Ten green bottles... Bottle training

Weaning your breast fed baby to bottle

This morning I decided that it was time to show my nanny how to feed baby expressed milk from a bottle. She took a bottle successfully a month ago, but she is, for all intents and purposes an exclusively breast fed baby.
What a disaster. She cried and spat and spluttered, she fussed and kicked and choked, she even spent a few minutes just chewing on the end of the teat. Finally, through guilt-ridden tears, I stuck a boob in her mouth, berated myself for stopping her bottle training at 5 weeks and researched what I had done wrong.



1. I waited too long to teach her

Yes that's correct, if you know that at some point your baby is going to have to drink from a bottle, you need to start training your baby to take a bottle's teat before they're too used to the breast. I guess the result  of not training is that you end up with situation like I had today, or worse, the same thing but in your mother's lounge while you're standing in the queue at Woolies, 20 minutes away.

Whatever you do, do not start giving your baby expressed milk before she's learnt to suck from the breast with ease. The last thing you want is to create nipple confusion early on. The danger being that she will prefer the easy-flowing bottle teat to your breast. My midwife recommended 4 weeks, some literature says 2, some say 6 weeks. I think you should play it by ear and make sure that you and baby are completely comfortable with her latch first and that she is picking up weight adequately. Don't, however wait till after she is too used to it to take anything else. My baby was 5 weeks when we first tried, and she drank beautifully, today she is 9 weeks, and clearly, it was a nightmare.

2. I fed her myself


Babies are so smart. They can smell their mothers from 6m away and know that a better, softer, warmer source of milk is a cry away. If you are struggling, try leaving the room, or better yet, leave the house well before and let someone else do the feed. This is actually a perfect opportunity for daddy to bond with baby early on and for him to struggle through some of the frustrations of caring for a newborn (you didn't hear me say that), so leave the bottle trial for evening when he's home from work.


3. She was really hungry by the time I fed her
and
4. I was tense
Don't try to feed a very hungry, angry baby. It is very important that you are both calm and relaxed when you try to feed her. As with breast feeding, your baby will easily pick up on your angst. If she is refusing a feed, back off, relax, calm her down and try again. Always make sure that everything is prepared well before she is due to feed. This means...

• sterilising your bottle and teat about 30 minutes before the intended feed
• allowing 30 minutes for defrosting frozen milk or expressing fresh milk
• warming the milk in a warmer or in a jug of boiling water (not the microwave)
• getting baby a bib (its a messy business)

5. I held her in the position I do when breastfeeding


The literature recommends holding baby in an upright position, completely different to the position they're used to while breast feeding. You can even try putting her in a car seat or in a bouncer. This is so that baby always differentiates bottle from breast feeding. Remember that baby swallows more winds during bottle feeding, so keeping her upright prevents the collection of too many winds. Once she is settled into bottle feeding, you can hold her in your usual feeding position.

6. I tried the bottle for half an hour


By which time she was angry, frustrated, miserable and starving (and so was I to be honest). The worse danger is that baby associates the bottle with all those feelings and rejects it before you've even begun. A rule of thumb... if baby rejects three attempts, give up and move on.


7. I gave her the breast too quickly after failing with the bottle

The trick is to wait at least 5 to 10 minutes before breast feeding. So do something completely different for a while first and distract baby with walking or singing then sit down and feed her. You don't want to create a scenario where baby associates refusal with immediate gratification.

8. I hadn't warmed the bottle enough


Your expressed milk should be as close to body temperature as possible for baby to accept it with ease. The best way is to warm it in a jug of boiling water or let hot water from the tap run over the bottle. If you have a bottle warmer, even better. Yoomi bottles have a warmer you charge up and then just place inside the bottle. With the touch of a button your milk is warmed to exactly body temperature. Do not be tempted to warm it in the microwave, microwaves warm unevenly and you can burn babies mouth without realising.

9. I wasn't burping her between gulps


Always make sure you burp a bottle fed baby frequently. They swallow a lot more winds than breast fed babies and this can result in refusing to feed if their tummies are too full of air.


10. She was struggling to drink from the bottle I was using


Because the bottle I used had worked a few weeks earlier, I immediately assumed that she would always take it easily. This specific bottle is also only meant for breastfed babies who have never used any other type of bottle before, so I didn't want to go against the manufacturer's recommendations. The thing is, like dummies you have to try and try and try till you find the bottle that works for your baby, and even then, as time goes on, their bottle needs change.
Things to consider when choosing a bottle...

• Are you planning to exclusively breastfeed for a while still?

If you are weaning to a bottle completely, then the shape of the teat is not so important, as long as baby can drink easily from it. If you plan to continue breastfeeding, make sure the teat is a similar shape to your nipple and breast. Also make sure the milk doesn't come out of the bottle too easily as baby will inevitably prefer the easier option.  

• Is your baby a strong sucker?

Different babies need different flow from their bottles at different stages of their lives. Usually the younger the baby, the stronger the suck reflex, the slower the bottle flow. Buy the correct flow for your baby's age and change it if you find baby is drinking too quickly or choking on her feeds or if she is struggling to get the milk out.

• Does your baby suffer from colic or reflux?

Most manufacturers will specify on the packaging if the bottle is recommended for colic. These bottles usually have an air vent system or angled shape that protects baby from swallowing too many winds.

• How easy is it to assemble, to clean and to sterilise?

I have some very complex looking bottles in my collection. The problem with these is that putting the parts together once the bottle is sterilised is a nightmare, I also find it very difficult to teach my nanny to do it correctly without contaminating the sterile parts. Some of the bottles also need specially shaped bottle brushes to reach the bottom of the bottle. 

• Which nipple material will your baby prefer?

Often you will find that baby will prefer a latex nipple if she sucks a latex dummy or a silicone nipple if she sucks a silicone dummy. Allergies are important to consider here and to watch out for if undiagnosed. Nowadays most nipples are made of silicone, as they are stronger so have less risk of breaking in baby's mouth, they also don't hold on to odours as easily as latex, and have less chance of being allergenic. Latex is however softer, but does also mean they don't hold their shape as well.    

So finally, after spending all day gratefully breast feeding with ease, I handed my husband the reins, and armed with all this new knowledge, cried with relief as my baby peacefully sucked away at her dinner.

A NOTE ABOUT VOLUMES

When calculation a feed volume you need to take into account your baby's age, weight and growth. The best thing is to first check with your paediatrician or baby clinic sister before attempting to bottle feed.

By the time most babies are bottle training, their weight gain has steadied at they are over 4 weeks old.

If this is the case and your baby is at an acceptable weight for age, the calculation is: 

150 x wt(kg) / number of feeds a day 

So for example, my baby weighs 5.5kg and has 7 feeds a day, so she will have 150x5.5/7 = 117ml per feed.