Your Ultimate Guide to How to Bottle-Feed a Baby
August 24, 2018
Whether you’re breastfeeding, formula-feeding or doing a combination of both, chances are you’ll eventually use a bottle with your infant. No big deal, right? But while images of a parent blissfully holding a bottle make the process look easy, there’s a learning curve when it comes to proper bottle-feeding. Here, everything you need to know about how to bottle-feed a baby safely and happily.
In this article:
How to choose the right bottle and nipple
How to make a baby bottle
Best bottle-feeding positions
What is pace feeding?
How to get baby to take a bottle
When to wean baby off the bottle
When it comes to figuring out how to bottle-feed a baby, selecting an appropriate bottle and nipple is step one. If people gifted you a bunch of bottles at your baby shower, you may want to hold off before opening and sterilizing them until baby is born, or at least take out just a few to try in the early days of feeding. Why? Because you won’t know what kind of bottle is best until you figure out what baby’s feeding needs are.
“Certain bottles work better for certain babies,” explains Jamie O’Day, BSN, RN, CLC, a registered nurse, certified lactation consultant and cofounder of Boston NAPS, a pre- and postnatal resource center in the Boston area. “For example, some babies who have issues with gas may do better with a bottle that has a filtration system, like a Doctor Brown’s style bottle, while babies who are used to being breastfed may have more success drinking from a bottle that aims to mimic the shape and feel of a mother’s breast, like the Comotomo.”
That said, O’Day has a universal tip for all parents: Look for a bottle that’s easy to take apart and clean. That generally means a nice wide neck and the fewest parts possible. “Proper cleaning is so important, so I always tell parents to choose the simplest bottle, which may just have a nipple, bottle and collar,” she says. If your child seems happy and easily takes the bottle, then there’s no need to switch.
Of course, it’s not just the bottle that you have to consider. It’s also important to pay attention to the flow of the nipple, which varies based on infant age. Generally speaking, young babies need a slower flow, while older babies who’ve mastered the art of bottle-feeding can handle a faster flow. The nipple may be called “slow flow,” “medium flow” or “fast flow” or may be numbered from one to three, with one being the slowest flow. There is no standard of flow between different brands, but most newborns should begin on level one or slow flow.
So how can you tell when it’s time to change the nipple size? That depends. Some infants happily use the same flow nipple throughout their infancy, while others may need a faster flow nipple. “If you notice your child taking a long time to finish a bottle, or losing interest midway through feedings, a faster flow nipple may be needed,” O’Day says, adding that this might happen at around 3 or 4 months of age, with another potential upgrade around 6 or 7 months.
If your infant finishes a bottle quickly (say, under five minutes), seems gassy or cranky, or spits up a lot of milk right after feedings, it may be time to go back to a slower-flow nipple. Your pediatrician can also help determine if it may be time to switch the flow of the nipple.
If you’re wondering how to bottle-feed a baby, you’re probably new to prepping baby bottles. Take a new skill, add in sleep deprivation and sprinkle in some very real safety concerns and you’ve got the somewhat daunting process of making a baby bottle (at least at first). Don’t despair. By reading directions, following the advice of a pediatrician and making sure to err on the side of caution, you’ll get the hang of it in no time.
How to make a baby bottle with formula
Baby formula comes in three different forms: ready-to-feed, concentrate and powder. The Centers for Disease Control and Prevention (CDC) recommends that babies under 3 months start off with ready-to-feed formula because of the small but real risk of cronobacter, a bacteria that can live in powdered infant formula.
• Preparing ready-to-feed formula: These require very little prep, since they come ready to be poured into a bottle and fed to an infant. Some ready-to-feed formulas come in bottles that can accomodate disposable nipples—all you need to do is screw a nipple on, feed and discard.
• Preparing concentrate formula: To prepare a baby body with this liquid formula, you’ll need to add water. It’s important to read the directions to learn the right ratio of water to concentrate. As for what type of water should you use, that depends on where you live, your pediatrician’s recommendation and your own wishes. If your tap water is safe, feel free to use it—just run it for several minutes before you fill the bottle to remove any trace contaminants in the water. You can also use filtered water, bottled water or boiled (and cooled) tap water.
• Preparing powdered formula: Just like concentrate, it’s important to follow directions on the right ratio of scoops of powder to ounces of water, says Carmen Baker-Clark, an International Board Certified Lactation Consultant (IBCLC) in Hoboken, New Jersey. When using powdered formula, make sure to shake well so the liquid isn’t clumpy. “Some parents notice powdered formulas may make their infant more gassy, more prone to spit-up or more constipated. A lot of this is due to the bottle preparation. For example, not shaking enough can create uneven consistency that may be harder for baby to digest,” Baker-Clark explains.
Regardless of what kind of formula you choose, Baker-Clark recommends sticking with the same brand or being deliberate as you try new ones, instead of just using whatever formula is on sale. While all infant formulas are regulated by the FDA and must pass the same nutrient tests, babies may react differently to various brands of formula. If an infant has frequent reflux, crying episodes or seems uncomfortable after a feeding, speak with your pediatrician. Your child may have an allergy or intolerance and may need a special formula.
Whether you warm the bottle up is up to you. “Many infants have no problem taking a cold bottle and the advantage is that you then don’t need to warm a bottle when you’re on the go,” Baker-Clark says. Once a formula bottle has been made and the nipple has touched baby’s lips, the bottle is good for an hour. But if the bottle isn’t used, a bottle may be refrigerated for a day, O’Day says. Some parents like to prepare and refrigerate a bottle in advance to make middle-of-the-night feedings easier, while others may prepare a pitcher to use during the day.
How to make a baby bottle with breast milk
Preparing a bottle of breast milk is of course much more straightforward, since the milk itself is ready to go. But when grabbing a bag of breast milk to use, it’s important to keep an eye on when it was pumped and how it’s been stored since. According to breast milk storage guidelines, it’s safe to use freshly pumped milk that’s been stored at room temperature for up to four hours, in the fridge for up to four days or in the freezer for up to 12 months. Always use the oldest milk first. If baby doesn’t finish a bottle, you can offer it again within two hours of the last feeding.
Before giving baby the bottle, you can warm the milk up by placing the bottle (or milk storage bag) in a cup of warm water for a few minutes, or pop the bottle into a bottle warmer. Whatever you do, steer clear of the microwave, which can cause dangerous hot spots.
How you hold your little one during a feeding is a crucial part of knowing how to bottle-feed a baby properly. Chances are, you’ve come across loads of images of parents bottle-feeding babies—but the positions you sometimes see in photos or on TV may not actually be the best for baby. For one, forget about laying baby across your lap. “Have you ever easily drank something while you lay on your back?” O’Day asks. (Answer: no.) “It’s the same for baby.” Not only can a back position lead to reflux, but it may also cause ear infections. Try these bottle-feeding positions instead:
• Cradle baby in your arms. This is the classic position you probably think of when you imagine giving baby a bottle. In this bottle-feeding position, baby’s head rests in the crook of your arm as you hold her head and chest at a slight incline—close to your chest is great.
• Hold baby upright. Instead of lying down, baby should be almost in a seated position, with his head on your chest or in the crook of your arm. “This position can work especially well for infants who have reflux,” Baker-Clark says. Tilt the bottle so the milk completely fills the nipple, since a nipple filled only halfway with milk may lead to baby gulping some air, which can lead to gassiness or reflux.
• Use a pillow. A nursing pillow can be helpful in keeping baby’s chest and head propped up at an angle. Bonus: It can give your arms a break too as you cradle baby in your lap.
• Switch sides. Regardless of whether you’re breastfeeding or bottle-feeding exclusively, switching baby from one side to another can help prevent your little one from developing a side preference and can give your arms a break. Switching sides can also naturally pace a feeding session and can give baby a chance to decide whether or not he’s full before the bottle is finished.
As baby gets older, she may toy with holding the bottle. That’s fine, if she wants to, but it’s not a developmental milestone. “She may want to hold the bottle at 6 months, so you can let her, but you should still be close by, holding her and supervising her,” O’Day says. And if baby doesn’t show any interest in holding her bottle? As long as she’s reached other developmental milestones, like reaching or grasping for toys, it’s totally normal if your older infant wants his bottle served to him.
You may have heard of “pace feeding” and wondered how to bottle-feed a baby using this method. “Paced bottle-feeding is where you follow baby’s cues and allow for breaks,” Baker-Clark says. “Taking the bottle away and re-offering it benefits both breastfed and exclusively bottle-fed babies.”
Pace feeding helps babies learn to regulate their hunger and allows ample time for digestion. It can also cue you into baby’s biorhythm, O’Day says. You may find baby doesn’t uniformly eat the same size bottle at each time of day. For example, maybe he’s extra hungry in the morning and drinks 8 ounces, but prefers 4-ounce bottles post-nap. Paying attention to baby’s cues can help you clue into her unique needs and natural schedule.
Plus, paced bottle-feeding makes a feeding session—which can last about 15 to 20 minutes—a great time for baby and his caregiver to bond. Here, some tips for how to pace feed:
• Hold the bottle at a horizontal angle. When the bottle is held horizontally, baby has to work to pull milk from the bottle, instead of the milk dripping into her mouth.
• Give baby some breaks. Instead of pulling the bottle away from baby’s mouth, lean the bottle back so the milk leaves the nipple. That way, baby has a chance to catch his breath. If he seems like he’s still rooting for milk, offer him more.
• Burp mid-feed. “If baby is pulling away, seems fussy or seems to be playing with the nipple with her mouth, give her a burp,” O’Day says. Then offer the bottle again.
Even if you’re planning to exclusively breastfeed, at some point you’ll likely need some pointers on how to get baby to take a bottle. “I tell my clients to introduce baby to a bottle once breastfeeding has been established, which depends on each mother-baby dyad, but on average, it’s around one month,” O’Day says. “Even if they’re not planning to regularly bottle-feed, doing so can give peace of mind if an emergency comes up, and can also be a way for mom to get a break.”
Some babies take a bottle no problem—after all, sucking is an instinctive reflex, which is why bottle-fed babies tend to get the hang of it in the first few days of life. But other breastfed babies may initially be reluctant to take a bottle. And sometimes breastfed babies have no issue taking a bottle when they’re one month old, but if a bottle hasn’t been regularly offered, by 3 or 4 months of age, they’re less happy to accept a bottle. Bottle resistance is pretty common, but luckily there are some tried-and-true tips for what to do when baby is refusing a bottle.
• Offer often. Even if you’re breastfeeding, O’Day recommends giving baby at least one bottle a week, once breastfeeding has been established. “That way it’s part of their routine, so they’re less likely to resist it,” she says.
• Don’t offer it when baby is starving. If you’re regularly nursing your infant, O’Day suggests offering a bottle in between nursing sessions. “If they’re too hungry, they may be too worked up to take a bottle. If they’re calm and not super hungry, they may take it,” she explains.
• Let others try bottle-feeding. Some moms have success leaving the house and allowing their partner to try feeding baby a bottle. Again, try it at a time that’s not baby’s “must-feed” time.
• Don’t get frustrated. If baby isn’t taking the bottle, O’Day suggests putting it down and trying again later rather than forcing it, which can make both you and baby upset.
• Ask for help. A lactation consultant can suggest some techniques to help get even the most resistant bottle-feeders to accept a bottle. They may check your infant’s mouth and tongue for any latch problems that could contribute to the difficulty, suggest the best bottle for your infant, troubleshoot any behavioral issues or offer alternate nutritive methods, such as cup- or syringe-feeding.
The American Academy of Pediatrics recommends parents stop offering bottles by 18 months due to tooth decay concern, but it’s smart to talk with your pediatrician about exactly when baby should wean from the bottle around the 9-month mark, O’Day says. “How and when to wean depends on how much table food baby is eating, any developmental concerns and your pediatrician’s assessment,” she says. Note, though, that cow’s milk shouldn’t be introduced until baby is 12 months old.
When baby is around 6 months old, offer a sippy cup or straw cup for water, O’Day says, since learning to drink from cups can help make the transition from bottles seamless. Some babies have no problem giving up the bottle, while others may require more time to make the transition, but looping in your pediatrician or lactation consultant can help make sure you’re all on the right track.
Whether you’re breastfeeding and offering the occasional bottle, combo-feeding or exclusively bottle-feeding, you might hit some bumps along your bottle-feeding journey. But there are ways to navigate through any problems that arise. If you’re struggling to find the best baby bottle for your child, need some pointers on how to bottle-feed a baby in an optimal position or encounter a full-on bottle strike, reach out to your pediatrician or lactation consultants for guidance.
Published August 2018
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