Bottle Feeding the Breastfed Baby FAQs

Did you know that lactation consultants not only help with breastfeeding, but can also help with bottle feeding?  It’s true! We are here to offer guidance with all aspects of feeding (introducing solids, as well!) and know a ton about bottles and how to balance them with breastfeeding.

Questions about bottle feeding come up in many of our private consults, as well as in our private Facebook Group (for those who purchased our online course: Breastfeeding for the Working Family.)  So, we figured we would write a blog article answering some of the most frequently asked questions. So, here you go…..

When is the best time to introduce a bottle?

Ideally, the best time to introduce a bottle is after your baby has mastered the art of breastfeeding.  There is a window of opportunity when your baby is between 3-6 weeks old where he/she still has an innate sucking reflex and is more willing to try a bottle.  Once babies reach 10-12 weeks, that innate sucking reflex goes away (or is integrated) which can make introducing a bottle more difficult at this time.  

Sometimes bottles are introduced earlier than 3 weeks, due to baby not breastfeeding well or baby not gaining weight well.  This DOES NOT mean your breastfeeding journey has been sabotaged! It might make breastfeeding a bit more challenging, as bottles are much easier to feed from than the breast, but you probably introduced the bottle earlier than 3 weeks BECAUSE you were having breastfeeding challenges, right?  So, definitely meet with an IBCLC to remedy those breastfeeding challenges, but please know that not all breastfeeding-hope is lost just because you offered a bottle to your infant before 3 weeks.

How should I choose a bottle and bottle nipple?

Many bottles out there say that they are ‘similar to the breast.’  Don’t be fooled by their marketing. Truthfully, there are no bottle that are similar to the breast.  If you haven’t noticed, our human nipples are all different shapes and sizes and no bottle nipple is stretchy like a woman’s areola and expands like a woman’s nipple when breastfeeding.  So start with choosing a bottle that helps your baby achieve a wide latch and choose the slow flow nipple of that brand.

Are all slow-flow nipples the same?

Nope!  Each bottle brand has its own slow flow nipple, but some ‘slow flow’ nipples flow really slow and some flow really fast.  You will want to see how your baby reacts to the flow to determine if it is the right flow for your baby. PS. Those bottle nipples given out in the NICU or postpartum floor ARE NOT slow flowing, even though they say they are.  They flow really fast, which is why your 3 day old is able to suck down 2oz in 5 minutes, which is way too much and way too fast.

How will I know if the bottle flow is too fast or too slow for my baby?

If the bottle flow is too fast for your baby, he/she will look panicked!  Eye bugging out. Hands splayed. He/she might choke or spill milk out of the sides of her/his mouth. He/she might be really gassy after finishing the bottle.  If this happens, you will definitely want to either try a slower flow nipple for that bottle brand or try a completely different bottle brand.

If the bottle nipple is too slow, your baby might get really frustrated when bottle feeding and it might take over 30 minutes to finish the bottle….way too long!

Bottle feeding should take about 15-20 minutes for the first few weeks to months.  Once breastfeeding is established and going well, then bottle feeding might speed up to faster than 15 minutes.

What is paced bottle feeding and why it is important?

Paced bottle feeding, or baby-led bottle feeding, is a feeding method that allows your baby to be in charge of his/her feeding.  This means, when your baby sucks, he/she gets food. When he/she pauses, no food is released from the bottle. Your baby is seated in an upright position and the bottle is held horizontally.  This is super important in those first few weeks of bottle feeding because we want the pace of the bottle to mimic the pace of milk at the breast. We don’t want bottle feeding to be so much easier than breastfeeding that your baby starts to prefer the bottle over your breast.  Also, baby-led bottle feeding also keeps your baby from overeating. This is important for all caregivers to know, which is why we created a YouTube video all about Paced (Baby-Led) Bottle feeding. Share with everyone who bottle feeds your baby!

If I am breastfeeding, am I able to offer a bottle, as well?

Yes!  If you have a partner or spouse who can offer the bottle while you pump, take advantage of this!  It’s just one less thing you have to do! But if you are in charge of all of your baby’s feeding sessions, then feel free to offer a bottle in place of a breastfeeding session to help him/her practice bottle feeding.

When do I need to change the bottle nipple to the next size up?

Probably never!  Really! Sure, you might want to replace the bottle nipple with a fresh, new one every few months, but as long as your baby is happy with the flow and taking the bottle in a normal amount of time (remember…. Somewhere between 10-20 minutes, depending on his/her age), then there is no reason to go up a level.  You could stick with the 0-3 month bottle nipple the entire first year. Essentially, if your baby is happy with the flow, stick with it!

How much milk should I put in each bottle?

One way to figure this out is to go to a breastfeeding support group and weigh your baby before and after a breastfeeding session.  That’s a great amount to leave in the bottle. Otherwise, most babies in the first 3-6 weeks take about 2-3oz per bottle. Babies above 10lbs need about an ounce an hour, in general.  This increases slightly as your baby continues to gain weight. Babies above 13lbs need about 30-32oz per 24 hours, so divide that by the number of feedings per day and there is your answer for how much your baby needs per bottle.

If I am returning to work, how often should I practice the bottle with my baby?

Ideally, you would introduce the bottle by the time your baby is 6 weeks old.  Then, offer the bottle a few times a week, just to keep practicing, so that when you return to work your baby is familiar with this additional way of getting food.  

What if my baby won’t take a bottle?

First, check out our article: Help!  My Baby Won’t Take a Bottle. Give these tricks about 1 week ONLY!  If your baby rejects the bottle for a full week, then is it time to meet with an IBCLC to figure out why your sweet babe is refusing the bottle.  Bottle refusal can happen for many reasons: baby doesn’t like a particular bottle, baby has a high palate, baby has a tongue tie, etc. Stop struggling and let us help you figure this out!

So what additional questions do you have about bottle feeding?  Share them here and we will add them to this article!

I’ve Had My Baby - Now What? Breastfeeding During Weeks 3-6

Welcome back to our new series, I’ve Had My Baby - Now What?  This is a guide with basic information to help you navigate the first days, weeks, and months of breastfeeding your new baby.  

Today we’d like to talk about weeks 3 through 6 of your baby’s life, and what breastfeeding looks like.  What can you expect for normal behavior from your new baby, and when do you know there’s a problem that you should seek professional help for?

What does normal breastfeeding look like in weeks 3-6?  How often should my baby be eating, and how long should feedings take?

It’s extremely common for babies at this age to still want to feed frequently, every 2-3 hours.  Some *may* become more efficient and take in more at feedings and start to space them out a bit more, but don’t fear if your baby hasn’t done this yet!  Feedings may start to speed up as mom’s milk volume is higher and baby has had good practice breastfeeding, but again, don’t worry if your baby still feeds at the breast for as long as he/she did in the early weeks.  It can take some time for mom and baby to really get their groove and you may still be working out some kinks during weeks 3 through 6.

How much weight should my baby be gaining at this age?  How will I know if he/she is getting enough when I’m not seeing my pediatrician as frequently for weight checks?

Up to 4 months of age, we expect babies to gain .5-1 oz/day, or 4-7 ounces a week.  There are many ways other than weight to be sure that your baby is getting enough milk.  If your baby is having plenty of wet and soiled diapers each day, and generally seems content after feedings for two hours or more (outside of growth spurts and cluster feeding periods), you can feel good that he/she is probably getting enough.  If you want a little more concrete evidence, a great way to track your baby’s weight is by attending a free weekly breastfeeding support group.  There will often be a scale there to weigh your baby, you can do test weights to see how much baby is taking during that feeding, get help from a lactation consultant or educator, and, the BEST part, meet and connect with other moms.

Can I give my baby a bottle now?  If so, who should give it and how often should they do so?

 Once breastfeeding has been established, weeks 3-5 are the perfect time to introduce a bottle to your baby if you’d like them to take one.  It’s normally best that someone other than mom gives the baby the bottle, as babies often associate mom with breastfeeding and may refuse a bottle from her.  Plus, often times, partners and grandparents have been waiting for their moment to participate in the feeding of the baby.  We recommend that mom start pumping after week 3, once a day or so, to start to save up milk for that first bottle.  2-3oz is an appropriate amount to start with.  Be sure that the bottle is fed to the baby in a breastfeeding friendly manner.  If mom is going back to work, we recommend that baby receives a bottle on a somewhat regular basis, a few times a week, so that he/she remains familiar with it.  Plus, mom should pump every time baby receives a bottle to maintain her milk supply.

My baby is inconsolable for a few hours in the evenings.  Why is this happening and what can I do?

Many babies have a “witching hour”, or as I like to call it, “an unhappy hour”.  The term is a bit misleading as the behavior normally lasts for more than an hour!  It occurs most frequently in the late afternoon/evening hours.  Babies are often fussier than normal during this time, and want to eat often.  And while they want to feed often, they may pull off more frequently as well.  There are a number of theories as to what causes this fussiness at this time.  They may be feeding often to “tank up” on calories before taking a long sleep (sounds wonderful!).  They may be overstimulated from their day and having a hard time winding themselves down.  This is often a busy time for the entire household, as partners are home from work and older siblings may be home from school.  Best thing that you can do during this time is to offer the breast often.  Learning to nurse in a baby carrier can be a lifesaver as it will allow you to be hands-free while the baby is snuggled, fed, and comforted.

How will I know if my baby is colicky?  Is this the same as the ‘witching hour?’

Many parents confuse normal fussy behavior for colic.  Colic is defined as 3 hours or more of crying, 3 or more times a week, for 3 or more weeks in a row.  It normally resolves itself around month 4.  If your baby’s crying looks like this, he/she may have colic.  There are no definitive cause for colic, but it could be related to gut issues due to food sensitivities.  The “witching hour” is the period of time of day when your baby may seem unusually fussy, normally lasting for a couple of hours. This behavior peaks around 6 weeks and then often starts to fade.

If I am still having a challenging time building up my milk supply at this time, have I missed the window for increasing my milk supply?

Not at all!  Depending on the reason for mom’s low supply, there are plenty of things that can help boost  supply at this stage.  The most important thing is to learn why mom is struggling with her milk supply.  As always, lots of good breast stimulation is best - either from a baby or a hospital grade pump. There are also herbs and medications that are available that can help boost supply as well.

There may be times when things aren’t going the way they should.  If you find this, please contact an International Board Certified Lactation Consultant to help you.  Some signs that you might need some additional help:

• Sore, cracked, bruised, or bleeding nipples.

• Baby is gaining less than 4oz per week.

• You suspect your baby may be tongue-tied.

• Painful, recurrent engorgement.

• Oversupply.

• Baby is having problems stooling.

• Overly gassy, fussy, or colicky baby.

• Breast infection - mastitis, abscess, or thrush.

For  more information about what normal breastfeeding looks like in the first few weeks, check out our article,What Every Mom Should Know About Breastfeeding During the Early Weeks, which highlights our brand new brochure!  Also, check out Ashley as she discusses more tips and tricks for breastfeeding during weeks 3-6 on the Boob Group episode, New Mom Breastfeeding Manual: Weeks 3-6.

Help a Mama Out: What to Do When Your Baby Refuses a Bottle

What tricks have worked for you when your breastfed baby refused a bottle?

Michelle La Plante: Bottle boot camp with daddy!  I left the apartment for the day, leaving baby and daddy there with plenty of expressed breastmilk and a bottle.  By the end of the day, they had figured it out.  (Kudos to hubby for this – it was tough on him to see her cry and fuss…. But, then again, his breasts didn’t leak at the sound of the baby crying!)

Amanda Garfinkel Young: Early and often worked well with my second.  With my first, the nanny had a good trick.  She held him facing out, looking out the window and fed him with the bottle in the other hand.  A little awkward, but it seemed to distract him from the fact that he wasn’t looking up at mama while eating.

Danielle Smith: Try lots of different bottles.

Stephanie Lorenzen: After trying a number of different bottles, we used a spoon and a shot glass.  We then moved on to a straw cup after 4 months of age.

Julie Chapin: As a nanny, I went through this.  Had to have mama away at first.  Plus, baby had to be laying or sitting out of arms… could not resemble nursing at all.  First successes were warm bottle given in a drowsy state as baby was waking in her bassinet.  Windows and toys distracting baby at other times or in a bouncy chair.  Had to use droppers and spoon feeding with a few babies leading up to the bottle.

Natalie Quebodeaux Cavender: Sippy cup!  Turns out he hated the warmed milk and not the bottle.  He likes mama’s milk cold when not from the tap!!!  LOL!

Jennie Bever: My first one took a straw cup fine.  Second one reverse cycled.  Now that he’s older, he’ll also take breastmilk warm in a straw cup.  He would also drink out of a regular cup, although it’s a bit messier!

Liz Anderson Weaver: At daycare, we have had to resort to using medicine droppers with two babies.  Then we tried ERERy NIPPLE EVER until we found their perfect bottle combo.  Both suck ‘em down like champs now!

Stacey Singh: I read that if you have the person who is feeding your baby wear the robe or another article of clothing you wear frequently, it can really help.  I had my husband try it and my baby actually did take a little from a bottle.  We’re still working on it though.

Sylvia Padilla Sullivan: We tried different bottles.  Because he is older (4.5mos), one with a pretty fast, easy flow worked better than the ones we had been trying (like when he was tiny and still learning to suck.)

Thanks to everyone who responded to our questions on our San Diego Breastfeeding Center and The Boob Group Facebook pages.  Check back every Tuesday for a new Help a Mama Out tip!