Will Giving a Bottle Ruin Breastfeeding? What Other Choices Do I Have?
Updated: Nov 12, 2020
When someone says ‘supplementing’ does your mind immediately turn to bottles? You’re not alone - many people think that’s the only option if a baby needs formula or expressed breastmilk in addition to breastfeeding. Other methods of infant feeding, though, get much less fanfare - so much less that you might not even realize they exist.
There are many valid reasons for needing to supplement - your baby won’t latch, your milk supply is low, your baby isn’t gaining weight, you or your baby are ill and the two of you are separated, etc. You may have heard, though, that you should avoid artificial nipples of any kind in the early weeks in order to avoid ‘nipple confusion.’ So what are you to do? That’s where these alternative feeding meth
ods come in. They preserve breastfeeding while keeping your baby growing and healthy.
According to the Academy of Breastfeeding Medicine, “[a]n optimal supplemental feeding device has not yet been identified, and may vary from one infant to another. No method is without potential risk or benefit” and “[t]here is no evidence that any of these methods are unsafe or that one is necessarily better than the other.” They conclude that more research is needed, but that these methods give a wide range of options to help you meet your breastfeeding goals.
Hand Expression and Spoon Feeding
If your baby is having difficulty latching in the early days, consider hand expression of colostrum and spoon feeding it to your baby. To practice hand expression, place your fingers and thumb on opposite sides of the breast a bit back from your areola, gently compress (squeeze) the breast, and roll your fingers towards the nipple, capturing the colostrum or milk on a spoon (or in a small container if you’re not planning to feed right away). Then simply tip the edge of the spoon to your baby’s lips and let them sip the milk (don’t pour it into their mouth). This video from Stanford University is one of the best resources for learning how to do this. Hand expression is the best way to gather colostrum, and it’s easy to just express it straight to a spoon and allow your baby to sip it from there. Your baby will get the energy they need while you continue working on learning to latch and building your milk supply. Hand expression is a good way to relieve engorgement and soften your areola once your milk comes in, too, making it easier for your baby to latch.
Can a newborn really drink from a cup? Absolutely. But maybe not in the way we imagine it. Your baby won’t be ready for their own sippy cup until the second half of the first year. But a cup of that you can control - tipping it to their lips so they can sip and tipping it away to give them a break - can be a great way of getting a supplement into your newborn while at the same time avoiding bottles. It’s messy - you’ll need a bib or other absorbent cloth to capture what baby loses on their chin. And you’ll need to choose a soft sided cup. Some companies make these expressly for feeding a newborn (Foley Cup, Nifty Cup and Medela’s Baby Cup are a few examples), but a small medicine cup, measuring cup or shot glass will work, too. Keep the baby in an upright position in your lap, and make sure they are calm and alert. Tip the milk so that it just touches the baby's lips, and let the baby sip or lap at the milk. Take breaks when the baby naturally wants to pause. Want to see cup feeding in action? Try this video from Global Health Media or this one from The Milk Mob.
If your baby isn’t latching at all, you can fill the syringe with milk, place it on your baby’s lips and slowly deliver drops of milk, allowing your baby to lick or sip them before you push more to them. If your baby will latch but your supply is low or your baby is having trouble staying at the breast, you can get your baby latched then use the syringe filled with expressed breastmilk at the corner of the baby's mouth. Give them a few drops at a time to encourage them to stay latched and begin suckling. Syringe feeding is less messy than an open cup, but does require you to really pay attention to your baby’s cues. You may be able to start with a small 10ml syringe in the beginning, though you may need a bigger one as your baby begins taking more milk.
For baby’s who aren’t yet latching or who have uncoordinated sucking, you may want to combine the syringe with tubing and try finger feeding (or you can purchase a ready-made device called the Hazelbaker Finger Feeder). For this method, the syringe (or the soft bottle depending on what device you’re using) is filled with expressed breastmilk or formula and the tubing is placed along the caregiver’s finger. Baby’s lips are tickled with the finger, letting them latch on their own without forcing the finger into their mouth. Keep the soft pad of the finger toward the roof of the baby's mouth. Baby’s suckling should draw fluid into the tubing, though the syringe can be depressed a little to move the milk forward to the baby's mouth (being sure not to overwhelm baby with too large a burst of fluid). This method can help babies learn to use their tongues correctly when they are having latching problems or if they have a tongue tie. You can find an excellent video of finger feeding here.
This is a good tool if you have low milk supply as it gives baby the supplement they need (previously expressed breastmilk or formula) while at the same time removing what milk you do have from the breast and stimulating the nerves in the breast - both of which will encourage more milk production
This tool is at its most basic tubing from a bottle that delivers a supplement to baby while they are feeding at the breast. Medela’s Supplemental Nursing System or the Lact-Aid Nursing Trainer are two options. This is a good tool if you have low milk supply as it gives baby the supplement they need (previously expressed breastmilk or formula) while at the same time removing what milk you do have from the breast and stimulating the nerves in the breast - both of which will encourage more milk production. You can make a homemade version, too - pediatrician and lactation consultant Jack Newman has instructions on his website.
Many babies easily go back and forth between the breast and the bottle
Paced Bottle Feeding
Many babies easily go back and forth between the breast and the bottle. But the more you can make it like breastfeeding, the more likely it is that you can avoid any nipple or flow preference. To practice paced bottle feeding, hold your baby in an upright position in your lap, and use a bottle with a slow flow nipple. Tickle your baby’s lips with the tip, and let them latch to the bottle nipple. Keep the bottle fairly horizontal as baby feeds, and give your baby plenty of breaks, just as they would at the breast. Consider repositioning them on your other side about halfway through the bottle. Follow your baby’s cues for when they’re done, never forcing them to finish the whole bottle if they have indicated they’re full.
While this isn’t really an alternative feeding method, it can be a helpful tool to get your baby back to the breast if you are using bottles. It can be used in conjunction with an at-breast supplementer or with a syringe. Since it’s a little harder than your bare nipple, the nipple shield will feel like a bottle nipple to your baby, helping them latch more easily and stimulating their suck reflex. If they unlatch before you experience a letdown, you can use the syringe (by itself or with tubing) or even a medicine dropper to deliver a little milk to entice the baby to keep going. Or you can use the at-breast supplementer.
While it’s great that we have all these options to get calories into baby when breastfeeding isn’t going well, it’s still a good idea to find the source of the problem and work on correcting it. Get in touch with Milk Diva Lactation Services, who can observe the baby’s behavior and make suggestions for improving breastfeeding. Keep an eye on your baby’s wet and dirty diapers to be sure they are getting enough, and work closely with your baby’s doctor if there are any concerns about your baby’s health or weight gain.
If you have more specific questions and would like expert advice from an IBCLC for your individual breastfeeding questions, check us out!
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