The Art of Responsive Feeding by Breast & Bottle - A Practical Guide to Combo Feeding Your Baby
This blog was written by Laura Sawers, a pediatric speech, language, and feeding therapist who is passionate about supporting infants and children with feeding and swallowing difficulties. She cares for families in acute care, community clinic, and home settings. In this post she provides tips and resources for families who are combining breast and bottle feeding.
Click here and here to learn more about Laura.
Note: These are general tips not intended to replace medical advice and may need to be individualized based on your family’s feeding goals and your baby’s feeding needs. Speak with your doctor, lactation consultant, or feeding therapist to develop your feeding plan.
Why Bottle Feed?
Every family’s feeding journey is different, and there are a number of reasons why parents may offer a combination of breast and bottle feeding to their baby. For instance:
Some families choose to offer both breastfeeding and bottle feeding in response to their individual family needs.
Supplementation by bottle may be recommended to support a baby’s growth or feeding skills.
Caregivers who are not breastfeeding may want to share in the experience of feeding the baby or supporting the breastfeeding parent by offering bottles.
Both breast and bottle feeding take time and resources, and combining the two can sometimes be overwhelming. Here are some tips to help you be as efficient as possible with the more mundane tasks (see the ‘Pumping’ section below), while supporting your breastmilk production and allowing you time to enjoy the snuggles and slow moments while feeding your baby.
Breastfeeding Tips
When possible, focus on establishing breastfeeding in the first few weeks before introducing bottle feeding. This helps your baby learn to breastfeed, avoiding a preference for bottles, and supporting breastmilk supply. Some providers suggest introducing bottles when breastfeeding is well-established, around 3-4 weeks.
Seek timely support with difficulty establishing breastfeeding. It is important to take steps to establish and maintain breastmilk supply while your baby learns to breastfeed. A lactation consultant helps with positioning, latch, breast/nipple pain, supply, pumping, and infant feeding assessment.
Whenever possible, hold your baby skin-to-skin when breast and bottle feeding. Skin-to-skin care stabilizes babies, reduces stress for parent and baby, and supports bonding. Skin-to-skin care is also linked to improved breastfeeding outcomes.
Bottle Feeding Tips
Responsive feeding means that you feed your baby when they are hungry, pay attention to their communication, and end the feeding when they show you they are full. Many babies regulate their intake well when breastfeeding but may take more than they need with a bottle. Caregivers may also be more focused on volume with bottles and feel that they need to encourage the baby to finish the whole bottle. While the amount that a baby will take in can vary from feed to feed, the total bottle volumes over the course of a day, growth, and wet diapers are more accurate reflections of adequate intake.
Here is a good resource to learn more about Responsive Feeding.
Choose a slower flow bottle nipple to avoid a preference for bottle feeding, and use a consistent bottle nipple so that your baby knows what to expect each time they receive a bottle. Bottle nipples with similar labels, such as slow flow, can have very different flow across brands. Focus on what works for your baby, not on the ages listed on packaging. Levels of bottle nipples are not developmental milestones that your baby needs to progress through, your baby may stay with a particular nipple for a long time or throughout their time bottle feeding.
Here is a good resource to learn more about Choosing a Bottle Nipple
Another caregiver can provide a bottle while the breastfeeding parent pumps, to increase rest time for the breastfeeding parent.
Plan when you will offer bottles. If you are mostly breastfeeding, but would like to include bottles in the feeding plan, it may be suggested to offer one bottle every 2-3 days. This frequency may protect the baby’s interest in bottle feeding and maintain bottle skills while minimizing impact on breastmilk supply.
Some babies refuse to drink from a bottle, this is normal and more common than we expect. If this is the case, continue with a responsive feeding approach, respecting your baby’s cues. If bottle feeding is a significant part of your baby’s feeding plan, watch hydration and growth carefully, and seek support from your doctor, lactation consultant, and/or feeding therapist.
Pumping Tips
Pump each time a breastfeed is replaced or supplemented by a bottle to maintain supply. This allows you to match the baby’s intake with the amount of stimulation for breastmilk production.
Some variation in pumping schedule is okay. For example, if it was just 2 hours since you pumped and you’d like to go to sleep, pump again then and go to sleep rather than staying awake or trying to wake up in an hour or so.
Cleaning Equipment
For a tired parent, washing bottles and pump parts might be the last thing they feel like doing. They may find themselves wondering if they should stay up a few minutes longer and wash the parts or deal with it at the next feed/pump. It may never feel like a good time!
Washing/sterilizing pump parts and bottles is a great task for other caregivers who want to be involved in feeding.
Feeding equipment for babies under 4 months needs to be sterilized. Methods include boiling, electric sterilizers, sterilize settings on some dishwashers, and microwave steam bags.
Here are Alberta Health Services’ Sterilization Guidelines
For babies over 4 months old, bottles can be rinsed in cool water, washed in warm soapy water, rinsed thoroughly again, then air-dried on a clean paper towel or rack.
Pump parts can be rinsed in cool water, washed in warm soapy water, rinsed thoroughly again, then air-dried on a clean paper towel or rack. Avoid using a dish towel as this may contaminate the pump parts.
If possible, it can be helpful to have 3 sets of pump parts. Dedicate a bin for used bottles and pump parts, and rotate one set of pump parts in use, one being washed, and one air-drying/ready.
How can a feeding therapist help?
This resource addresses When to ask for help with your baby's feeding.
Feeding is a complex skill. If your baby is struggling with bottle refusal, growth concerns, or coughing/choking during feeds, a feeding therapist (speech-language pathologist or occupational therapist) can help.
Feeding therapists have the utmost respect and compassion for meeting babies and parents where they are at in their journey and want to learn as much about you and your baby in order to find sustainable strategies on your way to your feeding goals.
A feeding therapist can provide infant feeding/swallowing assessment and work with your family to develop an individualized feeding plan. They can also support further progression from an existing feeding plan for fragile feeders following a hospital stay.
Support may be focused on optimization of the feeding system such as
finding the right bottle/nipple,
coaching on use of feeding strategies such as positioning and pacing, or
development of feeding skills.
The goal is to help you build positive feeding experiences to nurture and connect with your baby.