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. Because of this, some babies find it hard to switch between bottle and breast and may start using a bottle feeding suck on your breast—leading to discomfort for you and frustration for your baby. Or sometimes a baby may begin to fuss at the breast in preference for the bottle. This article shares ideas that may help to reduce nipple confusion if you need to bottle feed your breastfed baby.
Use a short or medium length teat (artificial nipple), with a rounded tip and a medium-wide base. The aim is for your baby take most of the bottle teat in his mouth all the way to the screw cap. This will give him a wide open mouth on 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 breastfeeding. 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.
Artificial nipples with a very narrow teat and a very wide base may force your baby to make a tight mouth around the narrow length or shaft. Try to avoid this as it can alter your baby’s tongue position and function when they breastfeed.
Slower-flow bottle teats will be closer to the rate of milk flow during breastfeeding. It should take about 15 – 20 minutes for your baby to take a full bottle feed.
Encourage rooting and gaping
By stimulating the rooting reflex and waiting for a wide gape before you give a bottle, you can copy what happens during breastfeeding. To do this, brush your baby’s lips gently with the tip of the bottle nipple to stimulate the rooting reflex—he will open his mouth and search for the nipple. When he opens his mouth very wide in anticipation, you can slide the teat into his mouth and encourage him 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.
Delay the flow at first
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 back so the milk won’t flow properly for the first few sucks.
Sit your baby upright
Positioning your baby so that he isn’t flat on his back but is sitting in more of an upright position gives him more control to take a bottle feed at his own pace—and to take a break if he wants to, just as he can with breastfeeding. Lying flat on his back, a baby can’t control the milk flow from a bottle and he will keep swallowing to keep up with the milk flow until the bottle is finished. This is one of the reasons bottle feeding is linked with higher obesity as it can lead to a tendency to over feeding. See “Watch your baby” below for signs that the flow of milk is uncomfortably fast for him. Keeping your baby upright, and supporting his back, neck and the base of his head with your forearm and hand, will avoid this. You can tilt the bottle just enough to keep the artificial nipple filled with milk. As the bottle empties take care not to hyperextend your baby’s neck.
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. This can help to maintain their willingness to feed in all directions at the breast and may be beneficial for normal eye development.
Horizontal bottle, 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 suck a little harder without gravity helping to pour milk into the baby’s mouth. This helps copy breastfeeding. Tipping the bottle further away from baby (see video) at intervals, will give your baby little pauses in flow rather than a continual stream of milk from start to finish.
Watch your baby
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. These signs can be very subtle: for example frowning or looking wide-eyed, holding hands up with splayed fingers. Gulping, not pausing to take a breath, or becoming cyanosed (blue in colour) can also indicate milk may be flowing too quickly.
Helpful video showing how to bottle feed a breastfed baby:
The tips above may 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 (often called nipple confusion). If your baby is fussy at the breast you could try:
- Breast compressions to increase the flow
- Cutting back on bottle feeds for a while can get breastfeeding back on track if your baby is showing signs of breast refusal. 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 have more patience for slow flow.
There are lots of ways to try to make a bottle feed more like a breastfeed and reduce nipple confusion. Some babies will happily switch between the two without any problems but others can begin to suck differently at the breast. Cup feeding or beastfeeding with a supplemental nursing system can be alternative options to consider for supplementing a baby.