Bottle Feeding a Breastfed Baby

I recently met with a family in my office that was practicing “paced bottle feeding” with their 5 month old daughter.  Mom had returned to work and had been exclusively breastfeeding until then, with bottles given only occasionally. Now however, bottle feeding was becoming difficult. The baby was mostly unhappy with the feeding taking an hour. I am embarrassed to say it took me a good hour to figure out what the problem was with bottle feeding, as Mom and baby nursed happily throughout our consult.  So often the answer is in the questions I ask, and if I don’t ask the right ones, I don’t get the answer. I am always learning!

I finally found out that to this family, paced bottle feeding meant letting the baby have a few sucks, and then pulling the bottle out of her mouth.  At that point the baby would get hysterical, as they made her wait a minute or two, and then offered the bottle again with that process repeated over and over.  In addition, this 5 month old was drinking from a bottle with a newborn nipple, even though she could have handled a bigger flow at her age. It would take the baby an hour to finish the bottle and be satisfied.  It was not a pleasant experience for anyone.

When I asked why they were doing this, when it was clearly distressing for everyone involved, it was because they didn’t want to do anything to disrupt the breastfeeding relationship, which of course I wholeheartedly agree with. However, what they were doing was developmentally appropriate for a newborn, not a 5 month old!  This poor baby was terribly frustrated. She was hungry, given a taste of milk, and then had the feeding stopped abruptly, albeit temporarily. In addition, the strength of her suck on a newborn nipple would collapse it, making it difficult for any milk to come out at all.

I encouraged Mom to get wide based nipples that are appropriate for a 5 month old, have her held upright when bottle feeding, and stop her for a burp after an ounce or two.  This is what paced bottle feeding means to me with an older baby, but there's not much on the internet about it. Most everything online is geared toward a feeding a newborn.  Once the family made these changes, bottle feeding took about 20 minutes, there was no crying and the baby was satisfied. In addition, she nursed eagerly and happily whenever with her Mom.

A great resource for families who want to use paced bottle feeding is this article on KellyMom, one of my favorite evidenced based breastfeeding websites. She references a video that I also like, although I wish a wide based nipple was used, which is the recommendation for breastfed babies.   It think it very helpful to see someone else do it, especially for people who have never fed a baby a bottle before.

This situation illustrates a couple of common issues I run into daily. I know I have written about it before, but it is worth repeating.  The first is that if what you are doing is not working, regardless of who told you to do it, even if it was me, stop doing it! Try something else. Trust your instincts. Get help from someone whose opinion you respect. The second is to change what you are doing so that it is developmentally appropriate for your baby. Often I meet with families at 6 weeks who are still doing as they were instructed in the hospital, in spite of the fact that everyone in their house is unhappy.  And lastly, remember that advice online is very general and may not be appropriate for your particular situation. If things are really not going well, please see someone who can help you sort it. Sometimes a fresh set of eyes on the situation makes all the difference!