Thursday, July 8, 2010

Feeding Your Baby: Choosing and Introducing the Bottle

Before you return to work, you will need to introduce your baby to the bottle - that's obvious, right?  But when?  Too soon, the experts warn, and your baby may develop the dreaded 'nipple confusion' (something that many experts believe should be termed nipple preference).  Too late and you risk the stress of a baby who so prefers mom that she won't drink from a bottle at all! And what kind of bottle is best for a baby who with be both bottle and breastfed?  So many things to consider and decide.

To help make the process easier, I've broken it all down for you into two categories, outlined below:

Choosing the Right Bottle
Nipple size and shape:  The most important factor in choosing a bottle is the size and shape of the nipple.  Breastfed babies are trained to open their mouths wide to achieve a good latch - so you want a bottle that mimics that same mouth positioning.  There are a number of good brands, including Born Free, AventMilkBank, Playtex Drop-Ins or any other bottle listed as 'wide-neck'.  Examples of narrower nipples to avoid include Medela, Dr. Brown's, and most of the generic or off-brand bottles.
Plastic vs. Glass: There has been a lot of press surrounding the presence of the chemical BPA in plastic baby bottles - it's been shown to cause significant reproductive problems in laboratory animals.  Most plastic bottles are now sold BPA free, but do make sure that any you choose are labeled this way.  An alternative to plastic is glass bottles.  These are 100% BPA-free, and also are likely free of the next 'unknown' plastic-based contaminants.  Generally these are very sturdy and some come with rubber covers that can reduce the likelihood of breakage.  However, they are more expensive (often much more) than their plastic counterparts, and no glass bottle can be made 100% shatter-proof against an older baby.
Sizes - bottles and nipples: Most bottles come in a small and larger size, typically 4-5oz and 8-10oz. Very few breast fed babies ever need more than 4oz per feeding, even at 10-11 months of age.  Knowing this, I recommend that you save your money and only purchase the smaller bottles.  When you're shopping, you'll notice that nipples come in a variety of flow rates, with 'faster flow' nipples recommended for older babies.  As with smaller bottles, breastfed babies only ever need the slowest, newborn flow nipples.  This is because a breastfed baby does not need larger volumes of milk as he gets older, and there's no need for hinm to guzzle down 4 oz of milk in a few minutes.  Just as with adults, there are benefits to consuming meals (and bottles) at a slower pace.
  Introducing the bottle
When to start: The general guideline for introducing a breastfed baby to his first bottle is that baby 1) must be well established with breastfeeding (proper latch, good suction, good weight gain and plenty of wet and dirty diapers) and 2) should be at least 2 to 3 weeks old.  Of course, if you need to be separated from baby before the 2-3 week mark you can introduce a bottle before this point - and in most cases your baby will learn to switch back and forth between breast and bottle just fine.  My oldest two started on bottles around 2.5 weeks of age, but my youngest had her first bottle at just 5 days old (I had to teach a class!) and is still nursing happily at almost 6 months old without issue.
How to start: Start with just an ounce or two of warm pumped milk.  Choose a time when baby is likely to be hungry - but not starving (or frantic!).  The best piece of advice is to have dad or another caregiver offer the bottle to baby.  A baby is more likely to accept bottle feeding from someone other than its mother - because he already associates mom with nursing directly from the breast and may be confused by the bottle.  This is a time when it is important to give up control!  Don't hover - don't even be in the room.  Go for a walk, go to the grocery store, take a nap, whatever it takes.  You will not be bottle feeding your baby, someone else will.  Hovering, worrying, or criticizing will not help matters - it is up to baby and daddy (or other caregiver) to figure this whole bottle thing out together.  Make sure that dad knows not to pressure baby - if she's not interested, save that milk and try again later in the day, or try again tomorrow with some fresh milk.  Under no circumstances should you try to starve your baby into accepting a bottle!
One you've established that your baby will drink from the bottle, you need to make sure to keep her in practice.  I recommend having someone else feed baby a small bottle (even a single ounce is fine) 1-2x a week until you return to work.  This will ensure that baby continues to be familiar with bottle feeding and won't resist it her first day of daycare.

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