need to consider both the pros and cons of both types of feeding for you and your baby. You don't have to choose completely between them - you can do both, for different periods of time and in different proportions. Each approach has advantages and disadvantages, and to help you think them through we have listed the main ones here:

Advantages of breastfeeding to your baby

  • Breastfeeding provides your child with the perfect, tailor-made source of nutrition, the one that nature evolved for them. It is the easiest food for them to digest, so it possibly causes less gas and colic.
  • Breast milk, particularly first milk, helps protect your baby from illness during infancy, particularly tummy bugs and ear infections. It also reduces the incidence of cot death (sudden infant death syndrome).
  • Breastfeeding has lasting benefits for your baby's metabolism, reducing the chance of obesity and diabetes, and of allergies like eczema, later.
  • Breastfeeding makes feeding simple: no other fluids (such as water) are needed for a breast-fed baby. In the hottest weather, the breast milk composition changes, to provide everything your baby needs.
  • Breastfeeding enhances the bonding process between baby and mother. Being cuddled naked, against the mother's bare skin for as long as possible at birth, is important. This can of course be done even if you do not breastfeed.
  • Babies generally 'take to' the taste of breast milk quickly, whereas not all babies like the taste of all bottled milks.
  • A breast-fed baby's bowel movements are less smelly and are not irritating to a baby's skin. Breast-fed babies are less prone therefore to nappy rash.
  • Breast-fed babies don't usually get diarrhoea or constipation.
  • Breast-fed babies tend to be less fussy at weaning.
  • Breast milk appears to help loosen a newborn baby's mucus and it acts as a laxative helping with the passage of the first poo (meconium).
  • Breast-fed babies perform slightly better in intelligence tests in early childhood.
  • Breastfeeding is comforting for you and your baby (although this can equally be true of bottle-feeding).

Advantages of breastfeeding to you

  • Breastfeeding will help speed your recovery from childbirth, particularly the shrinking down of your womb after delivery.
  • Breastfeeding helps you manage the initial breast 'engorgement' which often appears around day 3-4 and which can be very uncomfortable.
  • Breastfeeding is convenient: you don't have to prepare bottles. It is also the cheapest option - it's free.
  • Breastfeeding slightly reduces the chance of postnatal depression.
  • Breastfeeding gives you later protection, to some degree, against ovarian and breast cancer. It also decreases your chances of developing 'thinning' of the bones (osteoporosis), diabetes and obesity as you age.
  • Night-time feedings are easier and quicker when you breastfeed, meaning that you get more sleep.
  • Breastfeeding usually delays the return of your period for three months or more. Whilst you are breastfeeding exclusively, your fertility is suppressed for up to six months - a natural birth control method which is up to 98% effective.
  • Pumping or expressing your breast milk can give you some freedom, allowing you to spend time away from your baby yet continue to provide breast milk, and giving your partner the ability to participate in feedings.
  • Exclusive breastfeeding for the first six months of life provides the maximum benefit. However, any breastfeeding that you do will bring you and your baby benefits. 

Advantages of bottle-feeding

  • You have more flexibility in being away from your baby if you have to work, for example. (Although you can express or supplement breastfeeding with bottle-feeding, in the first few days when your breast milk supply is just establishing this is not so easy to do, so you can't easily be away from your baby. )
  • Breastfeeding can be tiring, especially during the first few weeks when you are feeding your baby on demand. Bottle-feeding is easier to delegate when you are tired, allowing you to rest properly and have more energy overall.
  • Breastfeeding can be painful: common problems include breast engorgement, leaking, sore nipples and infection of the breast (mastitis). Bottle-feeding allows your breasts to settle down more quickly after pregnancy.
  • Your partner can't breastfeed, and may feel a little left out (although you can express to allow them to bottle-feed).
  • You may find breastfeeding in public awkward and embarrassing, making it difficult to go out with your baby. Bottle-feeding removes this worry (whether feeding expressed milk or formula).
  • Bottle-feeding allows you to see how much milk your baby has taken, which you may find reassuring.
  • Breastfeeding can be difficult at first. Not all babies latch on immediately and breastfeed well, and you may find breastfeeding stressful and be unsure whether your baby has fed properly.
  • Breastfeeding can be particularly difficult if you have more than one baby to feed; partially or completely using bottles may help you manage.
  • Women who have had surgery to their breasts, including cosmetic surgery, can have a decreased flow of breast milk - the effect depends on precisely what surgery they have had.
  • Some women worry that they cannot produce enough milk to satisfy their baby, and bottle milk relieves this anxiety.
  • Bottle-feeding may be safer for your baby if you need to be on medications which would enter your breast milk and be harmful for your baby, or if your baby needs a specially adapted milk because they have a medical condition.
  • Women who are HIV positive are advised not to breastfeed unless in a country or situation where safe supplies of formula and water are not readily available.
  • Other, practical reasons why your baby might need to bottle-feed include you not being with your baby (for example, because of adoption, prematurity, or sickness in you or your baby, or because you need to return to work early).
  • If your baby is born before 32 weeks it can be harder to establish your breast milk supply, so some bottle-feeding may take the pressure off you as you try to establish your supply.
  • Some women just prefer the idea of bottle-feeding (although they may be able to express for a while if they want to give their baby breast milk).

Advantages of combination feeding

Breastfeeding or bottle-feeding doesn't have to be all or nothing. You can breastfeed fully or partly, and many mums combine breastfeeding and formula feeding, and breast-milk pumping, in differing proportions. It's easiest to begin combination feeding once you have breast-fed for six weeks so that your supply is fully established; however, you can try it sooner if you need or want to.

Combining breastfeeding with bottle-feeding offers the advantages and disadvantages of both options. It makes you more flexible, as you can move between the two, which might suit you if, for example:

  • You want to breastfeed but would like your partner to share in the feeding routines
  • You want to breastfeed but also to preserve your energy and offer the baby the best of both worlds
  • You are breastfeeding but want to be able to give bottles of formula for one or more feeds so that you can get some rest
  • You began by bottle-feeding your baby and have decided that you want to start breastfeeding
  • You need to leave your baby and want to make sure they have some milk while you're away
  • You have twins or more and feel this would be more manageable

Introducing formula feeds will tend to reduce the amount of breast milk you produce and this is more so if you do so in the first six weeks, whilst your breast-milk supply is adjusting to an 'even keel'. Your baby also has to learn to use a different kind of suck at the bottle than at the breast. However, with perseverance many mothers manage it successfully.

How do I express breast milk?

You might want to express milk because your breasts are engorged and you want to relieve the pressure, because your baby is very premature and not yet able to suck (see below), or because you need or want someone else to be able to feed your baby too. Expressing your own breast milk is a technique you can learn quite quickly, although it may take a little practice at first. Expressing breast milk is as it sounds: you 'milk' your breast for the supply it contains, and store the expressed milk so that you (or someone else) are able to give it to your baby from a bottle.

You can express milk using a pump (hand or electric) or by hand (often easiest at first). You can rent 'hospital-grade' breast pumps, which are the most effective. You can keep expressed milk in the fridge for up to five days, or freeze it for up to six months.

More detail on how to express breast milk is given in the separate leaflet called Breastfeeding Your Baby.

How should I feed my newborn baby?

You should offer your newborn baby a feed as soon as possible after birth. You can usually choose breastfeeding or bottle-feeding from the very start. Breastmilk, particularly early breast milk, is massively beneficial for your baby, and for this reason many mums who want to bottle-feed decide to breastfeed for the first couple of weeks. This means that they give their baby the important first milk (colostrum) before switching over to formula. 

Your midwife will be there to help you establish feeding, until you can do it confidently without help, so you won't be doing this alone. 

How often will my baby want to feed immediately after birth?

Straight after birth your baby will, like you, be tired and probably hungry. Some babies will want to feed straightaway; others may seem less keen to do so. Your midwife will encourage your baby to feed in the first hour after birth, as this helps both you and your baby recover from labour. It is particularly important for the babies of mums with diabetes to be encouraged to feed in the first half an hour or so after birth, as these babies can be particularly prone to developing low blood sugar otherwise.

Babies will vary greatly as to whether they will want to keep feeding in the first few hours after birth, or as to whether they seem to need a sleep. Newborn babies should be allowed to feed as often as they wish. If the baby is sucking actively they should be kept on the breast or bottle until they slow or stop. If you are breastfeeding you should offer the second breast before stopping (because it may be that the flow has slowed in the first breast but your baby is still hungry).

Will I have any milk in the first few hours?

When your baby is born your breasts will already be producing colostrum, which you may have noticed leaking from your breasts in late pregnancy. This yellowish 'milk' is a bit thicker than mature breast milk. Colostrum is only produced for the first few days of your baby's life, after which it gradually changes (and increases in quantity) to mature breast milk. Colostrum is very important to your baby. Even if you don't plan to breastfeed in the long term, any colostrum that you feed your baby will have long-term value to him or her.

What is colostrum?

Colostrum is a milky yellow 'first milk' which contains proteins, carbohydrates, fats, vitamins, minerals, antibodies and immune cells that fight disease-causing agents such as bacteria and viruses. It helps you pass on to your baby the immunity you have 'earned' through fighting infections yourself. This is hugely helpful to your baby, whose own immune defence system is not yet fully developed. Having their mother's colostrum reduces tummy and ear infections in babies in later childhood. Colostrum also helps prevent babies from developing early jaundice. 

Many mothers who don't want to go on to breastfeed decide to give their baby that vital, initial colostrum. After this, over the first two weeks the milk gradually changes from colostrum through a 'transitional milk' to 'mature' breast milk. In the first 24 hours after the birth you will produce about 40 ml of colostrum, and your baby will take about a fifth of this during a feed.

How does feeding my baby the colostrum help my body?

Breastfeeding in the minutes and hours just after your baby is delivered helps your womb expel the afterbirth (placenta) more efficiently and then helps it contract firmly down towards its pre-pregnant size. This helps kick-start the process of your own return to normal shape and can also help relieve the breast engorgement that usually arrives around day 3-4 after birth (whether or not you breastfeed).

How do I feed my premature baby?

Premature babies are ideally given breast milk from birth, although before 32 weeks of gestation they may not yet be strong enough to feed directly. If you are making milk and your baby is strong enough to suckle, you will usually be encouraged to breastfeed, as breastfeeding is particularly helpful for premature babies. If you are unable to breastfeed initially, or decide not to, your premature baby may be given formula milk or, occasionally after discussion with you, expressed donor milk.

  • If your baby is extremely premature, his or her digestive system may not yet be mature enough to have food in the stomach, so feeding may need to be into a vein using a special nutrient rich solution called TPN (this stands for total parenteral nutrition).
  • Premature babies who are ready to digest milk but not yet strong enough to suckle, may be given breast or formula milk through a tiny tube which goes to the stomach. Ideally your own breast milk will be used, if you can express it. Premature babies may also need food supplements, or special premature baby formula, to make up for the time in the womb that they have missed.
  • If your baby is very early it may take a little while for you to produce milk. However, if you keep expressing regularly, eight times a day, the milk is likely to come in. Whilst your milk supply isn't fully established then the team may talk consider using donated human breast milk or formula, until you can replace it with your own breast milk.
  • Your baby may continue tube feeding while they are learning to feed from the breast, from a cup or from a bottle, to make sure they get enough food.

How do I express breast milk for my premature baby?

To express milk for your premature baby, you should start hand expressing within six hours of delivering your baby. You'll need to do this eight to ten times a day, including once during the night. In the first few days you may make only a few drops of milk each time, which can seem like very little, but every single drop counts.

How many calories are there in colostrum and breast and formula milk?

Colostrum has around 50 calories per oz and mature breast milk has 60-75 calories, as does infant formula. When producing mature milk, each breast will produce 'richer' milk with a higher fat content towards the end of a feed when it is nearly empty, so it is important that breastfeeding babies get the opportunity to empty one breast before feeding from the other, so that they can access this richer milk.  

How do I breastfeed my baby?

See the separate leaflet called Breastfeeding Your Baby.

How do I bottle-feed my baby?

See the separate leaflet called Bottle-feeding Your Baby.

Can I go back to breastfeeding after bottle-feeding?

You can restart breastfeeding for weeks or even months after you have stopped, if you want to do so. It can take a little perseverance, but there are a few things which may help your milk to come back in:

  • Hold your baby as much as possible, skin to skin.
  • Express your breast milk around eight times a day - this releases the hormone prolactin, which stimulates your breasts to make milk. It may be easier to express by hand to begin with, although pumps are also available.
  • If your baby is latching on but you don't yet have much milk, feed little and often, when your baby is relaxed and not too hungry.
  • Decrease the number of bottles gradually, as your milk supply increases.
  • Consider using a lactation aid. This is a tiny tube which is taped next to your nipple and goes to your baby's mouth, so that when your baby suckles on your nipple he or she can get milk via the tube as well as from your breast. This helps keep your baby suckling, giving your breasts the stimulation they need to keep producing milk.

Can I breastfeed if I adopt?

It can be possible to breastfeed even if you have not just had a baby - it is called adoptive nursing. The principle is that repeated stimulation of the nipples triggers milk production. It is more difficult to trigger milk production if you have not been pregnant recently. This is because although the milk production itself is triggered by nipple stimulation, you won't have the high levels of pregnancy hormones that also prepare your body for breastfeeding by enlarging and sensitising the milk-producing apparatus. But it is possible.

It can take considerable perseverance to get a good supply of milk, but a lactational aid (as those described above) can be very helpful in persuading the baby to keep suckling, delivering the stimulation needed to create a milk supply.

How do I wean my baby?

Weaning is the gradual introduction of additional food to your baby, on top of infant formula or breast milk. See the separate leaflet called Baby-led Weaning.

What is the best way to help my baby eat a balanced diet after he or she is fully weaned?

Feeding children over the age of 12 months is both an art and a science. Your aim is to encourage healthy tastes and eating habits, which will set your child up for life.

See the separate leaflet called Feeding Your Toddler.

How to Bottle-Feed a Baby

Whether you’re breastfeeding, formula-feeding or doing a combination of both, chances are you’ll eventually use a bottle with your infant. No big deal, right? But while images of a parent blissfully holding a bottle make the process look easy, there’s a learning curve when it comes to proper bottle-feeding. Here, everything you need to know about how to bottle-feed a baby safely and happily.

In this article:
How to choose the right bottle and nipple
How to make a baby bottle
Best bottle-feeding positions
What is pace feeding?
How to get baby to take a bottle
When to wean baby off the bottle

How to Choose the Right Bottle and Nipple

When it comes to figuring out how to bottle-feed a baby, selecting an appropriate bottle and nipple is step one. If people gifted you a bunch of bottles at your baby shower, you may want to hold off before opening and sterilizing them until baby is born, or at least take out just a few to try in the early days of feeding. Why? Because you won’t know what kind of bottle is best until you figure out what baby’s feeding needs are.

“Certain bottles work better for certain babies,” explains Jamie O’Day, BSN, RN, CLC, a registered nurse, certified lactation consultant and cofounder of Boston NAPS, a pre- and postnatal resource center in the Boston area. “For example, some babies who have issues with gas may do better with a bottle that has a filtration system, like a Doctor Brown’s style bottle, while babies who are used to being breastfed may have more success drinking from a bottle that aims to mimic the shape and feel of a mother’s breast, like the Comotomo.”

That said, O’Day has a universal tip for all parents: Look for a bottle that’s easy to take apart and clean. That generally means a nice wide neck and the fewest parts possible. “Proper cleaning is so important, so I always tell parents to choose the simplest bottle, which may just have a nipple, bottle and collar,” she says. If your child seems happy and easily takes the bottle, then there’s no need to switch.

Of course, it’s not just the bottle that you have to consider. It’s also important to pay attention to the flow of the nipple, which varies based on infant age. Generally speaking, young babies need a slower flow, while older babies who’ve mastered the art of bottle-feeding can handle a faster flow. The nipple may be called “slow flow,” “medium flow” or “fast flow” or may be numbered from one to three, with one being the slowest flow. There is no standard of flow between different brands, but most newborns should begin on level one or slow flow.

So how can you tell when it’s time to change the nipple size? That depends. Some infants happily use the same flow nipple throughout their infancy, while others may need a faster flow nipple. “If you notice your child taking a long time to finish a bottle, or losing interest midway through feedings, a faster flow nipple may be needed,” O’Day says, adding that this might happen at around 3 or 4 months of age, with another potential upgrade around 6 or 7 months.

If your infant finishes a bottle quickly (say, under five minutes), seems gassy or cranky, or spits up a lot of milk right after feedings, it may be time to go back to a slower-flow nipple. Your pediatrician can also help determine if it may be time to switch the flow of the nipple.

How to Make a Baby Bottle

If you’re wondering how to bottle-feed a baby, you’re probably new to prepping baby bottles. Take a new skill, add in sleep deprivation and sprinkle in some very real safety concerns and you’ve got the somewhat daunting process of making a baby bottle (at least at first). Don’t despair. By reading directions, following the advice of a pediatrician and making sure to err on the side of caution, you’ll get the hang of it in no time.

How to make a baby bottle with formula

Baby formula comes in three different forms: ready-to-feed, concentrate and powder. The Centers for Disease Control and Prevention (CDC) recommends that babies under 3 months start off with ready-to-feed formula because of the small but real risk of cronobacter, a bacteria that can live in powdered infant formula.

• Preparing ready-to-feed formula: These require very little prep, since they come ready to be poured into a bottle and fed to an infant. Some ready-to-feed formulas come in bottles that can accomodate disposable nipples—all you need to do is screw a nipple on, feed and discard.

• Preparing concentrate formula: To prepare a baby body with this liquid formula, you’ll need to add water. It’s important to read the directions to learn the right ratio of water to concentrate. As for what type of water should you use, that depends on where you live, your pediatrician’s recommendation and your own wishes. If your tap water is safe, feel free to use it—just run it for several minutes before you fill the bottle to remove any trace contaminants in the water. You can also use filtered water, bottled water or boiled (and cooled) tap water.

• Preparing powdered formula: Just like concentrate, it’s important to follow directions on the right ratio of scoops of powder to ounces of water, says Carmen Baker-Clark, an International Board Certified Lactation Consultant (IBCLC) in Hoboken, New Jersey. When using powdered formula, make sure to shake well so the liquid isn’t clumpy. “Some parents notice powdered formulas may make their infant more gassy, more prone to spit-up or more constipated. A lot of this is due to the bottle preparation. For example, not shaking enough can create uneven consistency that may be harder for baby to digest,” Baker-Clark explains.

Regardless of what kind of formula you choose, Baker-Clark recommends sticking with the same brand or being deliberate as you try new ones, instead of just using whatever formula is on sale. While all infant formulas are regulated by the FDA and must pass the same nutrient tests, babies may react differently to various brands of formula. If an infant has frequent reflux, crying episodes or seems uncomfortable after a feeding, speak with your pediatrician. Your child may have an allergy or intolerance and may need a special formula.

Whether you warm the bottle up is up to you. “Many infants have no problem taking a cold bottle and the advantage is that you then don’t need to warm a bottle when you’re on the go,” Baker-Clark says. Once a formula bottle has been made and the nipple has touched baby’s lips, the bottle is good for an hour. But if the bottle isn’t used, a bottle may be refrigerated for a day, O’Day says. Some parents like to prepare and refrigerate a bottle in advance to make middle-of-the-night feedings easier, while others may prepare a pitcher to use during the day.

How to make a baby bottle with breast milk

Preparing a bottle of breast milk is of course much more straightforward, since the milk itself is ready to go. But when grabbing a bag of breast milk to use, it’s important to keep an eye on when it was pumped and how it’s been stored since. According to breast milk storage guidelines, it’s safe to use freshly pumped milk that’s been stored at room temperature for up to four hours, in the fridge for up to four days or in the freezer for up to 12 months. Always use the oldest milk first. If baby doesn’t finish a bottle, you can offer it again within two hours of the last feeding.

Before giving baby the bottle, you can warm the milk up by placing the bottle (or milk storage bag) in a cup of warm water for a few minutes, or pop the bottle into a bottle warmer. Whatever you do, steer clear of the microwave, which can cause dangerous hot spots.

Best Bottle-Feeding Positions

How you hold your little one during a feeding is a crucial part of knowing how to bottle-feed a baby properly. Chances are, you’ve come across loads of images of parents bottle-feeding babies—but the positions you sometimes see in photos or on TV may not actually be the best for baby. For one, forget about laying baby across your lap. “Have you ever easily drank something while you lay on your back?” O’Day asks. (Answer: no.) “It’s the same for baby.” Not only can a back position lead to reflux, but it may also cause ear infections. Try these bottle-feeding positions instead:

• Cradle baby in your arms. This is the classic position you probably think of when you imagine giving baby a bottle. In this bottle-feeding position, baby’s head rests in the crook of your arm as you hold her head and chest at a slight incline—close to your chest is great.

• Hold baby upright. Instead of lying down, baby should be almost in a seated position, with his head on your chest or in the crook of your arm. “This position can work especially well for infants who have reflux,” Baker-Clark says. Tilt the bottle so the milk completely fills the nipple, since a nipple filled only halfway with milk may lead to baby gulping some air, which can lead to gassiness or reflux.

• Use a pillow. A nursing pillow can be helpful in keeping baby’s chest and head propped up at an angle. Bonus: It can give your arms a break too as you cradle baby in your lap.

• Switch sides. Regardless of whether you’re breastfeeding or bottle-feeding exclusively, switching baby from one side to another can help prevent your little one from developing a side preference and can give your arms a break. Switching sides can also naturally pace a feeding session and can give baby a chance to decide whether or not he’s full before the bottle is finished.

As baby gets older, she may toy with holding the bottle. That’s fine, if she wants to, but it’s not a developmental milestone. “She may want to hold the bottle at 6 months, so you can let her, but you should still be close by, holding her and supervising her,” O’Day says. And if baby doesn’t show any interest in holding her bottle? As long as she’s reached other developmental milestones, like reaching or grasping for toys, it’s totally normal if your older infant wants his bottle served to him.

What is Pace Feeding?

You may have heard of “pace feeding” and wondered how to bottle-feed a baby using this method. “Paced bottle-feeding is where you follow baby’s cues and allow for breaks,” Baker-Clark says. “Taking the bottle away and re-offering it benefits both breastfed and exclusively bottle-fed babies.”

Pace feeding helps babies learn to regulate their hunger and allows ample time for digestion. It can also cue you into baby’s biorhythm, O’Day says. You may find baby doesn’t uniformly eat the same size bottle at each time of day. For example, maybe he’s extra hungry in the morning and drinks 8 ounces, but prefers 4-ounce bottles post-nap. Paying attention to baby’s cues can help you clue into her unique needs and natural schedule.

Plus, paced bottle-feeding makes a feeding session—which can last about 15 to 20 minutes—a great time for baby and his caregiver to bond. Here, some tips for how to pace feed:

• Hold the bottle at a horizontal angle. When the bottle is held horizontally, baby has to work to pull milk from the bottle, instead of the milk dripping into her mouth.

• Give baby some breaks. Instead of pulling the bottle away from baby’s mouth, lean the bottle back so the milk leaves the nipple. That way, baby has a chance to catch his breath. If he seems like he’s still rooting for milk, offer him more.

• Burp mid-feed. “If baby is pulling away, seems fussy or seems to be playing with the nipple with her mouth, give her a burp,” O’Day says. Then offer the bottle again.

How to Get Baby to Take a Bottle

Even if you’re planning to exclusively breastfeed, at some point you’ll likely need some pointers on how to get baby to take a bottle. “I tell my clients to introduce baby to a bottle once breastfeeding has been established, which depends on each mother-baby dyad, but on average, it’s around one month,” O’Day says. “Even if they’re not planning to regularly bottle-feed, doing so can give peace of mind if an emergency comes up, and can also be a way for mom to get a break.”

Some babies take a bottle no problem—after all, sucking is an instinctive reflex, which is why bottle-fed babies tend to get the hang of it in the first few days of life. But other breastfed babies may initially be reluctant to take a bottle. And sometimes breastfed babies have no issue taking a bottle when they’re one month old, but if a bottle hasn’t been regularly offered, by 3 or 4 months of age, they’re less happy to accept a bottle. Bottle resistance is pretty common, but luckily there are some tried-and-true tips for what to do when baby is refusing a bottle.

• Offer often. Even if you’re breastfeeding, O’Day recommends giving baby at least one bottle a week, once breastfeeding has been established. “That way it’s part of their routine, so they’re less likely to resist it,” she says.

• Don’t offer it when baby is starving. If you’re regularly nursing your infant, O’Day suggests offering a bottle in between nursing sessions. “If they’re too hungry, they may be too worked up to take a bottle. If they’re calm and not super hungry, they may take it,” she explains.

• Let others try bottle-feeding. Some moms have success leaving the house and allowing their partner to try feeding baby a bottle. Again, try it at a time that’s not baby’s “must-feed” time.

• Don’t get frustrated. If baby isn’t taking the bottle, O’Day suggests putting it down and trying again later rather than forcing it, which can make both you and baby upset.

• Ask for help. A lactation consultant can suggest some techniques to help get even the most resistant bottle-feeders to accept a bottle. They may check your infant’s mouth and tongue for any latch problems that could contribute to the difficulty, suggest the best bottle for your infant, troubleshoot any behavioral issues or offer alternate nutritive methods, such as cup- or syringe-feeding.

When to Wean Baby Off the Bottle

The American Academy of Pediatrics recommends parents stop offering bottles by 18 months due to tooth decay concern, but it’s smart to talk with your pediatrician about exactly when baby should wean from the bottle around the 9-month mark, O’Day says. “How and when to wean depends on how much table food baby is eating, any developmental concerns and your pediatrician’s assessment,” she says. Note, though, that cow’s milk shouldn’t be introduced until baby is 12 months old.

When baby is around 6 months old, offer a sippy cup or straw cup for water, O’Day says, since learning to drink from cups can help make the transition from bottles seamless. Some babies have no problem giving up the bottle, while others may require more time to make the transition, but looping in your pediatrician or lactation consultant can help make sure you’re all on the right track.

Whether you’re breastfeeding and offering the occasional bottle, combo-feeding or exclusively bottle-feeding, you might hit some bumps along your bottle-feeding journey. But there are ways to navigate through any problems that arise. If you’re struggling to find the best baby bottle for your child, need some pointers on how to bottle-feed a baby in an optimal position or encounter a full-on bottle strike, reach out to your pediatrician or lactation consultants for guidance.

Published August 2018

Please note: The Bump and the materials and information it contains are not intended to, and do not constitute, medical or other health advice or diagnosis and should not be used as such. You should always consult with a qualified physician or health professional about your specific circumstances.

Plus, more from The Bump:

14 Best Bottles for Every Feeding Need

Pumping 101: How to Pump Breast Milk

The Best Baby Formulas for Your Child’s Needs

Various breastfeeding positions

Try different breastfeeding positions to find the one that works best for you and your baby. You can see the options in our selection of photos

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There is no right or wrong way to hold the baby while
feeding, and mom and baby are sure to find their favorite position.
It is important that both you and your child feel comfortable. nine0011 1.2 It's good to learn a few different breastfeeding positions and techniques because life's circumstances often require us to be flexible, especially as your baby gets older and you start to leave the house more often.

Whatever position you choose to breastfeed your baby, remember a few simple rules.

  • Prepare everything you need before feeding, including drinks, food, mobile phone, TV remote control, book or magazine. And do not forget to go to the toilet - the feeding process can take a long time! nine0018
  • Make sure your baby is comfortable. Whichever position you choose, it's important to keep your baby strong, level, and provide good support for their head, neck, and spine.
  • You should also be comfortable. Don't stress. If necessary, use pillows of different sizes or rolls of towels to support your back or arms.
  • Make sure your baby is latching on correctly. Proper grip is the key to comfort when breastfeeding. nine0018
  • If your baby does not latch on well or you experience pain while feeding, contact a lactation consultant for help. The specialist will also be able to show you how to hold your baby more comfortably.

1. Relaxed feeding or reclining position

The relaxed feeding position, also known as biological feeding, 1 is often the first position for most mothers. If, immediately after birth, the baby is placed on the mother’s chest or stomach, normally, he instinctively reaches for the breast and tries to grab the nipple. This phenomenon is known as the breast seeking reflex. Skin-to-skin contact stimulates the infant's feeding instinct, and gravity helps him to latch onto the breast and maintain balance. nine0003

But it's not just newborns that can be fed in the reclining position - this position is great for babies of all ages. It can be especially helpful if your baby does not latch well in other positions or does not like to be touched during feeding, and also if you have too much milk flow or too large breasts. Isabelle, a mother from the UK, shares her experience: “I had large breasts, and the baby was born small - 2.7 kg, so it was not easy to find a comfortable position at first. After a few weeks, it became clear that there was no “correct” posture for me. As a result, I most often fed lying down, putting the baby on my chest. ” nine0003

It is more convenient to feed not lying flat on your back, but half-sitting, leaning on pillows. So you will have a back support and you will be able to watch the baby during feeding.

2. Cradle position

This is the classic
first thought of breastfeeding. Mom sits straight
, and the baby lies on her side on her arm, pressing his stomach against her stomach. 3 Although this is a very popular position, it is not always easy to master with newborns because it gives the baby less support. Try putting a pillow under your back, and put a special breastfeeding pillow on your knees and lean on it with your hands. So you can more reliably support the child, without overstraining your back and shoulders. Just make sure that the baby does not lie too high on the pillow for feeding. The breast should remain at a natural level so that the baby can grab it without effort, otherwise sore nipples cannot be avoided. nine0003

“I breastfed in the cradle position because it suited me perfectly! It was comfortable and I loved just sitting and looking at my little one,” recalls Rachel, a mother of two from Italy.

3. Cross Cradle

This breastfeeding position looks almost the same as Cradle, but the baby is on the other arm. 3 This gives your baby support around the neck and shoulders so he can tilt his head to latch on. This position is great for breastfeeding newborns and small babies, as well as for babies who do not latch well. Since the baby lies completely on the other hand, it becomes easier to control his position and you can adjust the chest with your free hand. nine0003

Julie, a UK mother of two, finds this position very practical: “I usually breastfeed my youngest in the cross cradle position. So I have a free second hand, and I can take care of an older baby at the same time. ”

Do not hold the baby's head at first, otherwise you may inadvertently press his chin against his chest. Because of this, the child will not be able to take the breast deeply, because the nipple will rest against the base of the tongue, and not against the palate, which will lead to inflammation of the nipples. As the child grows, this position becomes more comfortable, and he can rest his head on your palm (as shown in the photo above). nine0003

4. Underarm breastfeeding

In this position, also known as the “ball grip”, the mother sits with the baby lying along her arm at the side, legs towards the back of the chair (or any other seat). 3 Another comfortable position for newborn breastfeeding, you can give your baby good support, full control of his position and a good view of his face. And the baby feels safe in close contact with the mother's body. This position is especially good for those who have had a caesarean section or a premature birth, as well as mothers of twins and women with large breasts. nine0003

“When I breastfed my first daughter, I had very large K-sized breasts—twice the size of her head,” recalls Amy, an Australian mother of two. - I put rolls of towels under each breast, because they were very heavy, and fed my daughter in a pose from under the arm, but only sitting straighter so as not to crush her. This position was also convenient because I had a caesarean section and could not put the baby on my stomach.”

5. Side-lying position

The side-lying position is ideal for a relaxed
nighttime feeding in bed or on the couch. If you had a
caesarean section or ruptures during childbirth, this position may be more comfortable than sitting down. 3 In this position, mother and baby lie side by side, tummy to tummy.

“It was difficult for me to sit during endless night feedings, firstly because of the caesarean section, and secondly because of lack of sleep,” recalls Francesca, a mother from the UK. “And then I discovered that you can feed your baby lying on your side and rest at the same time.” nine0003

“Because of the short tongue frenulum, Maisie could only properly latch on to her breasts while lying on her side. The lactation consultant showed me how it's done. In this position, the flow of milk was optimal for my daughter, and it was easier for her to keep the nipple in her mouth. As she got older, she became much better at grabbing her breasts in normal positions,” says Sarah, mother of two from Australia.

6. Relaxed breastfeeding after caesarean section

If you can't find a comfortable position for breastfeeding after caesarean section, 3 try holding the baby on your shoulder in a reclining position – this does not stress the postoperative suture and allows you to breastfeed your baby comfortably. You can also try side feeding.

7. Sitting upright breastfeeding or “koala pose”

When breastfeeding in an upright position or “koala pose”, the baby sits with a straight back and a raised head on the mother's hip. 4 This position can be tried even with a newborn if it is well supported, but it is especially convenient for feeding a grown child who can already sit up by himself. The upright sitting position, or “koala pose,” is great for toddlers who suffer from reflux or ear infections and feel better sitting. In addition, this pose may be suitable for children with a shortened frenulum of the tongue or reduced muscle tone. nine0003

“When my daughter got a little older, I would often feed her in an upright position, which was more comfortable for both of us, and I could still hold her close,” recalls Peggy, a mother from Switzerland. “Besides, it was possible to discreetly breastfeed her in public places.”

8. Overhanging position

In this position, the baby lies on his back, and the mother bends over him
on all fours so that the nipple falls directly into his mouth. 4 Some moms say this breastfeeding position is good to use occasionally for mastitis, when touching the breasts is especially unpleasant. Some say that this breastfeeding position helps with blockage of the milk ducts, although there is no scientific evidence for this yet. You can also feed in the “overhanging” position while sitting, kneeling over the baby on a bed or sofa, as well as reclining on your stomach with support on your elbows. Pillows of various sizes that you can lean on will help you avoid back and shoulder strain. nine0003

“I have breastfed several times in the 'overhang' position for clogged milk ducts when no other means of dissolving the blockage worked. And this pose seems to have helped. I think it's because of gravity, and also because the breasts were at a completely different angle than with normal feeding, and my daughter sucked her differently, ”says Ellie, a mother of two from the UK.

Feeding in the "overhanging" position is unlikely to be practiced regularly, but in some cases this position may be useful. nine0003

“I used to breastfeed in the overhang position when my baby was having trouble latch-on,” says Lorna, mother of two in the UK. - This, of course, is not the most convenient way, but then I was ready for anything, if only he could capture the chest. We succeeded and have been breastfeeding for eight months now!”

9. Breastfeeding in a sling or in a sling

Breastfeeding in a sling takes some practice, but it can be used to go out, look after older children, or even do a little household chores. nine0003

The sling is also useful if the baby does not like to lie down or is often attached to the breast. Lindsey, a mother of two in the US, notes: “I used the carrier frequently for both of my children. When we were out, I tied the sarong around my neck and covered the carrier with it. Under such a cape, the baby can eat as much as he wants until he falls asleep.

This breastfeeding position is best when the baby is already good at breastfeeding and can hold his head up by himself. Any slings are suitable for breastfeeding, including elastic and rings, as well as carrying bags. Whatever option you choose, the main thing is that you can always see the face of the child, and his chin does not rest against his chest. nine0003

10. Double hand-held breastfeeding

Double hand-held breastfeeding (or “double-ball grab”) is great for mothers of twins—you can breastfeed both at the same time and keep your arms relatively free. 4 When feeding in this position, it is advisable to use a special pillow for breastfeeding twins, especially at first. It will provide extra support and help keep both babies in the correct position, as well as reduce the burden on the abdomen if you had a caesarean section. In addition, the hands are freer, and if necessary, you can deal with one child without interfering with the second. nine0003

“My twins were born very tiny and had to be fed every two hours at any time of the day or night. Very soon it became clear: if I want to do anything besides feeding, I need to feed them both at the same time, - says Emma, ​​mother of two children from the UK. “I breastfed them two by hand using a breastfeeding pillow.”

Other good positions for breastfeeding twins are two criss-cross cradles, one baby in the cradle and the other close at hand, reclining feeding, or sitting upright (one baby on one side, the other on the other). nine0003

11. Breastfeeding in the "hand-supported" or "dancer's hand" position

muscle tone (which is typical for premature babies, children suffering from various diseases or Down syndrome), try supporting his head and your chest at the same time. 4 Grasp your chest with your palm underneath so that your thumb is on one side and all the others are on the other. Move your hand slightly forward so that your thumb and forefinger form a "U" just in front of your chest. With the other three fingers, continue to support the chest. With your thumb and forefinger, hold the baby's head while feeding so that his chin rests on the part of the palm between them, your thumb gently holds the baby on one cheek, and your index finger on the other. So the baby gets excellent support, and you can control his position and see if he is holding his breast. nine0003

Literature

1 Colson SD et al. Optimal positions for the release of primitive neonatal reflexes stimulating breastfeeding. Early Hum Dev . 2008;84(7):441-449. - Colson S.D. et al., "Optimal Positions for Provoking Primitive Innate Reflexes to Induce Breastfeeding." Early Hume Dev. 2008;84(7):441-449.

2 UNICEF UK BFHI [ Internet ]. Off to the best start ; 2015 [ cited 2018 Feb ]. - UNICEF UK, Baby-Friendly Hospital Initiative, Start the Best You Can [Internet]. 2015 [cited February 2018].

3 Cadwell K. Latching - On and Suckling of the Healthy Term Neonate: Breastfeeding Assessment. J Midwifery & Women's Health. nine0133 2007;52(6):638-642. — Cadwell, K., "Latching and sucking in healthy newborns: evaluation of breastfeeding." F Midwifery Women Health. 2007;52(6):638-642.

4 Wambach K, Riordan J, editors. Breastfeeding and human lactation. Jones & Bartlett Learning ; 2014. 966 p . - Wambach K., Riordan J., "Breastfeeding and female lactation". Burlington, MA: Publishing House Jones & Bartlett Learning ; 2014. Pp. 966.

Breastfeeding with pierced, flat or inverted nipples

The shape and size of nipples can vary greatly from woman to woman. Our practical tips will help you make breastfeeding easier, no matter what your nipples are.

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Most women's nipples protrude, enlarge and swell when touched, but some have flat or even inward nipples. In addition, some women pierce one or both nipples. Usually flat, inverted or pierced nipples do not cause problems when breastfeeding, but in some cases additional help may be needed.

“Don't panic if you have flat or inverted nipples. As a rule, this does not interfere with breastfeeding in any way,” says Shawnad Hilton, a lactation consultant, health visitor and newborn care specialist who has worked with Medela in the UK for more than a decade. “Remember that your baby takes into his mouth not only the nipple, but also part of the breast. ” nine0003

However, in the early days, when the baby's mouth is still very small and suckling skills have not developed, inverted or flat nipples can make feeding difficult, especially if the baby is unwell or born prematurely.

“Flat or inverted nipples may not reach the baby's palate and therefore not trigger the sucking reflex,” Schoned explains. “That is, the baby may have trouble grasping and holding the breast in the mouth, and the baby will not get enough milk.” nine0003

How to tell if you have flat or inverted nipples

Flat nipples 1 do not protrude much from the areola (the darker
area surrounding the nipple) even when stimulated.

Inverted nipples seem to be recessed in the center. They may look like this all the time or only if they are stimulated. Sometimes inverted nipples are on the same level with the areola, and sometimes even sink deep into the breast tissue.

This feature may occur on one or both nipples. It is estimated that approximately 10% of nulliparous women have at least one retracted nipple. nine0011 2 If you're not sure what type of nipples you have, try a simple pinch test: Gently squeeze your breast with your thumb and forefinger on both sides of the areola. The nipple should come forward. If your nipple hides inside, creating a depression, then it is retracted.

Preparing inverted and flat nipples during pregnancy

You may have noticed that during pregnancy your breasts have changed and your nipples have become more protruding. If this does not happen and you are worried that the shape of your nipples will make breastfeeding difficult, try using nipple formers* in consultation with your doctor. These are soft and flexible silicone discs that are discreetly placed in the bra and slightly squeeze the nipples, helping to pull them out. nine0003

“In a normal pregnancy, nipple formers can be worn from 32 weeks,” advises Schoned. - Start wearing them for an hour a day, gradually increasing the time to eight hours. If you have an incompetent (weakened) cervix or are at risk of preterm labor, check with your healthcare provider about when you can start using shapers, as nipple stimulation can trigger contractions. ”

“Nipple formers can be worn after childbirth,” adds Schoned. “Try to put them in a bra 30 to 60 minutes before feeding.” nine0003

“I have inverted nipples, and after two or three weeks of constantly trying to latch on, I almost switched to formula,” recalls Nina, a mother from Germany. “I turned to La Leche Liga for help, and one nice woman came to me and supported me to continue to feed. She suggested trying nipple shapers and they really helped me. Somehow my baby began to understand what to do! Breastfeeding went well and I nursed him until he was 21 months old.” nine0003

How to help your baby latch on to flat or inverted nipples

If your baby enjoys sucking on your thumb but isn't as interested in your breasts, chances are your nipple isn't reaching the palate. The baby may become nervous, push off the breast and cry or even fall asleep on your chest. If this happens, ask a lactation consultant or healthcare professional to check the grip.

There are several tricks you can use before every feed to make your nipples more comfortable to latch on to. Schoned recommends the following:

  • twist the nipple between thumb and forefinger so that it protrudes better;
  • Place fingers in a "V" or "C" shape and squeeze the breast just behind the areola to push out the nipple;
  • apply a cold compress or ice cube to the nipple to push it forward;
  • Express milk manually or with a breast pump for a couple of minutes before feeding so that the nipple comes out more.

“I had a flat nipple, but I only found out when I noticed that Austin had trouble suckling on that side,” says Jennifer, mother of two in the UK. “From an anatomical point of view, there is nothing abnormal in this, it’s just that my nipple does not protrude so much, and this requires some skill when feeding. Before giving this breast, I always pinched and squeezed the nipple a little and tried to put it into the baby's mouth. It was a little difficult at first, but over time I learned.” nine0003

Using nursing pads

If none of the above work and your baby still has difficulty latch-on, your lactation consultant or healthcare professional may recommend that you breastfeed with a nursing pad*. They are thin and flexible nipple-shaped silicone funnels with holes at the tip through which milk will flow.

It is easier for the baby to put the feeding pad in his mouth, as it is larger and more rigid. In addition, such an overlay will reach him to the sky, causing a sucking reflex. Do not use nursing pads for a long time. If you experience pain or other problems, contact your lactation consultant or healthcare professional to check that your baby is latching on properly with a breastfeeding pad. You will also need to monitor your baby's weight gain to ensure that milk production is meeting his needs. nine0011 3

Over time, as your baby learns to suckle properly and your nipples get used to breastfeeding, you will be able to breastfeed without breast pads.

“My nipples are rather flat. The doctor advised me nursing pads, and I was successfully able to feed my two babies,” says Ann-Sophie, mother of two from Sweden. “My secret is to make them adhere better to the skin, I lightly wet the edges before use. ”

Breastfeeding with pierced nipples

Many women with pierced nipples find it does not affect their ability to breastfeed. However, jewelry must be removed before feeding, as the child may choke on them or injure their tongue, gums or palate.

“I had a nipple piercing, but I got it off a year later when I got pregnant because my breasts were very sensitive,” says Kelly, mother of three from the UK. “I breastfed my daughter exclusively, and then her two younger brothers, and never had any problems. And the pierced nipple was my favorite!” nine0003

Some women report that milk can leak from piercings, while others believe that piercing scars reduce milk production 4 - but this has not been well researched.

“You can't predict how a piercing will affect breastfeeding until milk production begins,” Schoned explains. - If you are concerned, talk to a lactation consultant or healthcare professional. And remember that one breast may be enough for babies to get the nutrition they need if there are problems with the second. ” nine0003

What to do if you can't breastfeed with flat or inverted nipples

If you've tried all the options and still can't breastfeed, you still shouldn't deprive your baby of breastmilk.

“Mom and baby's health is the most important thing,” says Schoned. “Maybe you should switch to full pumping and feed your baby only expressed milk. You can also try the supplementary feeding system** where the baby continues to feed at the breast while receiving additional expressed milk through a tube. That is, the baby will still suck on the breast and stimulate the production of milk, which, in turn, will help you pump even more. nine0003

“I have inverted nipples. After the disastrous experience of breastfeeding my first son with my second, I decided to get my way after all,” says Babettli, mother-of-two from Italy. - On the advice of experts, I tried nipple formers and nursing pads, but everything was unsuccessful. In the end, pumping with the Medela Symphony*** Double Electronic Clinical Breast Pump proved to be the best solution for us. I fed exclusively on expressed milk for up to four months.” nine0003

Care for different types of nipples

Flat or inverted nipples may require extra care as the baby may squeeze them harder and they may become inflamed at first. Tips on how to care for sore nipples can be found in Nursing Nipple Care.

If your nipples become inverted after a feed, any moisture can lead to inflammation and increase the risk of infections, including thrush. Blot your nipples dry after each feed before they have time to hide inside. nine0003

With swelling of the mammary glands, when even protruding nipples can become flat, flat or inverted nipples can be difficult. Read the helpful tips in the article on breast swelling.

The good news is that continuous breastfeeding or pumping can change the shape of your nipples and breastfeeding will become easier over time. With the arrival of the next child, you may not have to face this problem at all, as happened with Leanne, a mother of two from the UK. nine0003

“The second feeding was like a fairy tale,” she says. “After almost four months of pumping for my first son, my flat nipples were so extended that with my second son I no longer had to use breast pads - he was able to suck directly from the breast. The youngest is now nine months old and I still breastfeed him.”

Literature

1 Pluchinotta AM. The Outpatient Breast Clinic. Springer International Publishing ; 2015. - Pluchinotta A.M., "Treatment of breast diseases on an outpatient basis". Springer International Publishing. 2015.

2 Alexander JM, Campbell MJ. Prevalence of inverted and non-protractile nipples in antenatal women who intend to breast-feed. The Breast . 1997;6(2):72-78. — Alexander JM, Campbell MJ, "Prevalence of inverted and intractable nipples in pregnant women who intend to breastfeed." nine0133 Ze Brest (Chest). 1997;6(2):72-78.

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