How To Introduce A Bottle To A Breastfed Baby

You might want your breastfed baby to feed from a bottle for a lot of reasons. Maybe you’re returning to work during your baby’s first year. Or it might be helpful if he would accept a bottle-feed from another caregiver so that you could have an occasional sleep-in. Perhaps you need to your baby to be partially fed formula. Regardless of the reason, having a plan to introduce bottles to your breastfed baby will set you on the best path for success.

While both breastfeeding and bottle-feeding provide for a baby’s nutritional needs, the physical actions required to successfully breastfeed are very different to those required to bottle-feed. Your baby is born knowing how to breastfeed; however, he will need to learn the skills to bottle-feed.

Timing is everything when it comes to getting a breastfed baby to feed from a bottle. You have a narrow window of opportunity where it can be relatively easy. If you have missed the window, don’t despair, it’s still possible to get a baby to accept bottle-feeds, but it just won’t be as easy. 

Why do parents want their baby to bottle-feed?

A mother may want her baby to accept breastmilk or infant formula from a bottle for any number of reasons, including:

• anxiety caused by not knowing how much milk baby receives;
• concern about low milk supply;
• painful cracked nipples or repeated bouts of mastitis;
• returning to work;
• maternal exhaustion;
• breastfeeding strike or aversion;
• breastfeeding-sleep association;
• misdiagnosis of a milk allergy or intolerance;
• to share feeding responsibilities with others;
• worry that baby is reacting to foods eaten by mom;
• medical reasons (for baby or mother).

Pros and cons of offering bottle-feeds

If you are planning to be a stay-at-home mom to care for your baby for the first 12 months or longer, you may not foresee a reason for other caregivers to feed him. Unfortunately, unexpected events pop up at the worst of times.

You’ve probably been warned of the potential risks associated with providing bottle-feeds to your breastfed baby. But have you ever been warned of potential drawbacks linked to not familiarizing a baby with bottle-feeds in the early weeks?

Risks associated with giving bottles

Giving bottles to a breastfed baby is linked to an increased risk of problems such as:

• nipple confusion, because bottle-feeding requires a very different sucking action compared to breastfeeding;
• bottle-feeding preference, which develops when babies prefer the instant and consistent flow rate of bottle-feeding;
• loss of confidence, which is when baby is given infant formula ‘top-ups’ due to concerns that the mother has a low milk supply, or in the hope of increasing his rate of growth - this places mom on a slippery slope that leads to an early end to breastfeeding.

Risks associated with avoiding bottles

As odd as it might sound, avoiding giving your baby a bottle is also associated with a risk to breastfeeding. Imagine if your baby needed to bottle-feed on a regular basis – say you got sick or needed to get back to work – and he didn’t know how to! There are several risks associated with avoiding teaching baby how to bottle-feed, including:

• Reverse nipple confusion, meaning a baby accepts the nipple of a bottle into his mouth and attempts to suck, but uses a breastfeeding technique which does not work on a bottle. So, he receives no milk and becomes frustrated.
• Baby may end up preferring to breastfeed, which is fine except where it might be necessary for him to bottle-feed, but he is then at risk of consistently refusing because he wants to breastfeed instead.

When do I try to introduce a bottle?

If your baby accepts bottle-feeds in the early weeks you might then think that he’ll accept a bottle whenever it’s offered, even weeks or months down the track. This will not necessarily be the case.

An active sucking reflex will enable your baby to feed from both breast and bottle in the early weeks following birth. However, only with repetition does he learn to breastfeed and/or bottle-feed. Once his sucking reflex has disappeared, whether he ‘knows how’ to breastfeed and/or bottle-feed depends on prior learning. While a baby can learn to bottle-feed after his sucking reflex has disappeared, it’s not as easy.

If you want to encourage a breastfed baby to not only accept a bottle, but easily learn to feed from a bottle with minimum risk to successful breastfeeding, it’s all about the timing. Too soon, can make it harder for a baby to learn to breastfeed. Too late, can result in bottle refusal.

Starting birth to 4 weeks

Sucking is an automatic, involuntary action that occurs in response to a baby’s sucking reflex being triggered. Trigger baby’s sucking reflex and he will suck from a bottle. This is why babies can feed from a bottle in the first few days of life.

Unless there are no other options, it’s not a good idea to give a breastfed baby bottle-feeds during the first month. This is the time when he’s learning to latch and breastfeed. Providing bottles, which require a different latch and sucking action compared to breastfeeding, at this young age is associated with an increased risk of ‘nipple confusion’. 

Starting between 4–8 weeks

If breastfeeding is going well, between 4 and 8 weeks is an ideal age to familiarize your baby with bottle-feeding, so that he will be comfortable with both feeding methods. He has had weeks to become accustomed to breastfeeding. His sucking reflex is still strong enough to support him to learn to suck from a bottle.

It’s not enough to offer him a few bottle-feeds and then not offer again for days or weeks. Offer him a bottle-feed once a day or every second day. It doesn’t need to be a full feed; even one ounce (30 ml) of pumped breastmilk will be sufficient to help him learn how to bottle-feed with minimal risk to breastfeeding. Avoid offering a bottle too frequently, as this could impact breastfeeding.

Starting between 8–12 weeks

If you are only now starting to provide a bottle for the first time, it’s going to be more challenging. By this age your baby has now learned to psychologically link breastfeeding with satisfying his hunger. If you place the nipple of a bottle into his mouth, he’s likely to object or consider it a toy to chew on.

His sucking reflex, though present, is not as strong as it was. You might find you can trigger his sucking reflex by applying gentle upwards pressure under his chin while the nipple is in his mouth. It’s very important that you don’t continue if he becomes upset or wants to stop. 

Starting after 3 months

If your baby has not been offered regular bottle-feeds before three months of age, unfortunately, he will be less likely to accept a bottle and may refuse outright. By this age his sucking reflex has either disappeared or is close to disappearing; upwards pressure under his chin will no longer be effective.

With no, or limited, prior bottle-feeding experience, it’s going to be much harder for him to learn to feed from a bottle. A synthetic nipple will feel nothing like his mother’s nipple. He will have no idea why you’re placing it into his mouth, or what he’s supposed to do with it. If he’s not hungry, he’s likely to chew and play with it or push it out. If he is hungry at the time, he will be expecting to receive a breastfeed and he will become frustrated, cry, or spit it out.

Breastfeeding is not just his preferred method of feeding, it’s all he knows. If he tries to use a breastfeeding technique while bottle-feeding, he’s not going to get anything other than what drips into his mouth.

But don’t lose hope. A healthy baby can learn how to bottle-feed, but it’s not going to be easy. Expect resistance to bottle-feeding. With no sucking reflex, learning how to suck from a bottle will involve trial and error.

How can I teach my baby to bottle-feed?

If your baby rejects a bottle-feed, firstly try gentle persuasion techniques. Tactics will be more effective if your baby is under the age of 12 weeks, but this is worthwhile trying for older babies. Basically, gentle persuasion methods involve trying a multitude of different scenarios to see if your baby may be more receptive to sucking from a bottle under certain circumstances.

Consider:

• Level of hunger. Try when hungry, when not hungry, before a breastfeed, after a breastfeed, between breastfeeds.
• Level of consciousness. Try offering a bottle as your baby drifts off to sleep, is stirring from sleep, or while already asleep. NOTE: Only until he gets used to sucking from a bottle, which may be your goal at this time. If you repeatedly feed him while drowsy, this will encourage a feeding-sleep association, which can cause feeding and sleeping problems down the track.
• Nipple shapes. Try different shaped nipples. I recommend your try a latex (which are brown and soft compared silicone nipples) orthodontic shaped nipple.
• Flow rates. Experiment with different flow rates.
• Feeding positions. Try different feeding positions to the one used when breastfeeding.
• Locations. Try bottle-feeding your baby in places he does not normally associate with feeding, such as a baby rocker or stroller.
• Distractions. For instance, offer your baby the bottle as you walk around with him in your arms, rocking and singing to him, or when dangling a toy within his arm’s reach. NOTE: This too is a temporary measure. Don’t do it over the long term as it’s exhausting and not necessary. Also avoid this if your baby has developed a bottle-feeding aversion.
• Other caregivers. Your baby may associate you with breastfeeding. Let others try bottle-feeding. Ask your partner, mother, or mother-in-law to try to feed your baby using a bottle.
• Fresh milk. Offer freshly pumped milk.
• Drip feed. Drip some milk into your baby’s mouth, before placing the nipple into his mouth. NOTE: Not recommended if baby has a bottle-feeding aversion.
• Encourage sucking. Encourage your baby to latch and suck on your nipple, finger or a pacifier and then quickly replace this with the nipple of a bottle. NOTE: Not recommended if baby is averse to bottle-feeding.
• Stop if your baby becomes upset. Try again once he is calm or at another time.
• Don’t pressure or force. If your baby isn’t drinking from the bottle, it’s because he does not know how, trying to pressure or force him will only upset everyone involved.
• Encourage new sleep habits. He may reject bottles if he has developed a breast-feeding sleep association. Before you can leave him in the care of others, you may need to be sure that he can easily be settled to sleep in your absence.

It could take weeks of repeated exposure before he accepts the nipple into his mouth and sucks from a bottle using gentle persuasive strategies. Unfortunately, these measures won’t work for every baby. Some babies will continue to resist, fuss or cry until they finally receive a breastfeed. Remain patient; your baby is not being deliberately difficult. Consistency, practice and planning are the keys to your success.  

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By Rowena Bennett, RN, RM, CHN, MHN, IBCLC.

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