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There usually comes a time in the breastfeeding journey, that the mother will need to provide an alternative feeding method. This could be to involve her partner in the feeding duties to help them bond, it could be because mom is returning to work, baby may need to be supplemented for a medical condition, or simply because mom needs a break! Whatever the reason, the breastfeeding mother has many options to choose from for providing her expressed breast milk.

When breastfeeding is first being established, it is best that the baby feeds from the breast directly as early and as often as possible. This will not only allow for an increased milk supply, but it also helps to prevent nipple confusion or flow preference problems with the baby. However, once breastfeeding has been established, and both mom and baby are in a good feeding rhythm, then it is perfectly acceptable to introduce the bottle or alternative feeding method. This is usually recommend around 4-6 weeks of life.

If the baby is needing to be supplemented at birth with formula or expressed breast milk for additional feeds due to a medically indicated reason such as jaundice, poor weight gain, or pre-term birth; it is best to use an alternate feeding device such as a tube/syringe (a device that allows the baby to be supplemented while nursing at the breast), cup feeding, finger feeding, or even a spoon. This way there will not be a disruption in the learning process between mother and her baby as breastfeeding is being introduced and established. A trained Lactation Consultant can help initiate the steps needed for additional instruction with artificial feeding devices, while maintaining good breastfeeding support.

Below are some simple steps to take to help the mother, her partner, and infant care persons provide the appropriate instruction for evaluating how to bottle feed the breastfed baby.

Breastfriendly Way to Bottle Feed

• FEED ON DEMAND: Just how you would go off of your babies cues when breastfeeding, you would also want to go off of your babies cues for bottle feeding. When the baby is eliciting hunger cues, go ahead and begin feeding.


• SLOW FLOW NIPPLES: Be sure to find a bottle that has a slow flow nipple. Most nipples have different stages that correspond with the age of the baby. Only silicone nipples should be used, as brown latex nipples break down over time from the saliva and often harvest bacteria.


• BREAST FRIENDLY BOTTLE :Your baby will most likely be the one who will determine which bottle works for them. Hopefully you wont be purchasing several dozen bottles before finding the perfect fit. My personal favorite is the "Breast Flow" bottle made by First Years. The "Nipple within a Nipple" design really encourages the baby to "work" to get the milk out of the bottle just like he has to "work" to get the milk from the breast. Ultimately however, I would encourage a wide mouth framed bottle. The more similar the bottle is the better the transition will go.


• SOMEONE OTHER THEN MOTHER: The first time the baby receives a bottle it should be from someone other then mom. The baby will smell the breast milk from the actual source and will always prefer the breast over something new and different. This is a wonderful opportunity for the mother's partner to get involved.


• LESS IS MORE: Only fill the bottle with 2-3oz of expressed breast milk or if not available, pediatrician recommended formula to start. It's always best to start with a less amount then too much milk. Once baby has fed from the bottle, you MUST discard any remaining milk residue. Saliva will transfer via the bottle nipple beginning the digestion process. If you were to try and save any left overs to feed at another time, it could cause the baby to become sick.


• AVOID MICROWAVES: Never heat the bottle in a microwave. Not only with the radiation destroy the important antibodies in the breast milk, it will also allow harmful chemicals from the plastic to seep into the milk. There also is a very serious risk of hot patches forming with in the milk. The bottle may "seem" luke warm to the touch, but the center will be scalding hot that could result in blistering and burning the baby's mouth and throat. NEVER USE A STOVE to heat the bottle in a pan of boiling water as this can also cause hot patches to form. Instead, use a bowl of warm water to heat up your breast milk or pre-made formula. A store bought bottle warmer is also an appropriate choice for warming the bottle.


• FEED BABY IN AN UPRIGHT POSITION: A baby should always be held when being fed. It is NEVER appropriate to prop a bottle. Not only does this not provide the very much needed sense of comfort the baby craves, it also is a choking hazard, that can lead to respiratory aspiration. Baby should be held in a more upright position, with the bottle in a horizontal position. Tilt the bottle just slightly to fill the bottle nipple with milk. When the bottle is resting is a horizontal position in the baby's mouth rather then in a vertical position, the baby is forced to suck harder. This way the baby is again working to get the milk out of the bottle, just as they work to get the milk


• SWITCH FEED: Half way through feeding, remove the bottle, burp the baby, and switch sides. Just like with breastfeeding, baby will be expecting to switch sides to complete the feeding process. This provides good eye stimulation needed for development, and prevents a "side preference" from developing. Burping half way through the bottle allows less gas to be swallowed resulting is less colic and stomach upset. So for example if the bottle has 2 0z of milk, feed 1oz and burp, then switch arms and feed the remainder of the bottle.


• BE CONSISTENT AND FEED GENTLY: The idea is to some what mimic what the baby does while feeding at the breast. Stroke the bottle nipple gently along the baby's lips to elicit a rooting response. When the baby open wide as if to latch on, gently guide the nipple in. It is best to allow the baby to draw the nipple into their mouth rather then forcefully pushing the bottle in. This way the baby is in control of the feed rather then you. Once the nipple is resting comfortably in the baby's mouth, gently rub against the roof of the mouth to encourage sucking. Once baby is sucking, allow him/her to be the guide. Encourage frequent pauses while the baby is drinking from the bottle. This will help to mimic the breastfeeding mother's milk ejection. This will prevent the suck/swallow reflex that can sometimes cause a "guzzling" from the bottle which can lead to flow preference.


• FULL MEANS FULL: When the baby begins to release the bottle nipple and has started to become drowsy, that is the cue that baby is full, even if the bottle is not empty. Forcing the baby to "Finish" the bottle by pushing the nipple into the mouth, massaging the jaw or throat, rattling the nipple in the mouth in hopes of "reawakening" the baby to empty what was provided, is strongly discouraged. This will lead to an increase of gas and colic, and develop a pattern of overfeeding. It is crucial to allow the baby to control the amount taken in. It is never appropriate to force feed a baby when the child has clearly indicated being done. Be sure to discard any remaining milk residue.

Following these easy steps will allow the baby to consume the volume that is perfect for their size and age rather than encouraging over or under eating. This also aids in supporting the working or pumping mom who is able to pump a more accurate daily volume that is equivalent to what the baby is demanding. This will support the breastfeeding relationship leading to a longer and more successful breastfeeding relationship.

Copyright 2011 Danielle Gauss/ JustBreastFeeding.com. All Rights Reserved