Bottle Feeding 101

I’m a new mom. Can you help me understand bottles and bottle feeding?

The way you feed your baby a bottle can impact the way his tongue, lips and jaw work. This could have a negative or positive impact on breast feeding and the development of future feeding skills and speech development.

The variety of bottles on the market makes it difficult to be confident that you have picked the right one for your baby. Because marketing of bottles are often based on statements that have not been researched, what is printed on the package may not actually be valid. While there is no best bottle for everyone, there are some things to consider when looking for a bottle. If your baby is coughing, choking, has irregular breathing patterns or you are concerned in any way, please ask your physician for a referral for an evaluation of your child’s feeding and swallowing.

Picking a nipple: In general, pick a classic shaped nipple, with correct firmness (so that your baby does not flatten or bite the nipple) with an appropriate flow rate so that your baby’s suck/swallow/breathe pattern is coordinated and rhythmic. In other words, so that feeding is easy and comfortable for both you and your baby. If your baby has special feeding needs, these suggestions may not apply. Choosing the correct nipple will also support breast feeding.

Positioning: Supportive positioning is very important for you the feeder and for your baby. Make sure that you are comfortable before you start to feed your baby. Be sure your baby is in an upright position providing support to the thoracic spine (back). Baby’s head should be in a neutral position so that his eyes are looking at you (not at the ceiling). This position is good for swallowing, breathing and bonding.

Placement of the bottle: Gently rub baby’s top lip with the nipple, just under the nose before placing the bottle in the mouth. This will help your baby know that milk is coming and encourage a wide open mouth to accept the nipple. Make sure that the nipple is deep in the mouth and both top and bottom lip are flanged (by the nipple ring). Your baby’s tongue should extend over the gum ridge and “cup” around and stabilize the bottle nipple.

Increasing suck strength: The negative resistance technique will help encourage a strong suck pattern for the baby who is using a “bite” pattern or is a slow ineffective feeder. When used appropriately, this technique can encourage the graded jaw movements necessary to stabilize the tongue enabling it to produce a strong suck pattern (longer draw on the nipple) and decrease “chomping” or “biting” (compression based pattern). A stronger, more efficient suck pattern will result in easy, more effective milk transfer from a bottle and will enable baby to get the richer hind milk during breastfeeding.

Pacing: Pacing may be necessary for the baby that “chugs” or has difficulty coordinating suck/swallow with breathing. Coordination difficulties place baby at significant risk for aspiration (milk going down the “wrong tube”) congestion and choking. A baby with coordination difficulties would benefit from a feeding evaluation. Pacing intervention helps baby learn to self-pace and will slow down chugging patterns and reduce the risk of swallowing dysfunction.

Nipple flow rate: Nipple flow rate can impact your baby’s tongue patterns and ability to swallow safely. Making sure that you have a flow rate compatible with your baby’s feeding skills is vital to feeding success.If the flow rate is too fast, your baby will “chug” down the bottle. Chugging patterns utilize inactive tongue patterns and can negatively impact breast feeding and could contribute to reflux, gas and irritability. A nipple in which the flow rate is too slow could result in fatigue as the baby is using too much energy to obtain the milk. Limited milk transfer could contribute to weight gain difficulties. As a rule of thumb, most babies complete a feeding in 20-40 minutes. Anything faster or slower could cause complications.

Following these simple guidelines should put you well on your way to successful bottle feeding for you and your baby. These guidelines are based on the limited research available and over 26 years of clinical experience. If you are concerned about your baby’s feeding/swallowing, now is the time to get help.