“Paced” Bottle Feeding
Paced bottle feeding is an essential skill for any caregiver who will be giving a bottle to a baby at any age. It prevents gas and spitting-up, protects baby’s airway, helps their eyesight develop properly, and may prevent overeating in adulthood!
Moreover, if you are also breastfeeding your baby (or hoping to get them to breastfeed if they haven’t so far) there are elements of bottle feeding that you can change to increase the success of breastfeeding babies going back and forth between bottles and breast, or in learning skills to become breastfeeders as they grow.
Read on to learn how to pace your baby’s feed and why paced bottle feeding is such a good idea!
Doesn’t everyone know how to feed a baby with a bottle?
Sure, I’d say almost everyone can get some milk into a baby using a bottle! But, will they feed that baby in an optimal way that leaves baby satisfied and creates healthy habits? My experience trying to find free images of paced feedings suggests the answer may be “no”…
Most of the images I found show babies being fed with the bottle in a very upright posture, which allows gravity to “push” the milk into baby’s mouth and can overwhelm an infant, cause spit-ups, increase gassiness, and instill unhealthy habits about speed and amount of food intake that your kiddo may take with them into adulthood.
How can pacing a feed help your baby, exactly?
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The urge to “finish the bottle”, speed along the feed, or techniques that increase flow of milk to baby (like holding the bottle vertically or using a teat size that is too large for baby’s age) can over-fill baby’s tummy and create neural pathways that over-ride the body’s natural satiety expressions.
Bottle fed babies are more likely to be fed on a schedule, disconnecting the feeding from the expression of hunger.
(see Ref 1, below)
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Using frequent pauses for baby to catch their breath, and the slowest-flow nipple that baby will tolerate, caregivers are supporting a deliberate and careful swallow pattern.
If you have ever chugged a drink vs drank one, then you know what I mean!
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A major anxiety among my clients is this double edged sword: what if they introduce a bottle and baby never goes back to the breast? what if they never introduce a bottle and they can never leave the house for more than three hours ever again!?
Babies are smart - they will go for easier calories. If you slow down bottle feeding and make it mimic breastfeeding more closely you have a better chance at avoiding any preference from baby.
(See Ref 3, below)
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New parents can feel quite out of their depth in caring for a new baby. Paced bottle feeding skills allow parents to respond to their baby’s needs, see the success it brings, and build confidence in overall parenting.
The infant gets the message that “these caregivers are keeping me safe and comfortable”, allowing everyone to enjoy babyhood more!
(See Resource 1 for more, below)
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The mechanics of feeding on a bottle are different than from those at the breast. Infant posture and swallowing with a wide-open mouth at the breast prevents milk from flowing into the eustachian tubes (thats a fun word to say!).
The sucking (instead of the jaw-intensive suckling at the breast) on a bottle can cause negative pressure in the ears - ouch! This can pull milk into the ears, further aggravating baby. And laying flat on their back for a feed also promotes pooling of milk near the eustachian tubes.
(See Ref 2, below)
And here’s how to do it!
Hold baby either upright/slightly reclined. To mimic the coziness of breastfeeding, you can cuddle baby in close with their cheek against your chest. For parents who are working to get their baby to progress to breastfeeding directly, feeding in this position with a bare breast is recommended when possible.
Ensure baby's neck is supported and they are able to tip their head slightly back (this about how you would tip your head back if you were drinking from an open cup of water)
Pick the right bottle and the right teat. I need to do a whole post on this… choose a teat that is “rated” for your infant’s age. Check what size the teats are that you inherited from your neighbour/sister in law etc. Choose the slowest-flow teat that your baby can work with.
Don’t fill up the whole bottle. Formula that is offered to an infant can’t be reused later so pour a little into the bottle at a time so that, if baby doesn’t finish the bottle, there is less waste!
Hold the bottle as close to horizontal as you can - we don't want gravity doing any "helping" - just tipped down enough that the milk is covering the hole in the teat.
Gently stroke down from baby's top lip to bottom lip, offering the bottle. You may want to let a little drop of milk leak out onto the teat so baby can smell and taste it. Let your baby open up when they are ready to drink - resist the urge to force the bottle into their mouth.
Mimic the rhythm of breastfeeding. Allow your baby to take a few sips, then tilt the bottle so that the milk leaves the teat, or remove it from baby's mouth completely and allow them to take a breath. If they slurp the bottle back in and don't want to stop, let them keep drinking a few more sips and try again.
Watch baby's cues throughout the feed. Signals like wide eyes, splayed toes, fists in "fighting posture", or baby turning their head away may be showing you that your baby is struggling with the flow and needs a break, or is done feeding for now. We want baby's brain to be able to query their body for fullness and for that to be respected.
Feed on both sides, either switch halfway through the feed or feed from the other side on the next feed, to help baby's eyesight and neck strength develop equally on each side.
What to do about caregivers that are “not on board”
So your Nana doesn’t believe in pacing the feed, or your daycare provider needs to speed up the feed and baby is yarfing it all back up each day, or baby is fed by someone else while you are ill…
It couldn’t be easier - send them this link, ask them to watch it, and tell them that they might get a cookie if they are very nice and listen to mother, who knows best.
How long is this going to take?
I would argue that speeding along a feed doesn’t save you time in the long run, with the burping and fussing that can come after a quick drink.
Infants bottle feeding, especially when they are newborns, may take 15-20mins to drink a bottle. This is normal. By supporting this behaviour, you “go slow to go fast” so that by the end of the feed you have a happy camper, ready to drift off to sleep, who won’t throw up all over you. Bliss.
References
Paul IM, Bartok CJ, Downs DS, Stifter CA, Ventura AK, Birch LL. Opportunities for the primary prevention of obesity during infancy. Adv Pediatr. 2009;56(1):107-33. doi: 10.1016/j.yapd.2009.08.012. PMID: 19968945; PMCID: PMC2791708.
Brown CE, Magnuson B. On the physics of the infant feeding bottle and middle ear sequela: ear disease in infants can be associated with bottle feeding. Int J Pediatr Otorhinolaryngol. 2000 Aug 11;54(1):13-20. doi: 10.1016/s0165-5876(00)00330-x. PMID: 10960691.
Howard CR, Howard FM, Lanphear B, et al. Randomized clinical trial of pacifier use and bottle-feeding or cupfeeding and their effect on breastfeeding. Pediatrics 2003;111:511–518.
