I am working for a few weeks as a maternity nurse for Debbie, a first time mother whose baby came earlier than expected. Her sister Susie comes for tea with her daughter who is eight months old.
Come and sit down, I want to pick your brains!” says Debbie when I bring in the tea tray. “Susie is saying that Eliza won’t take a bottle and it is concerning her a lot. I’ve only thought about getting breastfeeding established, but I don’t want to find myself in Susie’s situation later.”
I look at Eliza, contentedly sucking away under her mother’s jumper. “I know,” says Susie, returning my look. “This is so easy, and we both know it. But I have to go back to work eventually and I don’t want a battle on my hands. What can I do?”
There are two expectant faces looking at me, one with a newborn and one with an 8 month old.
“Well,” I begin. “The first thing to remember is that you need to get breastfeeding established before you start trying anything else so that your baby doesn’t get confused.
That really ought to have happened by six weeks for most babies, so then you can introduce something new. I would suggest possibly expressing some breast milk and feeding an ounce or so at the beginning of a feed (making sure you follow storage and preparation guidelines) then continuing the feed on the breast. You can find latex teats which are very similar in texture to a mother’s breast, so the difference is minimised; you can warm and soften the teat with warm, boiled water that has been allowed to cool. Don’t force the teat into your baby’s mouth, put it near so she has to latch on, in the way she is used to doing with a breast. And remember, bottle-feeding is easier because the milk is squirted to the back of the baby’s mouth, so she won’t have to work as hard for it.”
“Alternatively, you could use a bottle for one feed in every 24 hours. This has the benefit of your baby getting used to the same milk coming from a different source, and of course someone else feeding her, which gives you a break. You might choose to express during this feed, so your body maintains the same production routine, but your body will get used to whatever milk routine suits you within three days or so.”
Debbie interjects, “That’s a useful thing to know when you are dropping a feed altogether,” she says. “But I thought exclusively breastfeeding is the best way to feed your baby?” I explain that I am not talking about formula milk at this stage, unless parents have decided they want to introduce it. I clarify that the great work Debbie is doing with breastfeeding would not be jeopardised by replacing one feed with a bottle of expressed milk and that even working mothers can express their milk at work in order to continue breastfeeding for longer.
“But what if you haven’t done these things from an early stage?” asks Susie. “Is it too late?”
“No,” I reassure her. “And don’t turn it into a struggle, just know that you have to be patient. You are a good teacher to your baby. Look at what you have already taught her – breastfeeding, sleeping routines, social interaction. And the many things you will teach her in years to come. This is just another one of those things, so approach it calmly, confidently and consistently, and you will succeed.”
By this time Susie has finished breastfeeding Eliza and has pulled a pen and pad from her bag. I laugh. “I’m always at the end of the phone, you know,” I tell her. “Yes, but I’m serious about getting this cracked,” she replies.
“Okay,” I say. “Here you go. I suggest you start on a number 1 teat regardless of what it says age-wise on the box. Breastfed babies are used to working for the food and a higher numbered teat can mean it comes out too fast and surprises them, offering a negative first experience. I would get someone else to feed Eliza, like her dad or granny, because she will smell your milk on you even from 20 feet away and wonder why you are changing the habits she is familiar with. Assuming I was working with a baby like Eliza who is weaned, or in the process of being weaned, I would offer other drinks and in other ways, say a sippy cup with water or juice in it, and a teaspoon with some breastmilk on it.
This makes them interested in the new changes because there are so many of them, and they forget to fight for the one way they are used to getting breastmilk. An obvious point, but worth making, is that if you are introducing formula, bring it to the same temperature as breastmilk, by which I mean body temperature. Shake a few drops on your wrist – it shouldn’t feel hot or cold.”
As with all forms of babycare and child-raising, every baby will respond differently. Some babies will put up less resistance when they are tired, so you can pick a night time feed to start bottle feeding. Other babies like being in control and will respond better when they are awake and able to learn this new skill, so try it at lunchtime or a morning feed. Position can vary, snuggling your baby into your body like you do when you breastfeed and then having the bottle tucked in against your body can make the bottle more acceptable to some babies, although I have also known babies who prefer to be fed in a completely different position, upright in a baby seat with the bottle offered from the front!
Don’t ever leave your baby with a bottle propped up for her to feed from; leaving your baby unattended during a feed is potentially dangerous if your baby chokes and needs attention, but also sucking from a bottle while lying down allows milk to enter the middle ear through the Eustachian tube and triggers ear infections, especially if you’re using formula milk.
“Oh, no!” Both sisters look horrified. “Feeding is such a bonding experience and even with my older boy, we try to make meals a time of social interaction,” exclaims Susie.
“Make sure you allow yourself plenty of time to do it, whenever you decide to start. And in order to avoid a battle, try offering the bottle three times and if she refuses all three times, then call it a meal. Don’t breastfeed her immediately. Wait five or ten minutes, do something else before you put her to the breast so she won’t associate her refusal to bottlefeed with immediate gratification. Remember that a crying baby isn’t going to feed well anyway, and may bring up the milk you have battled to get down her – so it isn’t worth it!”
The most controversial issue is probably how firm to be; some mothers will tell you how they simply didn’t offer their baby anything except the bottle and, of course, eventually the baby accepted it. But a professional shouldn’t need to employ such drastic methods and ought to be able to teach your baby how to take a bottle using patience, imagination and empathy. ✿
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