Are you going to exclusively breastfeed or bottle-feed expressed breast milk? Or would it be a combination of both?
If you are returning to work after maternity, it is probably critical that you and your baby are comfortable with both breastfeeding and bottle feeding.
Even if you are a stay at home mom, there will be times when you need to be away. The flexibility of having the baby being comfortable with the bottle gives you a peace of mind knowing that your little one will take the bottle when you are not there to nurse.
If you have been primarily breastfeeding, you will probably be wondering when can I give my baby a bottle of breastmilk? And how should I get started?
In this post, I’ll be sharing some tips on when and how to introduce bottle to breastfed baby.
When to Introduce Bottle to Breastfed Baby?
The ideal period to introduce a bottle to a baby who has been primarily breastfeeding is probably around 4 to 6 weeks of age. But honestly, there is no perfect time.
Generally, it is recommended by lactation specialists and pediatricians to only introduce the bottle when the baby is at least 3 to 4 weeks old and latching well.
When to start bottle feeding will also depend on the length of your maternity leave. You might want to start introducing a bottle of expressed milk to the feeding routine 1 or 2 weeks prior to your return to work.
Do not wait until the day itself or the night before!
Start early so that both you and your baby are picking up the new feeding skill in a gradual, unhurried and relaxed manner.
Introducing the bottle too early may contribute to a lower milk supply. There is also a higher chance for the breastfeeding baby to prefer the bottle and reject the breast.
However, if you introduce the first bottle too late (after 8 weeks), your little one may refuse the bottle as they have developed a strong preference for mom’s breast.
Both problems are also often known as nipple confusion.
To be exact, it is not that the baby is “confused” by the breast and artificial nipples. Milk tends to flow faster and more easily from the bottle compared to breast feeding. If the baby is too used to the bottle in the early weeks, they become lazy to have to suck for the breast milk or become frustrated with the slower flow when returning to the breast. Hence preferring the bottle over the breast.
Picking the Time of the Day to Introduce the Bottle
Ideally, your baby should be hungry, but not starving. A happy and relaxed baby could be more patient and acceptable to learning a new feeding skill than a fussy one.
It would also be helpful if you choose a feeding time that matches the time during which you will be away. Introducing the bottle during this timing can help the baby adapt to the change and gradually become part of the daily routine.
If you have a longer maternity leave, you can introduce the first bottle by 8 weeks. However, it is not necessarily to make this into a daily routine until 1-2 weeks before your return to work.
Preparing the Breast Milk Bottle for Feeding
To start bottle feeding, you will need to pump just before feeding, or have some expressed breast milk stored in advance.
While there are no dangers of feeding cold expressed milk, breastfed babies are used to feeding breast milk at body temperature. The expressed breastmilk should be warmed to make it more acceptable for the baby. Running the bottle nipple under warm water may also help.
The next thing to be mindful of is to prevent the formation of bubbles in the bottled milk.
When you store breast milk, you will realize that the milk will separate into layers. The layer sitting at the top is actually a layer of fats.
Do NOT shake the bottle to mix it up as that will cause bubbles to form in the milk. This can eventually result in gas and abdominal pain if the baby is unable to burp.
Instead, SWIRL the bottle to mix the milk and let the bottle sit for a couple of minutes before feeding.
Best Nipples for Breastfed Babies
When bottle-feeding a breastfed baby, you should use the slowest flow nipple so that the baby will need to suck and work harder to get the milk.
Breastfeeding is usually slow and babies have to make use of their muscles more actively to suck and get the milk out. If your baby is used to a fast flow nipple bottle, they would become lazy to work hard on nursing. That can lead them to prefer the bottle and reject the breast.
Most brand start with level 0 or a preemie nipple. However, different brands have different nipple size and flow rate. A Level 1 nipple from one brand can have a very different speed compared to a Level 1 nipple from another brand.
Most brands have their own recommendation as to what nipple size to use for different age. In general, the slowest nipple is for newborns and young infants and the faster flow rates for older babies.
Do remember that these guidelines are not set in stone. It is more important to watch and follow your baby’s lead.
As a rule of thumb, start with the nipple with the slowest flow rate (or the preemie nipple size if available). If your baby is taking too long for the feeding or seem frustrated with the flow rate, then move up 1 level.
If you find your baby squirming, pushing away the bottle or feeding less but getting hungry very quickly afterwards, these could be signs that the nipple flow rate is too slow.
Not all bottle and nipples are the same. Other than flow rate, nipples from different brands have different shapes, length, thickness and material. You may need to try a few bottle nipples to find the one that suits your baby’s preference.
Let Dad Introduce Bottle to Breastfeeding Baby
A breastfed baby may be more likely to accept the bottle if dad or a caregiver is the one in charge of introducing the first bottle… in the absence of mom in the same room.
If mom is present in the room, it is natural for the baby to be expecting and waiting for mom to nurse him. Hence refusing the bottle.
How to Introduce a Bottle to a Breastfeeding Baby?
Well, try as much as possible to mimic breastfeeding.
Instead of shoving the bottle nipple into the baby’s mouth, gently tickle the baby’s lips with the bottle nipple to encourage him to open his mouth and latch on.
Tip: You can also dip the bottle teat into the warmed breast milk so that it smells and taste like breast milk.
I’ll share more about a bottle-feeding technique known as pace feeding in my upcoming article.
Pace feeding gives the baby more control of how fast and how much they are feeding.
Cuddle the baby seated in a fairly upright position, supporting the back and neck. Hold the bottle in a horizontal position so the milk is just filling the tip of the nipple, but not necessarily the entire base of the nipple.
In this way, the baby will have to work actively to draw out the milk, at their own pace, instead of letting gravity do the work. As the bottle gradually empties out, you may need to tip the bottle so that there is milk at the nipple.
Be patient as it would typically take about 15-20 minutes to finish a bottle.
Do not bottle-feed the baby lying flat. Gravity causes the milk to flow at a faster rate which can increase the risk of choking or overfeeding.
There are natural pauses during breastfeeding. Hence it may be too tiring or unnatural for the baby to be feeding at the same rate throughout the entire bottle-feeding session.
After 20-30 seconds, or depending on the baby’s cues, you can tip the bottle down to stop the flow or take the bottle away. This helps down the feeding and gives the baby some breaks, mimicking the pattern between let-downs.
Similar to breastfeeding, you can also try to switch sides during the feeding.
How Much Breast Milk to Bottle feed?
It is very normal for nursing mom to not know how much milk their breastfed baby is getting each time.
Breastfeeding babies between 1 and 4 months old generally take in about 2 to 4 ounces of breast milk every 3 hours. Unlike formula-milk, the composition of breast milk changes according to the developmental stages of the baby. So, it is not necessary for breastfed babies to increase in their intake in line with their weight.
On average, exclusively breastfed babies take in 25 oz of milk per day. Dividing this by the number of nursing per day will give an rough estimate of the amount of expressed milk to give your baby at 1 feeding. Assuming the baby nurses about every 3 hours, that’s a total of 8 times a day. So you can begin putting 3 oz (25 oz/8 times) of breast milk in the bottle. A 4 oz bottle would suffice.
However, this is just a starting point.
Every baby is different and we should trust them that they will take what they need. Even when breastfeeding, baby may not be feeding the same amount each time.
It is also common for breastfeeding babies to take less milk from the bottle initially. Their appetite may return when become more accustomed to the caregiver and/or the new feeding technique.
Remember, do not force the baby to finish the entire bottle. Instead, pay attention to baby’s cues to look for signs of fullness to know if they need more or less milk.
The goal of pace feeding babies is to let them tell you that they have finished rather than you or the caregiver to dictate how much to drink.
Which Breastfeeding Bottles to Use?
Other than your baby’s preference of the bottle nipples, another consideration is whether the bottles are compatible with your breast pump.
Bottles that can be screwed directly to the pump flanges allow you to pump and feed with the same bottle. This helps to reduce the loss during the transfer and also save you some effort.
The Medela and Spectra breast pumps are 2 of the most popular breast pumps in the market.
Here are the lists of compatible bottles as well the adapters needed to connect the bottles to the respective pump flanges.
Medela Breast Pump Bottles Compatibility:
• Medela Bottles
• Lifefactory Bottles
• Evenflo Narrow Neck
• Dr Brown’s Narrow Neck
• Spectra Wide-Mouth Bottles (Maymom adaptor needed )
• Philips Avent Bottles (Maymom adaptor needed )
• Munchkin Latch Baby Bottles (Munchikin adaptor)
• Comotomo Baby Bottles (using this Papablic Adaptor)
• Tommee Tippee Closer to Nature (Tommee Tippee Adaptor)
Spectra Breast Pump Bottles Compatibility:
• Spectra Bottles
• Lifefactory Bottles (Maymom adaptor needed )
• Evenflo Narrow Neck (Maymom adaptor needed )
• Dr Brown’s Narrow Neck ((Maymom adaptor needed )
• Comotomo (Papablic Adaptor)
• Philips Avent Bottles
• MAM Bottles
• Kiinde (Adaptor needed)
• Medela Bottles (Maymom adaptor needed)
• Tommee Tippee (Adaptor needed)
TIP: When you miss a nursing session, do replace it with a pumping session to maintain your milk supply.
Give You and Your Breastfeeding Baby Time to Adjust
Be patient. Some babies are able to switch between the breast and the bottle with ease, while the transition can be tricky for some babies.
You may have to try a few different bottle nipples to find the right one for your little one. But most importantly, stick with it. You can to vary things a little and try again when the baby is more relaxed.
If you are still struggling to bottle feed your baby expressed milk, do speak to a lactation specialist.
Bottle feeding is a great way to support you and your baby your journey to enjoy the benefits of breast milk even as you return to work or studies. And I hope this post has helped you better understand how to introduce the first bottle to your breastfed baby!