Introducing a bottle of expressed breastmilk to breastfed baby is a common challenge. There are many reasons why a family may choose to give their baby a bottle, and if it is appropriate for you then hopefully this content will be of help.
I have a number of tips / suggestions I will detail below. It is my hope one of these, or combination, will 'do the trick' for you.
There is not always one ‘quick fix’ or trick to get baby to take a bottle. In the same way that breastfeeding is as natural as learning to walk (something that takes practice, from both the baby and parent, a skill that benefits from support) as opposed to natural like breathing, so too is learning to take a bottle a skill that may take time and will benefit from appropriate support.
I am listing a few things for you to experiment with, often introducing baby to a bottle is trial and error, until you find what works best for your baby.
I recommend that you do use paced bottle feeding technique, to allow baby control flow from teat.
When baby is at breast, they often suck, suck, suck, stop, have a rest, suck, suck, suck, suck, suck, suck, stop have a rest … Watch your baby while feeding, you will notice the cheeks, moving, suckling, swallowing, then pauses. Try to replicate this pace with the bottle.
The angle of the bottle is important, don’t up end it, as this is similar to water boarding sensation, baby will become distressed. Bottle should be somewhat horizontal, with teat about half full of milk, to allow baby control the flow. Baby should still suckle to draw the milk out from the bottle, should not be case where milk is fast flowing into baby, spilling out sides of their mouth. Try first with milk only halfway in teat, then adjust angle slowly up or down to see if baby responds better.
This video is a great demo on how to pace the feed:
A few things to consider:
What temperature is the milk when you offer it? Some babies will drink EBM straight from fridge, others prefer it room temperature, others prefer it at your body temperature (have you noticed when you pump that the milk is a little warm?), some babies prefer the milk slightly heated.
What size teat are you using? For a 6 week old, depending on baby’s weight, and jaw strength, then a size 0 teat may be appropriate, or the flow may be too slow if your baby is an efficient fast feeder, then try a size 1 teat, a 6 month old may prefer different size.
The teat may be too rigid/hard, you could boil kettle, place teat in a bowl/cup, and soften it with recently boiled water, so it more closely resembles feel of your nipple.
Which bottle brand are you using? Different bottles have different shaped teats, your baby may prefer a bottle teat that more closely resembles shape of your nipple.
I recommend using an empty bottle as play thing with baby, outside of feeding times. Sit on your bed or sofa, with your legs bent, baby resting with their head close to your knees so you easily have eye contact, their bum on your belly, their legs resting against you, then hold the bottle and ‘boop’ baby on cheeks, forehead, chin, with teat, lots of laughs and smiles from you. Baby will enjoy this ‘fun’ time with you as you laugh with your baby. Your baby will be relaxed, because you are relaxed. Take the bottle and gently tap baby with teat on the forehead, then cheek, smiling each time, make it a ‘tickle’ fun game, “where next?". Keep this up for a few minutes until baby loses interest. The goal is to help baby feel comfortable with the bottle. Have an empty bottle on baby’s playmat as part of their toys they ‘reach’ for.
Babies have a strong tongue thrust reflex, and will push out anything they believe to be a foreign / dangerous object, it’s a survival instinct. Your baby has learned that your breast is ‘safe’, and you can teach baby that the bottle is ‘safe’.
If you are tense / anxious when offering baby bottle, your baby will pick up on this, so take a few deep breaths, big smile on your face, relax your shoulders down away from your ears before you attempt to offer bottle to baby.
Babies also respond well to triggers, you could try teaching a feeding trigger to your baby. When you next feed baby from the breast, instead of getting baby to latch as normal, first hand express a few drops of milk onto your nipple, so baby can smell the milk and the first thing baby tastes is the milk drop, not your nipple, then as you bring baby close to the breast, hold your breast and use your nipple to stroke from baby’s nose down to their chin, stroking from nose, over lips, to chin, this also encourages baby to open wide for deep latch. Do this stroke motion 2 or 3 times, and reward with nipple once baby opens wide.
When you offer bottle to baby, do the same thing, shake out a few drops of milk onto the teat, so baby can smell the milk on the bottle and when teat goes in their mouth the first thing they taste is the milk not the teat. Before you try to get baby to take the bottle, do the same stroking technique, stroke with teat of bottle from baby’s nose down to their chin, pulling down gently their lower lip, baby should open wide. Gently place the teat in baby’s mouth, baby should start suckling, the milk will flow from teat before they realise it is a teat not a nipple.
Some babies use a transition tool before taking a bottle, for some a calpol syringe works really well. Simply fill a calpol syringe with your EBM and give to baby a few drops at a time. Aim the calpol syringe into corner/side of baby’s mouth, not straight down the middle, and gently press on plunger to allow milk flow into baby’s mouth. Some babies will take EBM from an egg cup (the type for boiled eggs), or a drinking cup, tip gently a few drops at a time into baby’s mouth.
If you have a sense of baby’s feeding routine, then offer the bottle about 20 minutes before their anticipated next feed, do not wait until baby is hungry and crying for a feed. Your baby is more likely to experiment and be receptive with the bottle when not hungry. If you miss the window before baby is desperate for a feed, and offer bottle, baby will likely get frustrated and annoyed.
Some babies will feed from breast in any position, in bed, on sofa, side lying, cradle hold, any which way, but will not take a bottle in similar hold. I find that often babies will take a bottle while parent is standing, also try a slight heel bounce, so gently bounce on the spot, while offering baby the bottle.
If you would like another person, such as your partner, to offer baby the bottle, they may find it useful to try to replicate your feeding position. Although some partners ‘make it their own’, and find it works well for them to for example sit with baby on their legs facing them for a different feeding experience.
Your partner or other support person can try offering the bottle to your baby using all above tips, while wearing your dressing gown for example, so baby has your scent.
Don't throw out any unused expressed breast milk, it is great in bath for baby, just add to bath water, leaves baby skin so smooth and silky.
To minimise waste of breastmilk, after expressing you could split milk into small batches, then only offer a small amount initially to which you can add more if baby takes the milk offered.
Rest assured you are not doing anything 'wrong' if your baby refuses to take a bottle, your baby simply needs time to learn how to feed from a bottle, and for you and your partner to find a way to offer baby the bottle in a way that matches their feeding preference. You will figure it out, and your partner will be able to soothe baby. If you have a gym ball / birthing ball, then sitting on the ball while gently bouncing and holding baby often works well for partners as soothing technique (also good winding technique).
Do let me know if you are successful, or if you find some other tip that works well, I am always looking for more tips/ways to help families.
I am not a lactation consultant, and these are simply tips I have picked up over my time working with families. For supports related to breastfeeding, do reach out to the lactation team at your maternity hospital, your public health nurse, an IBCLC (check out www.alci.ie for list), Cuidiu breastfeeding counsellors, La Leche League.
There are many reasons a family may choose to transition to formula, or other milk when age appropriate, or combination feed, and there are supports available for this as well.
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