A while ago I saw a mom and baby who had begun to add several bottles of breast milk bottles to the daily schedule. She was readying to return to work and wanted to also allow the father time to bond with the baby during feedings. The baby would fuss at the breast expecting to have a steady, fast flow of milk coming from the breasts, as she was used to getting from the bottles. After nursing on and off and fussing, the bottle of breast milk was used to top the baby off since she was not satisfied.
The mom had a goal of six months to nurse the baby. I knew with only being at the breast two times a day- morning and evening, this was not likely to happen. The baby was already showing signs of nipple confusion and a lazy suck at the age of 3 weeks. I could tell the baby was used to the faster flow of the bottle and was demanding the same of the mom.
When I explained this to the mom, she asked me for solutions. I called my favorite IBCLC, Anne Grider for her input. This is what was shared:
As far as providing the baby with slow flow nipples to make it more difficult to get the breast milk from the bottle, she said: Nipples have no regularity or quality control- so you have to buy a bunch and just try them over the faucet with water in the bottles and mark the ones in the package that are the real slow flow ones- there is just no telling without testing them if they are really slow flow. She said a package of nipples marked “slow flow” could have a plethora of different flows within the same package. The premie ones they make now are too small- use a slow flow instead.
Her recommendation was to not use Avent- it is too wide for most babies. She also said not to use Nuk, ironically it has shown too many orthodontic issues later. She said we all are different and we have to determine what kind of nipple is right for this baby. It is up to the size of the baby’s pallet. So put your finger in the baby’s mouth and take it back to the hard part of the pallet and mark on your finger how long the nipple needs to be to reach there. And notice the baby’s size of her mouth- not too wide or is it a large mouth and width is not an issue.
Get a symmetrical nipple- a silicone one is preferred. And use a regular shaped bottle. The slanted bottles actually were meant for babies with medical issues who had to feed lying on their tummies- they actually make the milk flow even faster- so don’t use that kind.
Sit the baby up in a full sitting position to bottle feed. For example sitting the baby where the baby’s back is against the provider’s chest is best- less mom and baby dyad confusion that way- mom nurses the baby everyone else feeds the baby this way. The bottle needs to be parallel to the floor. Don’t worry about keeping the nipple full of milk- the issue of air has been proven to not be as big of an issue as they once thought.
Listen to the baby- is she swallowing comfortably? No gulping and she has time to breathe in between swallows? If not you need to make sure the bottle is parallel and not tipped up too high. Check the flow of the nipple. And if need be you may need to pace the baby’s feeding.
Paced feeding is to sit the baby up and when the baby is gulping and not breathing- pull the nipple out so it only touches the lip and then when the baby breathes- put the nipple back in- do this several times. After the third or fourth time the baby catches on and does not protest when you do it. The ideal feeding is a comfortable one no gulping or problems breathing.
When a mom returns to work she needs to be prepared to have a lot of mother baby time when she returns home. Nursing on demand is what is best. No bottles should be given if the mom is available to nurse. This will help her keep her supply and also keep the baby satisfied during growth spurts as well as continue the breastfeeding bond between the mom and the baby. A side car- co-sleeper is best if the family does not share a bed so that the mom is fully accessible to the baby. A baby being fed on demand at the breast is usually essential for breastfeeding to be successful once a return to work has occurred. And night time nursings are important as well to this success. The family bed or side car allow the mom the rest she needs while still meeting the baby’s needs.
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