Bottle-Feeding

Bottle-Feeding: The Basics

Whether parents opt to breastfeed or formula-feed their baby, chances are that bottles will be involved at some point. Nursing may go smoothly, but parents may opt to bottle-feed pumped milk when mom’s not around, or supplement with formula if supply dips. Nursing may also end sooner than hoped: While the benefits of breastfeeding are undeniable, the unfortunate reality is that it’s a round-the-clock job, and mothers often can’t be available to nurse for as long as everyone would like.

Some parents, on the other hand, go straight for formula, a choice sometimes fraught with emotional weight due to the heavy responsibility of parenting, societal expectations, and a cottage industry of gurus who seem to delight in spinning unrealistic narratives about parenting perfection. But in real life, nursing can be impossible for a wide variety of reasons, and bottle-feeding is a legitimate choice that parents need not be ashamed of. 

Just because bottle-feeding is healthy for babies, though, it’s not necessarily straightforward, especially if it’s being done in combination with breastfeeding. Here’s everything you need to know to get bottle-feeding off to a great start.

Bottle-Feeding FAQs

Is breastfeeding better than bottle-feeding?

While it’s true that breastfed babies spend a great deal of time experiencing “kangaroo care” with their mothers – skin-to-skin contact that is a crucial part of bonding and body regulation – that does not mean that bottle-fed babies are somehow deficient in parental bonding. Is the baby getting enough to eat? That’s the real benchmark. Breastmilk, even in the bottle, still has incredible nutritional density and immune benefits, and while formula can’t replicate everything that breastmilk can deliver, it can be matched to specific allergy or nutritional needs. As long as the child is thriving, whatever method works is the right one.

Does bottle-feeding interfere with parental bonding? 

Breastfeeding definitely provides some unique bonding moments, but parents of bottle-fed babies have just as much opportunity to coo and look lovingly into their baby’s eyes. And when it comes to getting the skin-to-skin contact that babies receive with breastfeeding, there’s nothing wrong with Mom or Dad stripping to the waist and getting the kid down to their diaper before bottle-feeding. Bottle-feeding, in particular, allows fathers extra opportunities to bond with their baby and give their partners a break. 

Does bottle-feeding reduce milk production? 

Milk production is based on supply and demand: The more milk a baby consumes (or that is pumped and stored), the more the mother makes. As long as bottle-feeding moms keep a consistent pumping schedule when they are away from their baby, they should be able to keep up a very consistent supply. Of course, this is often easier said than done, considering the underwhelming infrastructure many workplaces have for supporting breastfeeding moms.

Do bottles and nipples need to be sanitized after every use? 

Sanitizing bottles after a thorough wash is generally unnecessary, which is good news for parents washing up after the 2 a.m. feeding. There are times when sanitization is necessary; one-time bottles should be sanitized after purchase, and any bottle needs to be sterilized after an illness. Otherwise, hand-washing with soap is fine, and dishwashers usually heat up enough to sterilize as part of the wash cycle. It should be noted that parents need to wash their hands before washing bottles or sanitizing, or there’s no point. And there’s no need for a fancy sterilizer: low-tech options, like a steam bag or six-minute boil, work just fine.

Can bottles be warmed in the microwave? 

Bottles don’t need to be warmed, but warming to body temperature will allow the fat in breastmilk to liquify (and some babies may prefer warmer formula, too). If you do warm a bottle, the microwave is the worst option. Microwaves heat unevenly, even with their little rotating turntables, and as a microwave heats a bottle, it can produce hot spots that a parent might not detect when they do the old wrist test. Swallowing a pocket of hitherto-undetected-yet-scalding milk can lead to a trip to the emergency room. A better bet is to place the bottle in a bowl filled with hot tap water until the milk or formula is roughly body temperature.

Do bottle-fed babies require more burping? 

There’s nothing particularly special about bottle-fed babies that requires they be burped. If a baby doesn’t burp right away after feeding, any gas in their system will come out one way or another with or without parental assistance. Besides, by 6 weeks of age, babies are usually able to burp just fine without a pat on the back, and recent research suggests that burping may be unnecessary. Babies aren’t less colicky when they’re burped. In fact, they may be less likely to spit up if you just leave them alone to digest in peace (instead of banging on their backs).

Does bottle-feeding make babies fat? 

Babies are supposed to have folds, but there are some concerns that bottle-feeding – with either breastmilk or formula – leads to obesity. There’s a bit of truth to this, since a bottle with a high-flow nipple can cause babies to drink way more milk than necessary before their brain has a chance to tell them they’re full, but this can be easily corrected by changing the nipple or angle of feeding. 

When should babies wean off the bottle?

Some health concerns emerge when kids older than 14 months continue to use a bottle. They’ve started eating a more varied diet of solid foods at this point, so the calories from bottle-feeding become unneeded extra calories. One study conducted by the AAP, titled the Early Childhood Longitudinal Study, showed that children who were still using the bottle after the age of 2 were far more likely to be obese up to three years later compared to those who had given up the bottle earlier. 

Paced Bottle-Feeding and Nipple Confusion

Nipple confusion, also known as nipple preference, occurs when a baby has trouble latching and breastfeeding after bottle feeding or using a pacifier. It’s frustrating for parent and child alike, but it can be managed, if not avoided. It’s recommended to avoid bottles and pacifiers altogether until breastfeeding is established, and after that point to practice paced bottle-feeding, which more closely simulates breastfeeding and may help babies avoid nipple confusion. The benefits of paced bottle feeding lie in the way it requires the infant to root and suckle the same way they would while nursing, and helps the baby bottle feed more slowly, which makes it a good practice even for babies who aren’t breastfeeding. 

Parents will also want to find bottle nipples that best match the latch and flow of the breastfeeding experience; it may require trying a few brands or styles to find the right fit. These are some techniques that might help. 

‘Classic’ Bottle-Feeding: The baby is positioned as upright as possible, and the bottle is inverted as much as possible to prevent the child from sucking in too much air. This position requires the right kind of nipple to control the flow of milk or formula: this keeps the baby from being overwhelmed and from consuming more than they need. A common mistake is to let the baby lie down to bottle-feed, but feeding a baby flat on their back can lead to, among other things, dental caries and ear infections, which are truly miserable. Experts recommend holding a baby up for 10-15 minutes after feeding to avoid reflux. 

Paced Bottle Feeding: With the baby supported and sitting upright, the bottle is introduced relatively flat, with the nipple angled up slightly towards the palate. The shallower angle of approach requires the baby to latch well and work a bit to get the milk flowing, and parents can control the speed of flow by keeping the bottle flat and adjusting as necessary. The nipple is not inserted into the baby’s mouth, but rather stroked on the baby’s lips gently to elicit the baby’s rooting reflex; the baby brings the nipple in themselves, as they would at the breast. 

“Breastfeeding is extremely important, but it’s also extremely difficult. If it doesn’t work, that doesn’t mean that somebody has done something wrong or failed in any way. It just is what it is. Luckily we live in a society where we have other options available to feed our children.”

—Dr. Elizabeth Murray

Essential Bottle-Feeding Tips

  • Find the Right Nipple: Bottle shape has less to do with how a baby feeds than the nipple hole size, the position of the bottle, and the position of the baby. Though the difference in hole sizes can be imperceptible, they are real: A nipple rated with a smaller hole or for a younger baby has a slower flow rate than one rated for an older child. Getting the size right is crucial to babies knowing when they’re full, and especially important for breastfeeding babies, who might grow impatient at the breast if they become used to a fast-flowing bottle. Trust, nipple confusion is easier to prevent than correct. 
  • Watch the Flow: When bottle feeding, babies can suck down a sizable portion long before they realize they aren’t hungry anymore, and it’s easy for them to be overwhelmed by the increased flow of a bottle. Feedings should take around 15 minutes, and parents should watch out for signs of panic. A baby that is feeding too quickly should use a slower nipple or a shallower angle of the bottle.
  • Follow the Formula: There’s no need to deviate from the instructions on a package of formula. Babies don’t need extra water on hot days. They just need formula (or breastmilk). In fact, diluting the formula can lead to seizures and other nasty side effects. 
  • Hold Baby Up During Feeding: Babies should never eat lying down. They should always be bottle fed in a supported, sitting position, as upright as possible, and should be held up for 10-15 minutes afterward. Feeding a baby on their back is an express ticket to earaches and a squalling kiddo. 

The Bottle-Feeding Experts

Dr. Elizabeth Murray
Pediatric Emergency Physician, American Academy of Pediatrics Spokesperson
Dr. Dennis Cooley
Pediatrician, American Academy of Pediatrics Fellow
Sabrina Freidenfelds
MPH, IBCLC, Director of Then Comes Baby

Spit-Up: Gross, But Normal

Babies are, fundamentally, unevenly pressurized. At the end of the esophagus, there is a sphincter that opens to allow nourishment into the stomach. But sometimes it just sort of opens randomly, and the difference in pressure between the esophagus and stomach drives a bit of the stomach contents up and out into the wider world. Two-thirds of infants spit up, and is mostly due to the fact that babies are still adapting to life outside of the womb, and have had very little practice eating with their mouths instead of their belly buttons.

Spit-up can be controlled, in part, with some good after-feeding behavior. Bottle feeding smaller amounts of milk more frequently, with a nipple that doesn’t express too much too quickly, can help decrease spit-up. So can holding the baby upright for a half-hour after a feed. (This does not mean babies should sleep wedged or propped with their head elevated; that increases the risk for SIDS.) Burping may or may not help. Ultimately, time will help the most, as babies develop and grow stronger. If parents are ever concerned about the frequency or the amount of spit-up, of course, they should consult their pediatrician.

Useful Bottle-Feeding Gear

Comotomo Baby Bottles

Comotomo's breastfeeding baby bottle promotes a 100-percent leak-free bottle without the use of any additional nipple caps because, as this brand knows, every drop counts.

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Transition Bottle by Nanobébé

The unconventional boob-like shape of these baby bottles means they warm up faster than the average bottle. This prevents hangry babies and allows the milk fats to dissolve faster.

BUY NOW $23.00

Lifefactory Glass Baby Bottle

Lifefactory glass bottles are pretty much the gold standard among non-plastic bottles. They come in 4- or 9-ounce sizes, and are made from thermal shock-resistant borosilicate glass — meaning they safely go from freezer to fridge to hot water.

Buy Now $13.22

OXO Tot Cleaning Set

You'll want to make sure you get baby's bottles as clean as possible, especially if you're not boiling them obsessively (which you shouldn't). This brush kit makes it easy and quick to get dried milk out of all the nooks and crannies.

Buy Now $5.99

Smart Baby Feeding Monitor

This smart bottle and the corresponding app records the amount of milk baby takes in, as well as its temperature, duration, and the angle at which it's given. The app will even alert parents when babies need to be fed (though your baby will likely let you know.) It's not a necessity per se, but it can give anxious parents some peace of mind.

Buy Now $109.00

Portable Travel Baby Bottle Warmer

This portable insulated container holds hot water so you can heat a bottle on the go.

Buy Now $17.97

Bottle Sterilizer

This compact machine uses UV light to kill 99.9 percent of harmful bacteria. It's medical-grade, and can be used on more than just bottles.

BUY NOW $299.99

The One-Handed Bottle Prep Accessory by Bokee

This genius accessory allows parents to open, close, and fill bottles with one hand.

BUY NOW $19.99

 

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