There are many reasons why breastfed babies need to take a bottle on occasion. Perhaps you need to rest your nipples with pumping, or you may have been asked to supplement the baby with formula by your pediatrician; pumping to increase your milk supply should be considered in this situation too. It may be that you want to make sure your baby will be able to take a bottle in the future, or dad may want to give expressed milk via bottle at night so mom can get more rest. Perhaps you are going to be separated from baby and she will need a bottle while you are gone.
If you have the option, it is best to wait until breastfeeding is well established, usually around four to six weeks, to introduce a bottle. Even giving expressed milk via bottle at night can possibly disrupt milk production, not to mention risk "nipple confusion." Very few people realize that the mechanics of breast and bottle-feeding are quite different. When a baby nurses, his tongue and jaw must work together rhythmically, cupping his tongue under the areola, and pressing it up against his palate. This flattens and elongates the tissue around the nipple. He then drops the back of his tongue to form a groove for the milk to flow from the nipple to his throat. He then swallows, followed by a breath. His lips are flanged out tightly around the breast to form a tight seal.
When a baby drinks from a bottle, the milk comes out quickly. In order to keep from choking, he lifts his tongue and uses it to block the flow of milk. He purses his lips around the hard nipple and he doesn’t have to use his jaw at all. There is a constant flow of milk that he doesn’t have to work for, unlike during breast-feeding, where the milk "lets down" initially, then slows to a trickle, and the process repeats several times during a feeding.
Many babies switch back and forth between breast and bottle without a problem from day one. Others have more of a tendency to become confused if artificial nipples are introduced too early. They may learn incorrect sucking patterns and breastfeed less effectively or even refuse the breast completely.
If you wish to bottle-feed expressed milk, due to a planned separation from baby, begin pumping after one or more feedings for five to ten minutes. Pumping for a few minutes after nursing is the equivalent of baby nursing for a few more minutes on each side and won’t significantly increase your milk supply, although repeated stimulation will increase it a little. Some mothers pump for just a few minutes after a morning feed and get several ounces. Others may only get a quarter to half an ounce when they pump after baby nurses and need to pump several times a day to get enough for a bottle.
If you are bottle-feeding a newborn, we recommend using a slow-flow, wide-based bottle nipple such as Playtex Natural Latch Silicone Nipple, or Dr. Brown’s wide-based nipple. It is possible to continue using slow-flow nipples even as baby ages, unless he starts to complain about the flow after a few months. It is best to offer the bottle when baby isn't very hungry or fussy.
It may be necessary to have someone other than mom offer the bottle; mom may have to leave the room entirely for it to be successful. Babies can smell their mother from 20 feet away. A more experienced bottle feeder may be more successful. Many babies refuse to take a bottle at home, but will at day care. Encourage the care provider to experiment a little. Some babies do best in the nursing position, wearing something that smells like mom. Others do better if you prop them up on your knees facing you or in a car seat or a bouncer seat.
Offer a small amount of milk that you pumped; that way, if baby doesn’t take it, you won’t have to waste much. Because the bottle nipple smells and tastes different, having a familiar fluid may help, and you may need to warm the nipple too. Go slowly and gently, first touching the baby’s lips with the nipple and watching the reaction. Don’t force the nipple past lips; let baby draw the nipple in at his own pace. Express a little milk from the nipple onto the baby’s lips or tongue. Remove the nipple before the baby protests, and keep a smile on your face while talking in reassuring tones.
Avoid letting baby get very upset and then taking the nipple away. This will teach the baby that if he/she protests enough you will remove the nipple. Wait 10-15 minutes before offering the breast; that way baby is unlikely to associate any refusal to take the bottle with immediate gratification from the breast. Remember to stay calm. The baby may resist a bit at first by turning away, making a face or pushing the nipple out with her tongue. Don’t force it and stop if baby shows signs of getting upset. Try again the next day. Even a few sips are a step towards accepting the bottle.
Some other tips are to move with the baby. Rock, sway, bounce or walk as you offer the bottle. Try holding the baby facing outward against your chest, where she’ll be distracted and bring the bottle in from around the side. Having the television on or using other distractions may also help. For older babies, another trick is to try a little apple juice in the bottle instead if they won’t take it. They may take some sips of this, and then you can begin mixing it with milk, gradually eliminating the juice. You may need to be creative and use a combination of these suggestions.
Sometimes a baby who is reluctant to take a bottle will do so when half asleep. Offer the bottle when baby is drowsy, has just fallen asleep, or is just waking up. Most babies will accept a bottle with time, patience and persistence. Don’t give up, but don’t make it a battle.
Some babies begin to refuse a bottle even if they’ve been taking one well, at around three to four months, so taking a bottle daily early on isn’t a guarantee that they will continue to do so. Offering a bottle every two to three days is probably enough to help him "remember" from time to time. Ideally, use the bottle when you're separated and nurse when you're home, so as not to affect your milk supply and risk the baby preferring the ease of the bottle.
If attempts to bottle-feed fail, other options include cups, droppers, spoons, syringes and feeding tubes attached to your finger. You can use a small medicine cup by holding her upright, bringing the cup to mouth and tilt it gently until a small amount of milk touches lower lip. The baby will begin to lap it and then drink. A hollow-handled medicine spoon works the same way. Older babies may go straight to a sippy cup, one with a valve and/or straw, or later one that you tip up.
When offering bottles at any time, a technique called "paced bottle feeding," used most often with premature babies, is a good thing to do. The bottle is held at an angle that allows milk to be in the tip. The more horizontally you hold it, the harder the baby has to suck. The more vertically you hold it, the easier it flows. Let the baby take some sucks and then remove or tip the bottle back so the flow is stopped to allow them to breathe before starting again.
We now know that babies usually peak at a feeding volume of three to five ounces, even as they get much bigger. If it seems they are demanding larger feedings, it could be because they are taking it too fast.
Remember that some babies don’t take as much from a bottle when mom isn’t home, and then make up for it later. Also keep in mind that a healthy baby will not starve himself.