How to "Pace Feed" a breastfed baby when supplementing by bottle
A supportive strategy for breastfed infants
Any baby receiving expressed human milk, or artificial formula milk by bottle, should always be fed slowly and carefully, whilst holding the baby close and providing lots of eye contact and human interaction, why? Because this is the norm and supports normal physiological development.
How to bottle feed a baby safely is often not taught to families and may not be something you have thought of, especially if you intend to breastfeed.
Breastmilk feedings directly from the mother’s breast are always preferred to any artificial source or substance. However, this is not always possible and there are situations when a breastfeeding family may need to supplement or replace breast feeds, by using a bottle.
In the early days and weeks after birth, there are more appropriate ways to supplement breastfeeding than using a bottle , such as feeding via syringe or cup, but once milk amounts exceed 10 mls the safest way to supplement your breast fed baby is either by using a Supplementary Nursing System (SNS), or a baby feeding bottle.
If you are needing to supplement your breastfed baby then it is always best to seek the support of an International Board Certified Lactation Consultant (IBCLC), who can advise you on the best way to support your breastfeeding journey.
Paced bottled feeding is appropriate for all bottle-fed babies regardless of what is in the bottle, as this feeding style supports the baby’s normal physiology, but it is particularly important for the breastfed infant.
Although feeds in a bottle are more easily measured, bottle fed baby’s often more frequently regurgitate some quantity of the feed.
Feeding with artificial formula milk will increase the metabolic workload for the baby, lower digestibility of nutrients and increase waste and therefore will substantially dilute the benefits of any feed. For this reason always use breastmilk if possible.
Responsive feeding means to feed a baby whenever their cues indicate that they are hungry, not to a pre-determined schedule.
It is particularly important that all babies are held frequently not just when they are being fed. This avoids them being trained to eat in order to be held.
How to bottle feed using paced feeding technique:
- All babies should be held in an upright position when feeding from a bottle. Feeding laying down forces a fast flow of milk and is associated with increased frequency of ear infections.
- As with breastfeeding it is important to switch which side the baby is fed from. This encourages normal muscle development of the head and neck. Choose a midway point in the feed to switch, so that the baby does not develop a side preference when being fed at the breast.
- A whole feed should take at least 15-20 minutes, this is a minimum! Many babies will take a lot longer when allowed to take it at their own pace. By feeding at an appropriate speed the baby will recognised when it has had enough – before the stomach becomes over filled and causes discomfort and vomiting.
- Gently invite the baby to take the bottle teat into the mouth, so that baby controls when the feed begins. Stroke baby’s upper lip with the teat to illicit the rooting reflex. When the baby is ready and opens the mouth wide, allow the baby to “accept” the teat. Do not force the teat in to the baby’s mouth.
- With the baby held close and upright, the bottle should be held horizontally with just enough milk in the teat to cover the hole.
- As soon as the baby starts to drink, milk will be delivered. This is not often the case at the breast, therefore frequent pauses should be given by lowering the bottle in the baby’s mouth, or taking it out of the mouth completely.
- Allow the baby to drink in short bursts, giving frequent breaks (consistent with a breastfed rhythm) we are trying to mimic how the breast releases milk and not overwhelm the baby with the fast flow.
- Frequent pauses also discourage the baby taking the whole bottle down too quickly and supports the baby recognising when it is full.
- If your baby is a healthy term infant that is gaining weight as expected, do not force them to finish the milk in the bottle, allow them to stop feeding when they have had enough.
- You will need to estimate how much milk to put in the bottle to avoid having to discard too much at the end.
- If you are using both breastmilk and infant formula during the same feed, then always use the breast milk first then follow with formula, so that any milk that is discarded will not be breastmilk.
Signs that the milk flow is too fast:
Signs that the baby has had enough:
The benefits of paced bottle-feeding:
- The baby will consume a volume appropriate to their size and age, rather than over- or under-eating.
- Avoiding over feeding will help to reduce colic-like symptoms as the baby will not have had it’s stomach over filled.
- It supports the breastfeeding relationship, by avoiding a preference for fast flow and therefore hopefully leading to longer durations and increased success at breastfeeding .