Baby Bottle-feeding

Equipment needed for bottle-feeding

For babies under 12 months, the only alternative to breast milk is infant formula. They should not be drinking cow's milk as their main source of food as babies can't digest it as easily as infant formula or breast milk. 

You will need a bottle to hold the expressed breast milk or infant milk formula. The teat should be held firmly in place by the collar of the bottle to avoid spills. 

You will need a container with warm water to heat the bottle. If you have other young children remember to keep out of their reach. 

It can also be helpful to have a bib or cloth to wipe your baby’s mouth.

What not to do during formula feeding

• Don't use a microwave oven to heat your baby’s bottles. It can be dangerous and is not recommended. The milk heats in an uneven way and presents the risk of severe burns to your baby’s mouth or throat.
• Don't force your baby to feed by constantly jiggling their chin or squeezing their cheeks.
• Don't prolong feeds – preferably no longer than 40 minutes. If your baby becomes distressed or falls asleep after this time, cease the feed.
• Don't leave your baby unattended with their bottle propped on a rolled up towel or pillow. Milk can flow into your baby’s ear canals and can cause an ear infection or the baby may inhale or choke on the milk.
• Don't leave your sleeping baby with a bottle in their mouth. The milk that is pooled in their mouth may cause tooth decay and recurrent ear infections.

Transporting infant formula

The safest way to travel with infant formula is to take the premeasured cooled, boiled water and the powdered formula in separate containers and mix them when needed.

Warm the milk by placing the bottle in a container of warm water. Once the milk is warm, add the powder to the milk, replace the bottle top and collar before shaking the bottle until the infant formula powder is well mixed with the water.

If you need to transport prepared formula or expressed breastmilk, it must be icy cold (5°C) when you leave the house.

Carry it in a thermal cool bag with a cooling brick to keep it cold. You must use the feed within two hours if you’re unable to refrigerate the bottle.

If able to refrigerate the bottle within the two hours’ travel time it can be stored for 24 hours from preparation time, in the coolest part of the fridge, at the back.

Bottle-feeding problems and bottle refusal

Using a bottle to feed your baby is not always as easy as it may seem. It’s not a matter of ‘just put your baby on a bottle’.

Some babies prefer to be breastfed and will actively refuse to take milk from a bottle, while other babies will fall asleep during feeds and then wake shortly after the feed wanting more food. Other babies will become agitated and upset, holding out for a familiar breastfeed.

Many bottle feeding problems start to occur when you are weaning the baby onto a bottle because you need to return to the paid workforce or for other reasons such as illness. For babies, sucking from a bottle is a very different type of suck to suckling milk from your breast.

The first thing to do is to try to identify the reason why your baby is refusing the bottle. Check for these signs:

• Has your baby always had some difficulty taking a bottle and it has become more problematic?
• Is your baby unwell? Do they have a temperature; have they started to vomit or become unsettled more than unusual; is their urine becoming smelly and darker in colour or more concentrated; are their bowel motions different, e.g. very frequent, loose, mucousy, frothy or with spots of blood?
• Does your baby have a sore mouth? Sometimes oral thrush can result in the baby having a very sore mouth. There are also other infectious diseases such as human hand, foot and mouth disease that result in small blisters in the mouth.
• If any of the above feeding issues are of concern, have your baby assessed by your child and family health nurse or doctor.

Once you have eliminated any health problems, there are several things to remember and strategies to try:

• Try not to become anxious. With time, patience and a gentle approach your baby will usually learn to take a bottle or in some instances a feeding cup.
• Find a quiet place to feed with minimal distractions and noise.
• If possible, ask your partner, family member or friend to try feed your baby. If breastfed, babies can smell breastmilk on their mothers and can become distressed when not offered the breast.
• If you do not have anyone in the house who can help for a few feeds, lay the baby in a comfortable elevated position in a rocker or pram so the head is raised higher than their shoulders. Feed your baby in this position, holding the bottle and gently touching and talking to them.
• Do not force your baby to feed by squeezing their cheeks or forcing their chin up and down. This type of forced feeding can create even more difficult problems to solve.
• Do not leave your baby with the bottle propped. This is very dangerous and can result in inhalation of milk into your baby’s lungs or choking, or long term it may cause dental caries and ear infections.

When your baby falls asleep during a feed

Some babies have a habit of falling asleep without finishing their bottle. This is not a problem unless they are waking and demanding a feed frequently or not gaining weight or are losing weight, or not passing adequate amounts of urine.

Check the following issues:

• Is your baby unwell?
• Are you offering too much milk at each feed?
• Is the infant formula correctly made up, i.e. is it too concentrated or too diluted?
• If on solid foods, try offering the bottle before solid foods
• Is the teat too slow or are the holes blocked?
• Does your baby have a rhythmical suck? If not, it may help to place your fingers under your baby’s chin. This provides a slight resistance to suck against.
• If bottle feeding your baby is becoming more and more difficult, it’s important to talk things over with your child and family health nurse or doctor to ensure your baby has no physical reasons for this behaviour.