Narrow Mouth
Wide Mouth
I can’t tell you how many times I have moms come into my office with questions or concerns about giving a bottle to a breastfed baby. They naturally wonder when the best time is to introduce a bottle, what is the right bottle, will their baby have “nipple confusion,” or will offering bottles impact their breastfeeding relationship negatively. One of the main complaints I get from parents is when their baby is starting to refuse the breast after the introduction of the bottle. This can happen for a multitude of reasons. For today, I want to focus on one of those main reasons. Flow confusion, or specifically, flow preference.
Sometimes we forget-babies are humans….and humans are lazy. Of course, I mean that in the nicest way possible. We don’t want to burn any more calories than necessary. It’s the conservation of energy. It’s how the human species has survived for thousands of years. We all know, it’s much easier (and usually more preferred) to go through a drive through or stop at a restaurant for dinner than take the time and energy to make a home cooked meal. Babies are wired the same way. They don’t want to burn any more energy than necessary. When babies are very young, two of their main priorities in life are breathing and eating and they want to do both of these things with the least expenditure of energy.
So, it only makes sense that this applies to breast and bottle feeding as well. So many moms complain to me that their baby is preferring the bottle over the breast; that breastfeeding was going great until mom started offering a bottle; that baby was offered a bottle right from the get-go in the hospital and after a few days when mom attempted to initiate breastfeeding baby would refuse the breast and wouldn’t even offer an attempt at latching. Other moms tell me that their baby will feed from the breast for a few minutes and mom will hear baby swallowing nicely and after the swallows start to slow, baby will pull off and cry, frustrated. This is common, and luckily can usually be avoided when we offer the correct nipples/teats.
Imagine an average baby taking a feed from the breast. A “textbook definition” of an average feed is usually baby feeding from each breast for an about 15 minutes, equating to a total feed of around 30 minutes. Of course, no mom is a textbook definition, and this will differ depending on mom and her particular milk flow. Now, this same mom who is breastfeeding her baby at the breast for about 30 minutes offers the next feed in the form of a bottle. This baby is taking the same volume of milk but is emptying the bottle in 5-10 minutes. Look at the difference! The bottle has a much faster flow which requires a lot less work from baby. Naturally, the baby will prefer this faster method. Who wouldn’t?
The good news is, it is easier to maintain a breast and bottle feeding relationship if done correctly. The goal is to mirror the breastfeeding experience with a bottle. So, for example, if it is taking baby 20-30 minutes to feed at the breast, it should take 20-30 minutes to feed at the bottle while taking in the same volume of milk. If the feeding experience is mirrored, mom will have a lot more success with transitioning between bottle and breast.
But, how do we know which nipple/teat is the right choice for you? Most babies will require a slower flow nipple/teat that mimics the flow of the mother’s breast. There are so many nipples/teats on the market that claim to be “breastfeeding friendly and supportive.” Unfortunately, many companies can make these claims with no proof to back them up. Even nipples/teats labeled as “slow flow” or “newborn” can be way too fast for baby. You can see this firsthand if you notice milk dripping out of the corners of baby’s mouth, baby has a shallow latch, baby is chomping or biting at the nipple/teat (usually to slow the flow), or is coughing, choking, or frequently unlatching. Luckily, unbiased studies have been performed to determine which nipples/teats on the market mirror the flow of milk from mother’s breast. The results can be seen here: https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4698468/ I love to recommend the Dr. Brown Preemie/Size 0 nipples/teats. These are some of the slowest flow nipples/teats on the market and really encourage baby to continue working efficiently at the breast. When a baby has a nice consistent flow at both bottle and breast, they really don’t know any different, so there will be no preference for one feeding method over the other.
Narrow Mouth
Wide Mouth
Of course, there can be other reasons that baby might be refusing the breast or not have a cohesive breast and bottle feeding relationship. Rachel O’Brien is an IBCLC who has written a fantastic article entitled ‘Bottles for Breastfed Babies. The link can be found here: https://www.rachelobrienibclc.com/blog/bottles-for-breastfed-babies-introducing-a-bottle-part-1/ This article will go into other factors that can also play into ensuring a successful bottle and breastfeeding relationship. Keep in mind that each baby and each mother is different. There is no nipple that is a one-size-fits-all. Any recommendations can be personalized for you and your baby by seeking professional help from a qualified lactation provider.