by Katie Kennedy, RN, IBCLC
Introducing a bottle to a breastfed baby is a topic that comes with some conflicting advice. Some experts warn against early bottle introduction due to the risks of nipple confusion, while others suggest introducing it early to prevent bottle refusal.
Finding Balance Between Breast and Bottle
Understandably, this leaves many parents feeling unsure about when and how to proceed.
However, knowing that bottle feeding can have multiple benefits for baby and family, like promoting bonding with other caregivers or giving tired mamas a break, we feel it’s worth exploring the breast-to-bottle journey in a way that eases the transition and minimizes the potential for refusals.
Is Nipple Confusion Real?
The idea of “nipple confusion” has been debated. We used to think that babies were confused by a change in how the breast nipples vs. bottle nipples felt in their mouths. However, we now believe that it’s the difference in milk flow between breast and bottle – rather than physical differences in the nipple – that affect the baby’s experience.
Research finds that babies introduced to both bottles and breasts early did not necessarily have more difficulty breastfeeding later. Instead, the speed and ease of bottle feeding were the primary concerns, as babies may develop a preference for a faster and even flow. To minimize this risk, paced bottle feeding and the use of slow-flow nipples are key.
Tips For Preventing Bottle Refusal
Introducing a baby to a bottle isn’t a requirement by any means, but it offers flexibility. For instance, some partners want to share the feeding responsibility, or you might be returning to work/school soon and will be pumping instead of nursing, etc.
While some babies readily accept bottles, others show resistance and may take a bit longer to go back and forth between breasts and bottles. This is totally normal. Give it some time to ease into the process, and odds are you and your baby will find the right breast-to-bottle groove.
Plan ahead to ensure you have everything you need
As you think about whether to offer your baby a bottle, these general themes can set the framework:
- What’s your version of consistency? To help with acceptance, keep the bottle as a familiar and consistent part of a baby’s feeding routine. This could mean once a day or a few times a week. It could also mean a full feed to replace a breastfeeding session or a partial feed to allow for bottle practice.
- Offer a variety of bottle nipples to start. Try different nipple types/shapes on the bottle so your baby can settle on the one that they’re most comfortable with. If your baby makes an easy transition on the first try or two, great! However, you may need to experiment with a few different ones.
- Experiment with safe milk temperatures. Experiment with varying temperatures of pumped breast milk or formula to find what your baby prefers. The Centers for Disease Control and Prevention (CDC) warns against microwaving or overheating milk. However, breast milk and formula can safely be served cold, at room temperature, or warm, depending on your baby’s preference.
When it comes to warming a baby’s bottle, the CDC instructs you to “…place the bottle under running warm water. Keep water out of the bottle and off the nipple. Before feeding, put a couple of drops of infant formula on the back of your hand to see if it is too hot.”
Hands-on strategies to help your baby ease onto a bottle
Bottle introduction is not a one-size-fits-all approach. Every baby, family, and breastfeeding journey is unique, and many factors should be considered.
If maintaining direct breastfeeding is a priority, bottle introduction can be handled in a way that supports and protects the nursing relationship. Finding the right balance between breast and bottle can take patience and planning.
Here are strategies to smooth the transition for both you and your baby:
- Timing Bottle Introduction: Most lactation consultants agree that introducing a bottle after breastfeeding is well-established (typically around 4-6 weeks of age) reduces the risk of flow confusion and bottle refusal. However, earlier introduction may be necessary for those who experience latch pain, low milk supply, excessive weight loss for baby, or other medical reasons. Timing matters when introducing a bottle – but flexibility is equally as important.
- Use Paced Bottle Feeding: Paced bottle feeding is a technique that slows down bottle feeding to more closely mimic breastfeeding. It involves positioning the baby upright, holding the bottle at a horizontal angle to control flow, encouraging the baby to suck and swallow at a natural pace, and offering breaks. Look for bottles and nipples specifically designed to support paced feeding.
- Choose a Slow-Flow Nipple: A slow-flow nipple is recommended to prevent the baby from gulping too quickly and developing a preference for a fast and steady milk flow or from choking on fast-flowing liquid. As mentioned above, experimenting with different nipple styles may also be necessary to find the preferred one.
- Keep Breastfeeding: Continue nursing on demand when possible, and if bottle feeding is needed or chosen, pump during those times to maintain your milk supply.
- Have Someone Else Offer the Bottle: Babies often refuse bottles from the breastfeeding parent because they associate them with nursing. Having another caregiver offer the bottle can help the baby accept it. Once introduced, keep the bottle familiar by offering it consistently.
Introducing a bottle to a breastfed baby can take some patience and practice, but with a flexible approach, most babies will accept the bottle while maintaining the skill of breastfeeding.
If you are struggling with resistance or refusal, experiment with different bottles, nipples, positioning, and feeding techniques – and keep the sessions short. Try to avoid the bottle battles to keep the feeding experience positive for everyone involved.
Pediatric Associates of the Northwest Is Here to Support Your Family
Pediatric Associates of the Northwest is committed to working together to find what works best for your family, whether that is breastfeeding, formula, pumping, or a combination.
There is no judgment or pressure, just compassion and individualized guidance from our experienced lactation consultants and providers. Contact us anytime if you have any questions or struggle with breastfeeding, pumping, bottle-feeding, or weaning.
