A bottle teat is not the same as a breast despite claims by the manufacturers. Breastfeeding uses a different tongue and jaw action to that needed to get milk from a bottle, and skin is not the same as silicone. Some babies find it hard to switch between bottle and breast and may start using a bottle feeding suck on the breast—leading to discomfort for you and frustration for your baby (nipple confusion). Or sometimes a baby may begin to fuss at the breast in preference for the faster milk flow of the bottle. This article shares ideas that may help to reduce bottle preference or nipple confusion if you need to bottle feed your healthy breastfed baby.
#1 Recreate a deep latch
Choose a short or medium length teat (artificial nipple), with a rounded tip (not flattened on one side) and a medium-wide base. The aim is for your baby to take most of the bottle teat in his mouth all the way to the screw cap. This will give him a wide open mouth around the base of the artificial nipple and the tip of the bottle teat will be deep in his mouth, close to the junction of his hard and soft palate. This recreates the deep latch wide-mouthed jaw position that is desirable when your baby breastfeeds. The photographs below from Latching Tips show the kind of wide open mouth you can try and recreate on the base of a bottle teat.
Avoid a tight mouth
Artificial nipples with a very narrow teat and a wide base may force your baby to make a tight mouth around the narrow length of the nipple. Try to avoid this as it could change your baby’s latch when they breastfeed. Try to choose a teat that has a gradual slope from tip to base so baby’s mouth is propped open rather than looking as if they are sucking on a straw.
Trial and error
Be aware that the branding on bottles is not very reliable. Claims that one is closer to breastfeeding than another can usually be disregarded. Look for a nipple that suits your baby, you may need to try a few to see which works best. See Best Bottle for a Breastfed Baby? for more information about shapes and characteristics of teats that can support or undermine breastfeeding.
#2 Encourage rooting and gaping
Encouraging the rooting reflex and waiting for a wide gape before your baby takes the bottle teat in his mouth replicates how a baby latches deeply at the breast. Brushing your baby’s lips gently with the tip of the bottle nipple will trigger his reflex to open his mouth to search for the nipple. When he opens his mouth at its widest point, offer the teat and encourage your baby to take the entire artificial nipple into his mouth right up to the cap. If the bottle nipple is too long for your baby’s mouth, this could make him gag, so be guided by your baby and choose a shorter teat if needed.
#3 Switch sides
Breastfeeding usually involves switching breasts either part way through a feed or at the next feed. To replicate this you could hold your baby in the opposite arm to have the second half of their bottle or turn him on to his other side if he is side-lying (see below). This can help to maintain a baby’s willingness to feed in all directions at the breast and may be beneficial for normal eye development.
#4 Mimic the first let down
At the breast your baby usually has to wait a minute or two for the let-down to receive plentiful flowing milk. You can mimic this delay by tipping the bottle down towards the floor so the milk doesn’t fill the teat for the first few sucks.
#5 Paced feeding—controlling fast flow
Bottle teats can often provide milk faster than a breast which some babies may like, and can lead to babies preferring the bottle over the breast. If the flow is very fast however, it can also be stressful for your baby to try and keep up. Ideas to help avoid either bottle preference or distress include; holding your baby in a way that gives him more control of the feed, choosing a slower-flow teat, pacing the feed, and watching your baby closely for signs of stress.
Not flat on his back
A baby can’t control the milk flow from a bottle if he is lying flat on his back—he will have to keep swallowing to keep up with the milk flow until the bottle is finished. This could be one of the reasons bottle feeding is linked with over feeding and obesity 1. Holding your baby so that he is either supported at a 45 degree angle or in more of an upright position can help him to control the flow. Encourage him to pause, take a break or decide that he is full if he wants to—just as he can when he is breastfeeding. A side-lying position can work well for a younger baby (see video). The carer can tilt the bottle just enough to keep the artificial nipple filled with milk. As the bottle empties, take care not to hyperextend the baby’s neck and check for signs that the flow of milk is uncomfortably fast for him (see below).
Bottle feeding a baby in a side-lying position
Slow-flow bottle teats will usually be closer to the rate of milk flow during breastfeeding. Avoid a teat that delivers milk so fast that it causes your baby to be overwhelmed causing him to gulp, choke or spill lots of milk. Be aware that the branding on bottle nipples means very little. A teat may be marked as slow flow but be very fast. And a teat branded as fast flow may be quite slow. The rate that milk drips from the teat when the bottle is held vertical is also not a reliable guide to the rate of flow when baby sucks.
Pace the feed, allow pauses
Holding the bottle horizontally (parallel to the floor) removes the pressure from gravity. Your baby will have better control of the amount taken at each mouthful and will have to suck more actively without gravity helping to pour milk into the baby’s mouth. Tipping the bottle downwards occasionally can give your baby pauses in flow when he needs them, rather than a continual stream of milk from start to finish (see video clip below). Pacing a feed can help your baby recognise when he is becoming full and prevents overfeeding.
Watch your baby
- Not too fast. Closely observe your baby during feeding. If your baby is showing signs of distress for example if the milk flow is too fast, then slow or pause the feed. Signs of stress can be very subtle: for example frowning, looking wide-eyed or holding hands up with splayed fingers. Also, gulping, not pausing to take a breath, or becoming cyanosed (blue in colour) can also indicate milk may be flowing too quickly.
- Not too slow. There is no need to slow the flow down unnecessarily so that your baby is frustrated, the pace can be “baby-led”. In particular, slowing the flow unduly is not appropriate for underweight babies with growth faltering who may need encouragement to feed in the easiest way possible rather than pacing.
Video clip showing how to pace a bottle feed:
My baby has nipple confusion
The tips above can help to reduce or avoid breastfeeding problems but sometimes you may still notice changes to your baby’s latch when you breastfeed. Or you may find that your baby starts fussing at the breast and seems to prefer a bottle (nipple confusion). If your baby is fussy at the breast you could try:
- Breast compressions to increase the flow of breast milk
- Cutting back on bottle feeds for a while can get breastfeeding back on track and see the ideas in How to Get Baby Back to the Breast
- If you are using a bottle to top up your baby due to low weight gain, and they are starting to fuss at the breast The “Finish at the Breast” Method of Supplementation described by Diana West and Lisa Marasco may be useful. This involves returning your baby to the breast to finish off their feed after having their top up. They then associate the breast with feeling full and may have more patience for a slower flow. Once your baby is gaining well and is stronger he may be able to take his supplement with a supplemental nursing system at the breast.
Bottle feeding could undermine breastfeeding if using a bottle changes the way a baby breastfeeds or if a baby begins to prefer a bottle due to a faster flow of milk. There are lots of ways to try to make a bottle feed more like a breastfeed and reduce nipple confusion or bottle preference. Some babies will happily switch between breast and bottle without any problems but others can begin to suck differently at the breast. Cup feeding or breastfeeding with a supplemental nursing system can be alternative options to consider for supplementing a baby.