FEEDING YOUR BABY

Bottle feeding for breastfed babies

It's not always necessary to teach a breastfed baby to use a bottle. Sometimes you may feel that other people want you to introduce bottles either because they want to share with the feeding, or so you can "get back to normal" by going out for the evening or taking a short break. You may agree, but on the other hand you might not feel ready to leave your baby with someone else. Try to think about whether introducing bottles is what you and your baby really want. After all, many babies do go happily from breastfeeding to drinking from a cup or beaker at mealtimes without ever needing to take a bottle.

Useful contacts

If you are still undecided about whether to introduce bottles, you could phone a breastfeeding counsellor and talk through your options. She will support you whatever decision you come to, and it can help to have a listening ear.
National Childbirth Trust Breastfeeding line: 0870 444 8708 (8am to 10pm daily)
Breastfeeding Network Supporters line: 0870 900 8787
La Leche League: 0207 242 1278

What do you put in a bottle?

If you decide to introduce bottles, your first decision is what to put in them. There are two options - expressed breastmilk (EBM) or artificial milk, often called formula.

Expressed breastmilk

You can express milk for your baby by hand or by using a breast pump. Have a look at the NCT booklet Breastfeeding - How To Express and Store Your Milk. You may need to express over several sessions in order to collect enough extra milk to leave for your baby.

Formula milk

Formula milk isn't nearly the same as breastmilk. It's modified, dried cow's milk. No one has discovered the "formula" for breastmilk; a living fluid containing hormones and many other substances that we are only beginning to understand, such as antibodies to fight the germs specific to your baby's environment. Formula also costs money, while breastfeeding is free!

Even a little formula milk could increase your baby's risk of respiratory illnesses, diabetes, gastroenteritis, ear infections or asthma and, if your family has a history of allergies, eczema. The best protection against all these illnesses is to feed your baby as much breastmilk and as little formula as possible.

Water and fruit juice also reduce the protection breastmilk gives your baby. Neither is necessary at least until your baby is having solids.

If you do need to use formula, it's important that it is properly prepared. Ask your health visitor or midwife to go through it with you. It's easy to make mistakes in preparation, but if it's too dilute, your baby will go short of calories, while too much powder may cause dehydration. You will always need to sterilise containers and teats whether feeding formula or EBM, as all types of milk can attract bacteria.

Protecting your milk supply

Breasts are not like bottles; you can't empty them. Even if you're not eating well, your body will produce milk. It makes sense though to keep your strength up, however you feed your baby. As soon as your baby takes milk from your breast, your body makes more to replace it, and the more you feed, the more milk you will have. Only your baby knows how much milk he or she needs, and if they're allowed to feed as often as they need your baby will be telling your breasts how much to produce.

If you replace any breastfeeds with other fluids, milk will stay in your breasts, which tells your body to make less milk next time. This is why it's best to avoid giving your baby supplements in the early days when your body is getting used to how much your baby wants. This is true also for situations like jaundice, which is best cured with breastmilk, rather than water or formula milk.

Once breastfeeding is established, your supply will be harder to disrupt; for many women this appears to be at around four to six weeks. You will still not be able to miss feeds without discomfort, so you may need to express. Going for long periods without feeding your baby can cause problems like mastitis. However, if you start regularly replacing certain breastfeeds with bottle feeds, although you will produce less milk at those times, your body will continue to produce milk at other times. So, for instance, if you go back to work you may well be able to breastfeed frequently at weekends and still manage to go longer between feeds on workdays.

Babies who prefer bottles

Sometimes breastfed babies who are given bottles show a preference for bottle feeding in future, especially if they have been having difficulties breastfeeding. Newborn babies who are given several bottles are thought to be especially vulnerable. We don't know why - perhaps the baby gets "confused" by the bottle teat and forgets the technique for feeding from the breast. Skilled help may be needed before your baby breastfeeds happily again. Perhaps the ideal solution is to wait until you and your baby feel really comfortable with breastfeeding before introducing artificial teats. This might be as early as two weeks, or could be as late as six weeks. If your baby has to be fed artificially before then, you could use a special baby-feeding cup or you could spoon-feed your baby.

Babies who prefer the breast

Although some breastfed babies may show a preference for bottles once introduced, it is also true that some breastfed babies can refuse bottles! Anecdotal evidence suggests that this is common in older babies. There are several things you could try.

Experiment with different teats. Sometimes softening the teat with boiling water helps (but allow it to cool before putting in your baby's mouth).

Some babies will only accept a bottle when it is obviously not a breastfeed. You could try using cold milk, or holding your baby in a different position to the one you usually feed in.

You could also ask other people (your partner or your childminder) to give your baby the bottle. Your baby will not expect them to breastfeed, and may be more willing to accept a bottle from them.

If it is formula he or she dislikes, they may prefer expressed breastmilk. Some experts think that babies are less likely to refuse a bottle if it's introduced by about six weeks. You could offer it once or twice week after this so your baby doesn't forget.

Your questions answered

Question Will my baby become ill if I bottle feed?
Answer Statistically it is more likely that your baby will become ill, but obviously many formula-fed babies are well and grow up to be healthy children. Similarly, breastfeeding your baby doesn't mean that they will never be ill either. Research only highlights relative risks and benefits, and only you can decide what is the best option for you and your baby in your circumstances.

Q If my baby gets colic, should I try switching to bottle feeding?
A Breastfed babies have similar levels of colic to formula-fed babies, so switching to formula is not the answer. Talk to a breastfeeding counsellor, your GP or health visitor if your baby seems to have colic.

Q I've heard that bottle-fed babies sleep better at nights - is this true?
A Yes, on the whole it is. One reason might be that formula milk is harder to digest, and takes longer, so babies will go longer between feeds. However, it may also be the case that preparing bottles at night is harder work, and so mothers of bottle-fed babies are keener to encourage their babies to sleep through, while breastfeeding at night is relatively easier, so mothers don't mind feeding so often. If you are finding night waking disruptive, talk it through with a breastfeeding counsellor.

Breast pumps to hire or buy

To find your nearest NCT breast pump supplier please call NCT enquiries on 0870 444 8707

Ameda Egnell Ltd. Tel: 01823 336362.
Medela 01538 399541
The Maternity Alliance, Third Floor West, 2-6 Northburgh Street, London
EC1V 0AY. Tel: 020 7588 8583; Information line: 020 7588 8582;

For information and help on employment rights and breastfeeding. The NCT booklet Breastfeeding - How To Express And Store Your Milk, price £2.50, is available through NCT Maternity Sales 0870 112 1120

Cup feeding

Most hospitals have baby cups available on the post-natal wards or in the special care baby unit. If breastfeeding is not possible, and your baby needs to be fed, you can request that cups are used rather than bottles. Although evidence is not yet clear whether using bottles in the early days affects babies' ability to breastfeed later, premature babies who use cups do seem to make a happy transition to breastfeeding. It is important that you are shown how to do this properly, as cup-feeding a small baby is not like feeding an older child.