Are you destined for breastfeeding failure if your baby has a bottle?…The short answer to this question is “NO”. However bottle preference is a REAL possibility and many babies unfortunately do start to show signs of breast refusal. This article will answer why this is and how to prevent it.

Nipple confusion. This is a term that I have grown to loath as it’s not only fear inducing…”My baby is going to get confused!” It’s also not very accurate. Now I cannot actually ask a baby, “Are you confused?” but knowing what I know about the mechanics of breastfeeding, infant behaviour and how they feed, over the years I have grown to prefer the term, “bottle preference” instead. This is because I feel as though it’s a much more accurate description of what’s going on. The way a baby uses their muscles; including their tongue, jaw and neck when breastfeeding, is very different to how they suck on a bottle. Babies are not confused…they just start to PREFER the bottle more than the breast. It’s an easier and more passive activity than breastfeeding. But will this happen to your baby? Will you ruin your chances of breastfeeding by introducing a bottle here or there or exclusively bottle feeding for a short time?

I will cover the different reasons women choose to bottle feed, alternatives to offering a bottle (if you would like to avoid bottle use) and how to encourage your baby to keep breastfeeding. So often we are told we have to give our baby or toddler a bottle and think it’s our only option! In many cases though, it’s not…

baby, breastfeeding, bottle feeding

Reasons a mother might think about introducing a bottle:

The mother has low supply in the newborn period…After you have established that you do have low supply (read through my checklist here) it might be suggested that you “top up” after each feed with a bottle.

How to encourage baby to keep breastfeeding during this time:

  • Make sure you use a bottle nipple with the slowest flow as this will help encourage your baby to really work hard to get the milk out. This makes it more similar to breastfeeding and less of a passive activity.
  • Try to use the “paced bottle feeding” method. Click here for information on how to go about doing this.
  • Always start by trying the breast first. If your baby is very hungry and unsettled then you can offer the bottle first until your baby settles, then offer the breast.
  • Hold your baby A LOT! This will encourage frequent breastfeeds and help keep your baby settled.
  • Be skin to skin with your baby, 24/7 as MUCH AS POSSIBLE in the early weeks and months. As simple as this sounds, it’s the most important way to help keep your baby interested in the breast.

Alternatives to bottle feeding: using a supplemental nursing system (SNS or supply line). Read Brogan’s journey of supplementing and using an SNS here. You can also try a syringe or a cup. Click here for info on cup feeding.

breastmilk, breastfeeding, low, supply, pumping

The mother has low supply with your older baby or toddler (12+ months old)…This might happen if you are very sick and dehydrated, a few days before your menstrual cycle starts or if you are pregnant. It’s really important to note that most will be fine within these few days if you are sick or before your cycle and they will not need extra fluids as long as you are breastfeeding frequently. However they will need more fluids if they are showing signs of dehydration:

  • dry, cracked lips and a dry mouth
  • a decrease in urine output, no urine for 8 to 12 hours, or dark-coloured urine
  • drowsiness or irritability
  • cold or dry skin
  • low energy levels, seeming very weak or limp
  • no tears when crying
  • sunken eyes or sunken soft spot (fontanelle) on baby’s head

You can choose to use a bottle to give your child extra fluids during this time. If you are pregnant and your toddler is showing sigs that they are upset by the decrease in your supply, there are ways to manage this which I cover in detail in my BOOBinar on the topic of Breastfeeding while pregnant and tandem nursing. Click here for info on this.

How to encourage baby to keep breastfeeding during this time: Spend lots of time with your baby just “hanging out” topless. Yes! It’s true! This really does work. The more your toddler sees your breasts, the more they will breastfeed and want to breastfeed. Even if your supply has dropped due to hormonal reasons and breastfeeding more frequently does not increase supply, at least it will keep your toddler interested! 🙂

Alternatives to bottle feeding: Use a cup! You do not have to offer an older baby or toddler a bottle, especially if they have never had one. It’s also highly unlikely that they will even take it. It’s not necessary as they can take water or expressed breastmilk from a sippy cup, shot glass or small cup. A straw works well too! Just try a few different cup options and find what they like best.

mastitis, breastfeeding pain, nipple damage

Mother is experiencing nipple pain and/or damage…I have been asked many times by parents, “Is it OK if I just stop feeding temporarily for 24 hours because I’m in so much pain? I really want to give my nipples a break.” And I always tell parents, “Yes, of course! I would never tell a woman in excruciating pain she has to keep feeding if she needs a break!” The important part of this though? Make sure the mother is getting AWESOME LACTATION SUPPORT AND GUIDANCE which includes a thorough history taking, a full oral assessment of the baby to rule out tongue tie, a detailed plan (short term and long term) for the mother and baby on where to go from here which includes different options. And of course a follow up!

How to encourage baby to keep breastfeeding during this time: Skin to skin 24/7 as much as possible, if using a bottle used paced bottle feeding and a nipple with a slower flow, feed your baby the bottle while holding them skin to skin, right against your breast, switch sides you are holding your baby on each time you feed them to mimic the movement of switching sides when breastfeeding.

Alternatives to bottle feeding: Depending on your baby’s age you can try a syringe (harder if your baby is older as their intake is so much) or a cup. You can also consider using a nipple shield short term as this can significantly decrease the pain. Just make sure you are working with a skilled International Board Certified Lactation Consultant as the same time so you can get the underlying issues of WHY you are experiencing painful breastfeeding. Pain is not normal.

Photo credit: Alexandra Grablewski

Mother wants someone else to feed the baby…You might be dreaming that you’ll wake up one morning to find your partner has started lactating so they can do the 2am feed?! Yes, we all have these fantasies, right?! Sometimes a woman will ask her partner to give their baby a bottle so she can run out to the store by herself or get some “me time” without baby attached.

How to encourage baby to keep breastfeeding during this time: If possible wait until your baby is a bit older (over the age of 6-8 weeks) to offer the bottle. This help make sure breastfeeding is well established and there are no concerns. Only offer the bottle occasionally in the early months and spend a lot of time skin to skin with your baby, frequently offering the breast without sticking to scheduled feeds (feeding by following your baby’s cues rather than a set schedule by the clock). If you do need to (or want to) offer a bottle before the age of six weeks, follow my paced bottle feeding suggestions and try to use a slow flow nipples.

Alternatives to bottle feeding. I have written about this a lot as I am an attachment parent, my three boys were breastfed beyond babyhood and never had a bottle. HOWEVER I of course understand the other side of it as well. Just make sure you are not feeling PRESSURE from family or friends to bottle feed and get “me time”. You might feel strongly that you want to be with your breastfed child 24/7. There are many ways to get some time to yourself without introducing a bottle (I talk about attachment parenting on my blog which you can find HERE) and there are many ways for your partner to bond with your baby too which you can read about HERE.

Mother is returning to work. This is a real struggle for women who live in countries with little (or no) maternity leave. Often times mothers are returning when their babies are still exclusively breastfed and would like to offer their milk in a bottle so baby is sucking on something (which is comforting) and a larger amount can be given more easily.

How to encourage baby to keep breastfeeding during this time:

For your baby’s health care provider: Give them a copy of my paced bottle feeding so they can easily refer to it. Ask that your baby is only fed on cue (rather than by a schedule) and to feed baby only as much as they are asking for (not trying to finish a bottle just because!)

For you: Focus on what you are doing when you are WITH your baby! Breastfeed them frequently and offer the breast every couple of hours before and after work. Be very organised (have a slow cooker on for dinner and lunch organised before you go to bed) so you can really just hang out quietly with your baby. This will help to encourage more frequent breastfeeds which will help protect your supply and breastfeeding relationship. Also make sure to pump when at work to keep up your supply when you are separated. I have more info about this in my BOOBinar on returning to work. 

Alternatives to bottle feeding: Depending on your age you may not need to introduce a bottle at all. Your baby can take the milk from a sippy cup or cup and straw. You may also be able to “reverse cycle” where you child takes a small amount of milk during the day but makes up for it overnight with frequent breastfeeds. The amount they need during the day depends on age and how much they are getting at night by breastfeeding. Other factors to consider include how frequently you are outside of the home and for how long each day (or night).

Mother has difficulty breastfeeding in public, worries about what people will think or feels self conscious. (Have you seen my documentary on this?!)

How to encourage baby to keep breastfeeding during this time: Try to limit the amount of times you have to be out while breastfeeding the in the early days. The less you are out and about the easier it is to help establish breastfeeding. Most of us just need a few weeks to get the hang of things and feel more comfortable. Go to gatherings with other mothers who are breastfeeding as well to practice. This might be your local mother’s group or breastfeeding group (Australian Breastfeeding Association or La Leche League International).

Alternatives to bottle feeding: You can find a quiet place where there are less people around or some women will try using a breastfeeding cover. You can also try to schedule your outing when you know your baby is less likely to ask for a breastfeed. Try feeding your baby right before you leave (although this is not guaranteed to work every time as babies often feed without following a schedule!)

The take home message here? There are many things you can do to help prevent bottle preference. It just takes some patience and perseverance on your part (and ruling out any other underlying issues that might be going on for you baby). Some babies will start to prefer a bottle…others will not.  By following these guidelines you will put yourself in a great position to help prevent bottle preference with your baby.

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