Bottle Feeding Babies Who Are Breastfeeding

Question:

I am exclusively breastfeeding my newborn but because she only gained 4 ounces in 2 weeks, my pediatrician said that I have to bottle feed. I wanted to exclusively breastfeed, I’m afraid that he won’t be able to breastfeed anymore. What can I do?

Response:

The thought of having to use a bottle in place of breastfeeding because your baby is not gaining enough weight is very stressful and very scary. Just remember, that babies are innately designed to breast feed. When used properly, the bottle can become a therapeutic device to ensure successful breastfeeding when your doctor says that he is ready.

The first thing that you need to do is to get your son evaluated by a speech pathologist that specializes in infant breast and bottle feeding difficulties (often called dysphagia), who will teach your baby the sucking skills to promote good weight gain while preserving the breastfeeding relationship. This will ensure easy transition back to breastfeeding when your doctor is comfortable with your baby’s weight.

What can I expect during an evaluation?

Potential reasons for the poor weight gain will be evaluated. First of all, tongue and lip tie need to be ruled out as restricted lip and tongue movements can result in a poor latch and cause a baby to “bite” instead of suck. When a baby uses a bite pattern, there is often poor milk transfer. Mom’s often report that their baby only swallows with letdown and doesn’t continue to suck or will fall asleep. Restricted tongue patterns can also cause nipple pain and misshaping.

You will learn how to listen for swallow breath sounds that can tell you when your baby is drinking. Learning to count how many sucks per swallow and learning when your baby breathes, what a coordinated and rhythmic feeding pattern looks and sounds like and how to identify the correct tongue patterns will help you teach your baby the skills for efficient feeding that leads to good weight gain.

What you put in your mouth can change how your mouth works! No wonder mothers are confused. Bottle manufactures tout the specific characteristics of their bottle claiming “most like mother” or “most like breast”. The truth is none of them are “most like the breast” however some are better than others. In my over 30 years of experience, the classic slow flow nipples best stimulate tongue patterns that support breast feeding.

Keep things consistent. Good breastfeeding requires wide open mouth for a deep latch, flanged lips and strong cup of the tongue. Your feeding therapist will help you make sure that the temporary use of the bottle will encourage these essential breastfeeding behaviors during bottle feeding.

So what else can I do? These are ideas that almost all babies can do, but check with your doctor first.

• Make sure that you maintain your milk supply by pumping. This will ensure that your baby gets “the best nutrition” while bottle feeding. The hormones released during pumping can act as a natural anti-depressant and keep you calm during this time of stress.

• Human milk is best and is most easily digested by your baby. A baby’s weight gain is dependent on more than just ounces.

• Ask if you can breastfeed before or after supplementation.

• Make sure that you spend as much time as you can with your baby’s bare tummy on your bare chest (skin to skin) and allow for opportunities to suck, lick, root or nuzzle at the breast. This will allow your baby to be comfortable at the breast and not “forget”. It will also help your milk supply. Just relax and enjoy.

• Take one day at a time. Some feedings may be easier than others. Try to look at the big picture to see improvements.

Remember, your goal of exclusively breastfeeding is not lost. Babies naturally want to breastfeed so if you use the bottle with breastfeeding in mind, the transition back to breastfeeding will be smooth. Sometimes just a little bit of weight gain is all your baby will need to have the skills and stamina to become a successful breast feeder.