Introducing a Bottle: When, How, and What to Look For
Maybe you have worked hard to get breastfeeding going, and now you're wondering how and when a bottle fits in. Maybe your return-to-work date is on the calendar. Or your pediatrician is recommending you supplement because weight gain is slow, and the bottle came sooner than you planned.
Wherever you are, the goal is the same: a bottle that supports breastfeeding, and a baby who can get the nourishment they need when a bottle is necessary. Here is what I share with the families I work with at Nourish Therapy in Poulsbo, Washington.
When to introduce a bottle
If breastfeeding is going well, bottle introduction can wait until around 4 to 6 weeks. That gives you and your baby time to find your rhythm at the breast first. Sometimes, though, a baby is struggling to gain weight at the breast, and an earlier bottle is needed to supplement. Early introduction won't wreck breastfeeding. Feeding your baby comes first, and a bottle can be part of a plan that still protects your breastfeeding journey. What I don't recommend is waiting until the week before you return to work to start.
Why timing matters: nature's training wheels
Babies are born with hard-wired feeding reflexes that act like training wheels for both breast and bottle feeding. These reflexes help babies learn new feeding skills more easily in the early weeks.
Around 12 weeks of age, those training wheels come off. Feeding becomes more of a learned skill, and a baby who has never had a bottle may find it much harder to figure out something new. Starting earlier gives your baby the chance to learn while the reflexes are still active.
What about nipple confusion?
I don't worry about nipple confusion. Many families hold off on bottles out of fear their baby will "forget" how to breastfeed, but in my experience that fear keeps a lot of babies from learning a skill they may really need. You may have also heard that you need the slowest-flow nipple available to prevent bottle preference. That may not be necessary either. A flow that's too slow can be just as frustrating for a baby as one that's too fast, and make it difficult for them to gain weight when bottles are necessary.
Finding the right flow
Aim for a flow rate of roughly 5 to 7 minutes per ounce. Faster than that, and your baby may struggle to keep up. Much slower, and baby may struggle to finish a bottle due to fatigue.
Which bottle is the best bottle?
There's no single best bottle for every baby. For most babies, though, a nipple with a gradual slope is preferred. This lets your baby open wide and seal their lips and tongue comfortably around the nipple. A few examples..
Bottles with gradual slope:
Bottles with less desirable design:
Avent Natural
Comotomo
Tommee Tippee
Emulait
MAM
I tend to avoid bottles that have flattened nipples, as they reward compression or "chompy" feeding. Other nipples I avoid are those that have a wide base with straw-like nipple. These are difficult for babies to have a deep, wide latch, and often they slide back to a shallow latch that looks like nipple feeding with overuse of the lips. We want to encourage a wide latch with use of the tongue, which is why a gradual sloped nipple is more ideal.
Signs your baby may be struggling with the bottle
Bottle feeding should feel relatively calm and efficient for your baby. These signs may mean something isn't working:
Can't seal their lips around the bottle
Appears to be "chewing" on the nipple
Milk leaking from the corners of the mouth
Gagging
Coughing
Clicking sounds while feeding
Gulping
Feedings that regularly take 30 minutes or more
Bottle refusal, or not being able to take a bottle at all
When to work with a feeding specialist
If bottles were recommended to help your baby gain weight, the bottle is a temporary solution, but it likely won't fix the feeding inefficiency. Working with a feeding specialist can help you get to the root cause of why your baby isn't gaining at the breast, and help build the necessary skills.
Similarly, if your baby can't take a bottle, offering one every day may not be enough. Persistence alone doesn't always build the skill. A feeding specialist can look at what's making the bottle hard for your baby and help you find a path forward.
You don't have to figure this out alone. If any of this sounds familiar, reach out to a feeding specialist who can look at the whole picture: your baby, your feeding goals, and your family. A feeding specialist includes an IBCLC Lactation Consultant, as well as a Speech-Language Pathologist or Occupational Therapist who specializes in infant feeding. Bottle feeding support in Kitsap County
At Nourish Therapy in Poulsbo, WA, I support families across Kitsap County, including Bainbridge Island, Silverdale, Kingston, Bremerton, and Port Orchard. As a Speech-Language Pathologist and IBCLC, I help with bottle introduction, bottle refusal, and slow weight gain, while protecting your breastfeeding goals. If your baby is struggling with the bottle or the breast, reach out to schedule a consultation.
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