Eva Bild, MA, AdvCD(DONA), LCCE
Whether we are exclusively bottle-feeding, breast/chestfeeding-with-occasional-bottles, or doing-half-and-half, it makes sense to feed the baby in the most physiologic, relaxing, pleasant way possible, which helps parent and baby develop a comfortable attachment. This process is sometimes called Paced Bottle Feeding. It involves mimicking the flow that the baby might get at the breast, and allowing the baby to have control of their experience, the way they would at the breast.
This information is intended for babies from birth to six months or so. After that, the baby will be better able to communicate their needs.
General guidelines:
Feed your baby based on the baby’s cues, not on a schedule. Hunger cues are:
a. Lip-smacking
b. Tongue darting
c. Squirming
d. Rooting – looking for something to suck on with their mouth
e. Hands to mouth
f. “Barking”
g. Crying is a very late cue – really more a sign of distress than hunger.
In the first three months or so, a formula-fed baby will need small amounts of milk, 2-3 ounces, about 8-10 times per day (24 hours). Gradually they will start to take more milk at a time and feed less often.
Hold and cuddle the baby a lot. Even when you are not feeding them. We often over-interpret baby’s crying as meaning hunger when really the baby is asking for physical contact, movement, stimulation.
Don’t change the baby before the feed (unless absolutely necessary.) It just makes a hungry baby angry to be changed when they want to eat. It’s better to take a little break in the middle of a feed to change a diaper. And babies often poop when eating anyway!
Have your baby skin-to-skin when feeding, if you like, and if it’s convenient. Do not swaddle the baby when feeding them. Let the baby’s hands be free to explore and participate.
Use a slow-flow nipple – this is a nipple which, when held upside-down with milk in it, will release one drop of milk per second. This makes sure the baby does not eat too much, too fast.
Plan to take 10-20 minutes to complete the feed. Every feed does not need to be the same length. We all have some long meals and some short ones. Taking a longer time to feed allows the baby to recognize the feeling of being full before they become over-full. This reduces “colicky” crying.
Step-by-step Feeding:
Make sure you, the parent, are comfortable. Make sure you are not hungry yourself, and can sit and focus on the baby for the next 20 minutes or so without interruption. Find a cosy place to sit, with good support for your back and arms. Make sure you have the bottle and a burp cloth and maybe a box of tissues nearby, as well as a water-bottle for yourself, and perhaps your phone, so you don’t have to jump up if it rings.
- Make the baby comfortable in the crook of your arm. Your elbow should be supported, and the baby’s head is resting against your forearm. The baby’s head should be higher than their stomach. The baby does not have to sit absolutely upright, but being on an incline is better than flat on the back. (Babies fed while lying flat are at more risk for dental caries and ear infections.) Being upright means the baby is able to release air they might swallow.
- Touch the baby’s upper lip with the nipple and draw the nipple downwards over the bottom lip. When the baby opens their mouth, put the nipple in slowly, letting the baby draw it in. Do not force the nipple into the baby’s mouth.
- Keep the bottle tilted so most the nipple is full of milk. But don’t worry if the baby sucks in a little air – this is quite normal.
- Count the baby’s sucks and swallows. If the baby does not take a breath by the fourth or fifth suck, remove the nipple and allow the baby to have a break in the flow to swallow and breathe. Keep the nipple right there, by the mouth, so the baby can latch on again when ready.
- The baby may be upset when you remove the nipple. Talk to them and tell them it’s coming back. They just need a little break. After you have done this a few times, and they know it always comes back, they will be calmer.
- Other signs a baby needs a break are:
a. Opening eyes wide
b. Pulling the head back, or turning it to the side
c. Arching the back
d. Pursing the lips
e. Letting go of the nipple - Take the nipple out right away and sit baby upright or put baby up on your shoulder if you see these signs of mild distress:
a. Milk spilling from the mouth
b. Opening eyes widely
c. Stiffening of arms and legs
d. Flaring nostrils
e. Grimacing
f. Lips turning blue - Talk to your baby. Tell them a story. Talk about your plans for the rest of the day, or about what you did this morning. Make it clear that you are focussing your attention on them in a loving and relaxed way, and that you enjoy their company. Develop a habit of pleasant meal-time conversation that will last a life-time!
- Switch sides halfway through the feed. If you were holding the bottle in your right hand to start with, switch so you are now holding it in your left hand, and the baby is resting on your right arm. This provides for symmetrical eye stimulation and development.
- Let the baby decide when the feed is done. Signs of being finished are:
a. Falling a sleep
b. Turning head aside or back from the nipple
c. No longer sucking
d. Letting go of the nipple - Resist the urge to encourage the baby to finish the last bit of milk in the bottle. The baby is in charge of their body and their stomach. Letting the baby feel satiation cues and responding to them is a good way to set up good eating habits for later life.
- Put the baby up on your shoulder to burp. Pat their back gently.
- A baby will often fall asleep for a few minutes, and then decide they could use a little more milk. Take advantage of that little break to change the diaper. Then be prepared to give the baby a little more milk. That’s okay.
- If the baby still seems to root around even when they have had a large amount of milk, consider that they might just need to do a little more sucking. Offer a pacifier and a cuddle and see if baby falls asleep.
Resources
HealthyFamiliesBC.ca is a good website on family health – lots of information there on formula feeding and bottle preparation.
HealthLinkBC.ca is another source of British Columbian health information.
https://www.inspq.qc.ca/en/tiny-tot/feeding-your-child/bottle-feeding-your-baby is a Quebec resource with good, detailed information – in English.
Much of the ideas I have shared here are influenced by:
https://www.peelregion.ca/health/family-health/breastfeeding/pdf/paced-bottle-feeding.pdf
https://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/