Why is bottle feeding a breastfed baby discouraged?
Many parents consider giving their baby a bottle of expressed breastmilk to allow someone else, usually a partner, the opportunity to feed the baby. Although this may seem an attractive idea especially if the mother imagines the bliss of sleeping through that feed time, it is not advisable for several reasons.
One reason bottle feeds are not a good idea particularly in the early weeks is the effect on the mother’s breasts. If the breastmilk is not released regularly (for example, if a feed is missed) the breasts quickly become over-full and engorged, which can lead to problems such as inflammation and mastitis. When baby is given a bottle feed the mother actually needs to be expressing her breasts around the same time to avoid these problems. If the breasts are not drained well and frequently the breasts’ chemistry changes to down-regulate her milk production, which will reduce the mother’s milk supply.
Introducing bottle feeds using a teat requires baby to suck very differently than how he does at the breast. The breastfeeding baby’s tongue massages the nipple and breast tissue which fills baby’s mouth, working in union with the natural suck-swallow-breath/pause rhythm that nature has designed to allow safe, comfortable feeding. Breastfeeding also enhances the development of the baby’s mouth and facial anatomy as he grows.
When a baby is given milk by a teat with holes in it the milk pours straight into the throat, and baby responds by swallowing the milk. The flow of milk dictates baby’s suck-swallow-breath action, and often forces baby to feed faster and take greater volumes than is comfortable for baby. The tongue is shaped to conform to the teat and works in a piston-like action using the tongue muscles differently to when breastfeeding. This can quickly confound baby’s natural and instinctive tongue action at the breast, and “derail” the baby from breastfeeding. Consequently it is not advisable to introduce a bottle and teat for feeds until baby is well established with breastfeeding (after about 6 weeks of age).
Nevertheless, it is a fact of our modern lives that many babies will be fed by a bottle and teat at some time, and breastfeeding mothers may decide to give some breastmilk by bottle once their supply is well established for a variety of reasons. They may be planning a night away from baby, or returning to work and needing to be able to leave the baby in someone else’s care for a period of time. It can be difficult to get a fully breastfed baby to accept a bottle and teat if it is not introduced by 3 or 4 months of age, so offering baby an occasional bottle feed after about 6 weeks of age can help baby adapt to this alternative feeding method more easily. It is important to understand that giving a breastfed baby frequent feeds by bottle and teat can ‘derail’ the baby from breastfeeding, and babies who are “mixed fed” breast and bottle can begin to prefer bottle feeds as the easier option, as it requires less physical effort than breastfeeding.
The rate the baby takes the milk is extremely important, and the “paced bottle feeding technique” is recommended for all bottle fed babies. Recent research has also indicated that some babies who are fed expressed breastmilk by bottle for every feed may be at increased risk of obesity, as they are unable to regulate the duration of feeds by signally they are feeling satisfied in the same way babies instinctively vary and regulate the frequency and duration of breastfeeds. The Paced Bottle Feeding Technique is key to allowing baby to signal feelings of satiety, and for the caregiver to respond accordingly.
There are numerous bottles and teats on the market which claim to provide a delivery system which is like breastfeeding, however in my experience most do not even come close. To maintain breastfeeding it is very important for babies to be offered teats which closely simulate the way breast milk flows from the breast. Slow flow teats are best, but check what actually happens by inverting the filled bottle and observing the teat for the rate of drips or stream; not all teats labelled “Slow” actually are!
Some teats do not have holes, instead have a Y shaped cut in the teat. Milk is only released from the teat when the baby applies pressure with the tongue and jaw as he sucks (similar to the action of breastfeeding) and when he pauses, the Y cut closes and milk flow pauses too. This also helps baby to “pace” the rate which milk is taken, enabling slower more comfortable feeding.
Ideally, the shape of the teat encourages baby to maintain a wide gape which resemble a good breastfeeding latch. Many wide-based bottles and teats are far too wide and baby’s mouth tends to slip to the tip of the teat, causing pursed lips and minimal jaw activity like sucking a straw, which does not resemble the oral activity of breastfeeding. Avoid “orthodontic” shaped teats (and dummies). These encourage abnormal tongue actions which can lead to changes in baby’s natural tongue and jaw action during breastfeeds. Consider if the teat or dummy shape is how you would like your nipple to look after a breastfeed!
When storing expressed breastmilk for feeding by bottle it is helpful to mark the time it was expressed as well as the date, and try to feed the milk at a similar time it was expressed (morning/afternoon/night). This is because the constituents of breastmilk varies slightly throughout the day and night which can influence how satisfied baby feels after being given the milk by bottle.
Take-home-message: giving occasional bottle feeds to a breastfed baby is fine, but it is important to consider HOW the feed is given, when and why in order to maintain baby’s breastfeeding reflexes and the mother’s breastmilk supply. This is adapted from “New Baby 101 – A Midwife’s Guide for New Parents” and was published in part on Mamamia http://www.mamamia.com.au/breastfeeding-tips/
Uncategorized