Dad's Guide to Bottle-feeding Breastmilk

As our world has changed over the last two years with more parents are working from home and sharing the responsibility of feeding the baby.  My own son is expecting his first and his wife will be working outside the home while he runs his business from home.  

Since babies don't come with an instruction manual, Dads and other caregivers can benefit from some advice on feeding while mom is away.

#1.  Introduce the Bottle at 6-8 Weeks

This time frame is optimal because it allows enough time for mom and baby to establish a good latch and breastfeeding rhythm.  Waiting longer than 6-8 weeks can sometimes make it more difficult for baby to want to transition from breast to bottle.  The goal is to use this window of opportunity so that baby goes back and forth from breast to bottle seamlessly.  

#2.  Choose the Bottle with Intention

The intention behind choosing a bottle is that the nipple had a wide mound so that baby opens wide simulating the same latch as they would on the breast.  The bottle nipple should be silicone and not rubber that has a smell and taste and should be a slow flow or newborn nipple.  Some recommended bottles and nipples are Spectra, Motif Luna, Hygeia and Comotomo.  

#3.  Schedule an Introductory Trial Run

It may be difficult for Dad or any caregiver to try to introduce a bottle with mom is nearby.  Plan a time that mom has a short outing and when it has only been 2 hours since the baby has fed.  Waiting until the three hour mark increases the infant's agitation and willingness to try a new way of feeding.

#4.  Position Baby

Make sure the baby's head is above their body.  Most images you see of bottle feeding have baby in a cradle hold with the bottle above them which can be effective.  When using a cradle hold, the crook of your elbow is lifted so you may want an extra pillow on the armrest so your arm doesn't get fatigued in that position.  If the infant is refusing the bottle in this position, there are several other positions to try.  One is to simulate the position at the breast, hold baby tummy to tummy with you and hold the base of the bottle close to your chest.

#5.  Take it Slow

It is important to slow down the feedings as bottles drip automatically and can cause the infant to feed too quickly getting more air and taking in more breastmilk than mom is producing.  One way to slow the feeding is to stop and burp after each ounce.  

It is important not to offer baby more than the appropriate amount for weight gain or you may undermine moms confidence in her milk production.  So the next question is, how much does the baby need?  To calculate the infant's need, take the baby's weight and multiply by 2.5 which will give you the number of ounces per day. Divide this number by the number or feeding per day which is normally eight.  This will give you the number of ounces per bottle.  But who has time to do math with a new baby in the house so below is a handy chart for you to use.

Once the baby gets used to the bottle, it can be daunting if they finish quickly and still act as if they are hungry.  It is evident a baby over 6 days of age is getting enough by the wet diapers which should be 6-8 per day.  The number of dirty diaper can vary but generally 3-4 per day up to 3 months and then can slow down to one every three to five days. It is also important to know that an infant going through a growth spurt which is typically 3 weeks, 6 weeks, 3 months and 6 months will act hungry and mom may need to increase her pumping schedule for 5 days in a row to boost her supply to match the baby's demand.

#6.  Know How to Handle Breastmilk

As anytime you feed an infant, you will want to wash your hands.  But there is much more to know about how to handle breastmilk when it comes to storage, thawing and feeding.  

Breastmilk is good at room temperature for 4 hours, but if the baby pauses a feeding it needs to be used within a 2 hour window.  It is good in the refrigerator for 4 days, but you should then use it and not freeze it as you have used up the life of the milk.  It is good in a freezer for 6-12 months but you should not store it in the door and you should never re-freeze thawed breastmilk.

When thawing breastmilk, it is best to do this in the refrigerator overnight, on the counter for three hours or in a container of warm, not boiling hot water.  You can also use a commercial bottle warmer provided it has a thermostat reading as breast milk is best served between 77 degrees and 98.6 degrees Fahrenheit for optimal digestion. If you are thawing breastmilk, use the oldest milk first.

Use fresh milk whenever available.  While it seem reasonable for mom to pump and stockpile her freezer, using frozen stock on the first workday of the week is good, but the rest of the week use Monday's expressed milk to serve on Tuesday, etc.  The reasoning behind this is that freshly expressed breastmilk has living white blood cells in it that are no longer living when frozen. Don't get me wrong, frozen milk is still far superior in nutrition and antibodies than artificial infant milk, but the fresh milk is optimal in those while blood cells providing greater active immunities for your baby.  In addition, breastmilk changes over the months so that as the baby grows and the needs of the baby grow, the milk expressed at that time is age appropriate in it's benefits as shown on the infographic below.

#7 Encourage Mom

Expressing breastmilk for baby takes time and commitment.  Remind mom that she is leaving her baby a gift every time she leaves breastmilk for a feeding.  Breastmilk is liquid gold and liquid love for her baby and this provision can help mom in the transition from being home to being away from her precious infant. Another bit of encouragement and boost to milk supply is to pack her bag with a water bottle, nutritious snack or lactation cookie bar. And of course a nice note in her pump bag every now and then never hurts!

Best wishes for Bottle Feeding Breastmilk!

Tanya

P.S.  Feel free to leave questions!

Introducing a Bottle to the Breastfed Baby

When should I introduce a bottle to my breastfed baby?

     

Waiting to offer a bottle is essential for initiation of lactation.  Experts tell us that we should wait at least 3-4 weeks.  I believe it should be at least four weeks because even a bottle of breastmilk can interfere with stimulation during the three week growth spurt period. It can undermine moms confidence when baby gulps a bottle down during the hunger games of growth spurts.  When you offer a bottle of expressed milk, it is essential to pump to replace that feeding or it can interfere with milk supply or cause plugged milk ducts. 
     Most moms begin a bottle because they want the freedom of allowing someone else to feed or out of necessity because they are going back to work.  If you choose to nap and let Dad feed make sure to fully empty the breasts by nursing first.  If a bottle has been given while you were asleep or running errands, pump when you return even if you have nursed immediately when you came through the door.  Anytime a bottle was given, baby will not be as hungry and therefore not empty the breast as well and residual milk can cause clogs especially in the early weeks of breastfeeding.
     If you are not going back to work or want someone else to feed, a bottle is not an absolute.  You may wait longer if you wish, but some moms who wait longer than 8 weeks find it difficult to coax their baby into taking a bottle.  So if you are going back to work, the best window may be 4-8 weeks.  If you are not going back to work, but find yourself in an emergency situation that you have to be away from your baby, the baby will normally take a bottle from another person if you are gone very long.  If you are not gone more than 3-4 hours, the baby may also wait for you.  In any case, it is important to have stored up at least 24-48 hours worth of breastmilk in the freezer.   Here is a breast milk intake chart to help you determine how much you need based weight.

Store milk in 2-4 oz increments.  This makes it easy to defrost and access just the right amount without waste.  You may store breast milk in sealed bottles or breast milk bags.  Bags have been the preferred method for most moms due to the quicker defrost time and space saving size.  They are more costlly in the long run so bottles may be more cost effective and better for the environment, but today inexpensive biodegradable breast milk storage bags are available.

What to do if you baby refuses a bottle?

First of all, don't panic.  Almost all babies will eventually take the bottle.  Here are some tips to help you get things going:

1.  Start with a soothing environment such as in a favorite rocking chair and you could even put on some music or white noise.

2.  Use a silicone wide mouth nipple so that the nipple itself does not have a taste.

3.  Squeeze a few drops out of the bottle nipple so that the baby can smell and taste immediately.

3.  Let someone other than mom initiate bottle feeding.

5.  Place the baby in a breastfeeding position which is tummy to tummy with the caregiver and hold the base of the bottle close to your collar bone.

6.  If the baby just takes the tip of the nipple, gently screw it in like a lightbulb to get their lips flanged.

7.  Often the best time to try bottle feeding on a reluctant infant is when they are already falling asleep or not yet fully awake from a nap.

8.  If  you are still having trouble, try walking while feeding.

Happy Feeding!

Tanya