Bottle feeding 101 for formula-fed and breastmilk-fed infants
BOTTLE FEEDING is... A time to bond? Time-consuming? Major source of calm? Major source of stress? Not an option? The hill you die on?
Every expectant and new parent has their own view of bottle feeding. But NO ONE should feel unprepared about how to feed their baby. Here are some things to know about bottle feeding your infant:
#1 Should I use breastmilk, formula, or both in a bottle? Fed is best. There are many ways that people feed their infants: with their own milk, donor milk, various types of formula, or a combination. The key is that this is an informed decision made with a professional, with you and your baby’s health and well being in mind. Whatever you choose, it should be safe, sustainable and fitting for your family. Uninformed opinions are irrelevant.
#2 When should I introduce a bottle if I’m breastfeeding? It is recommended to wait until the baby is 3-4 weeks old and until breastfeeding is going well. You can start with one bottle every other day until the baby can go easily between both bottle and breast.
#3 What type of bottle nipples are best? There are latex and silicone nipples. Silicone nipples are a bit sturdier. Latex nipple are more flexible. Some babies have allergies to latex.
For infants, slow-flow nipples (stage 1) are helpful for both formula-fed infants and infants fed with pumped breastmilk. Infants have the tendency to be overfed or overwhelmed with faster flow nipples (stage 2 or stage 3).
If you are bottle feeding and breastfeeding, you should use a slow-flow bottle nipple so that your baby has similar flow as the breast. The term “nipple confusion” is not evidence-based. It is actually a matter of flow preference. A baby has to work harder at the breast to get milk out. Baby sucks on breast, milk comes out. With a traditional plastic bottle (not slow flow), milk drips out regardless of whether the baby sucks or not. When a baby is fed with a bottle that is higher than their head, they can’t stop the flow of milk even if they wanted to. When the baby goes back to the breast, they will be frustrated by the work they have to do and the slower flow from the breast.
I recommend the Lansinoh NaturalWave® Nipple good for babies who are also breastfeeding. It has more textured nipples and has more sturdiness to the nipple than traditional bottle nipples.
#4 What types of bottles should my baby use? There are so many bottles out there. Ask your doula, IBCLC, pediatrician or local parenting groups. Here are some of my recommendations:
The Lansinoh Momma bottle for babies who are also breastfed.
Dr. Brown’s Natural Flow® Options+™ Anti-colic Baby Bottles Newborn Feeding Set, which gives you the option of slowing the flow.
Bare-Air feeding system and bottles for babies with gastroesophageal reflux/GER. In a clinical 2-week trial using these bottles, 75% of the babies with GER no longer met criteria for GER! This is a mom-owned company. Check out how it works with these videos of babies using the bottle.
There are Playtex Liners for Nurser Bottles to reduce gas and discomfort for baby.
There are also specialized bottles for babies with cleft lips, including the Haverman feeder bottle and Dr. Browns speciality bottles.
#5 What is paced bottle feeding? Why is paced bottle feeding important for all babies? Paced Bottle Feeding allows the infant to be more in control of the feeding pace. Babies who consistently pace feed are more likely to pace themselves over time regardless of whether they’re breastfed or bottle fed. In fact, HOW you offer a bottle can be more important than WHAT is inside. Check out the advice from veteran doula and infant feeding specialist, Angela Horn, in this Today’s Parent article. Did you know...
Paced bottle feeding can help you bond with your baby. You can sing, talk, hum, make eye contact or smile while feeding your baby.
Paced bottle feeding reduces the chances that they’ll prefer the bottle over breastfeeding or develop a faster “flow preference.”
Paced bottle feeding will help avoid overfeeding by mimicking the breastfeeding experience.
Doulas can show you in real time how to use this approach.
Check out a video of paced bottle feeding here.
#6 How much formula should my baby eat? How often should they eat? Some days babies will want to eat a little more, and some days they'll want to eat a little less (just like us)! That being said, in general, a baby should get 2.5 oz of formula for every pound they weigh within a 24-hour period. Here is additional guidance:
Preemies 24-26 wks: 2 cc every 6-8 hrs
Preemies 26-28 wks: 2 cc every 4-6 hrs
Preemies 28-32 wks: 2 cc every 4 hrs
0-3 months: up to 2-3 oz every 3-4 hours
4-6 months: 5-7 oz per feed, 4-5 feedings/day
6-9 months: 6-8 oz per feed, 4-5 feedings/day
9-12 months: 6-8 oz per feed, 4-5 feedings/day in addition to solid foods
#7 Am I overfeeding my infant? Many people worry about their baby getting enough to eat. Most babies will stop eating when they are full but caregivers may unintentionally encourage a baby to finish a bottle, which will lead to overfeeding.
Signs of being satisfied after a bottle feed include:
spitting out the nipple
turning away from the bottle when offered again
Signs of being overfed include:
Stomach discomfort after feeds
Fussiness
Increase in gas after feeds
Loose stools
Increase in spit ups after feeds
#8 What type of formula should I use? There are three different bases for formula: cow-milk-based, soy-based, and protein hydrolysate based. The latter two are used for babies with food sensitivities such as a milk protein intolerance. There are three formats for formula: ready to feed, powdered, and concentrate. Super specialized formulas like Neocate and several European brands are concentrate. If you have concerns or questions about which formula to use, consult your pediatrician or an IBCLC.
#9 Can a baby finish a bottle later if they don’t finish the whole thing? A bottle of human milk can stay out for about 2 hours and formula can stay unrefrigerated for about 1 hour before being thrown out.
#10 What’s the best way to clean bottles? You can sanitize bottles before the first by putting all of the parts in either a pot of boiling water, the dishwasher on the “sanitize” setting, or using a UV sanitizer. You do not have to sanitize after every use, soap and water should be fine. That being said, it’s up to the parents. Parents can sanitize if their baby has been sick.
For more help navigating the seismic shift into parenthood, reach out to the Boston Area Doulas team.
www.bostonareadoulas.com
