Download Breastfeeding Babies and the

Breastfeeding babies
and the use of
bottles and pacifiers
Introducing a bottle to the breastfed baby
If you are returning to work or school, or wanting your baby to get used to a bottle to be able to
be fed by someone other than yourself, you will want to introduce the bottle around 3-4 weeks of
age. This will give you time to establish a good milk supply and give the baby time to learn how
to breastfeed well.
To begin, offer your baby a snack of breastmilk once every day between feedings. It is important
that your baby is breastfeeding for meals to protect your milk supply. Since a breastfeeding
mother’s prolactin (the “milk-producing” hormone) levels increase during the night, most moms
will find that they are able to collect the most amount of milk if they pump in the morning or early
afternoon, within 30-60 minutes after a feeding. You may want to begin pumping a day or two
before offering the bottle so as to have some expressed milk in the refrigerator to give to your
baby. Pumping once or twice a day should give you enough milk to be able to practice bottlefeeding with your baby. Giving one half to one ounce of expressed breastmilk in a bottle will
allow enough time for your baby to practice but not fill his/her tummy so much that he/she won’t
want to breastfeed. When your baby accepts the bottle willingly on a daily basis, you can
consider offering the bottle every other day, as long as he/she continues to take it happily.
It is common for a breastfed baby who “used to take a bottle” to refuse a bottle all together if
he/she is not given frequent practice times. It is best to not skip more than a day or two of
offering a bottle.
Learning to prefer the bottle over the breast is one of the risks associated with bottle-feeding.
The reason for this is that the delivery of milk a much quicker through a bottle. When a baby
breastfeeds, the feeding typically begins with non-nutritive sucking, which essentially means that
the baby sucks for awhile before the milk starts flowing. With bottle-feeding, the milk flows
immediately. It is important that the bottle nipple is not dripping when it is offered to your baby.
Once a baby latches and begins sucking, it is possible for the baby to gulp the whole bottle
without pausing. This is a significant difference between breast and bottle-feeding. You can
mimic breastfeeding by letting your baby pause and rest periodically while bottle-feeding.
When your baby willingly accepts a bottle with ease, it is good to offer the bottle in a
breastfeeding position, cradled in your arms. Just like with breastfeeding, making eye contact,
touching, and talking with the baby is important.
On average, babies should finish a bottle in 10-15 minutes. It is acceptable for feeds to take
longer when your baby happily feeds, plays while bottle-feeding, or needs extra time for burping.
However, if feedings are taking longer than 15-20 minutes and your baby seems disinterested or
frustrated, perhaps your baby is unable to effectively suck on the bottle nipple. Feedings that are
MNM 7660.106 (04/12)
too long may burn more calories than necessary or frustrate the baby. Either choose a different
nipple or go up in nipple size to achieve active swallowing. Conversely, babies may gulp down a
bottle in less than five minutes, which may leave your baby feeling like he needs more. Allow
your baby more time to suck to recognize the “full” feeling.
Mom’s flow rate from the breast does not necessarily change as the baby grows. Some babies
do well with the slowest flow nipples as long as they are breastfeeding and bottle-feeding.
However, as babies grow older, many need nipples with an increased flow rate. It is common for
breastfed babies older than three months to become disinterested in finishing a bottle if it takes
too long, indicating that it is time to try a medium flow nipple. For example, if your baby usually
eats three ounces in 15 minutes, and starts eating only one and a half ounces in 15 minutes and
stops, this indicates that the milk no longer flows quickly enough.
Eventually, it is time to wean your baby from a bottle. The American Academy of Pediatrics’
book Birth to Age 5 states, “Most pediatricians recommend that the bottle be given up entirely
around age one and almost certainly by 18 months.” (AAP, 1998, p279). Introduce a cup around
five or six months, so your baby can begin practicing.
Introducing a pacifier
Research says to wait to use a pacifier for at least 3-4 weeks (Howard et al., 2003). This time
frame will teach your body to make the right amount of milk. When your baby sucks on a pacifier
instead of breastfeeding, it tells your body to make less milk. Babies who suck on pacifiers often
drink less milk, eventually reducing the mother’s milk supply. Also, pacifiers require the baby to
suck differently than the way he sucks at the breast – to put his tongue or lips in a different
position and move his jaw differently.
If you’ve waited 3-4 weeks and breastfeeding is going well and your baby is happy without a
pacifier, you may not want to introduce a pacifier. Research has shown that pacifier use is
related to higher risk of illness, such as diarrhea and earache (North et al.,1999). It has also
been proven that pacifier use is positively associated with the frequency of yeast infection/thrush
(Maatos-Graner, de Moraes, Rontani, & Birman, 2001).
However, if you have a baby that likes to suck a lot and calms him/herself that way, you may
decide your baby needs something to suck on while you are away or if you need a break.
Choose what works best for you to achieve the goal of a happy mom and happy, content baby.
If you choose to use a pacifier, minimize the risks by following these guidelines:
 The best shape for the breastfed baby is the cylindrical shape (as opposed to the
orthodontic, butterfly, or cherry shapes). The cylindrical shape encourages proper
tongue placement and movement.
 Be sure your baby’s lips are flipped out, just as when breastfeeding.
 Avoid pacifier use 30 minutes to an hour before the next feeding time.
 Do not use a pacifier to space feedings.
 Avoid using the pacifier during a growth spurt.
 Do not use a pacifier when your baby is content.
 Do not offer a pacifier to satisfy boredom. Instead, change your baby’s
position or environment.
 Remember to sterilize your pacifier every day.
Discontinuing pacifier use is recommended during the day when your baby is four months old.
While your baby may feel sad temporarily, young babies are more easily distracted than older
babies, so the loss of the pacifier will be an easier adjustment at four months of age rather than
later. Also at four months, many babies are able to grasp toys with their hands. Your baby can
now explore toys with his mouth, a necessary part of child development that is sometimes
delayed by pacifier use. Dr. Sears’ book, The Baby Book, states, “If you have a baby who really
needs a pacifier, then use it, don’t abuse it, and quickly try to lose it.” (Sears & Sears, 1993, p.93)
Comparison of bottle-brands and rate of flow
Below is a list of bottle-types, labeled as “slow-flow.” Within the “slow-flow” category, the brands
have been listed as “very slow,” “medium-slow,” and “fast-slow.” Very-Slow bottle nipples will
most likely be too slow for most babies and fast-slow is too fast for most babies.

Very-Slow
 Evenflo Eden
 Dr. Brown’s Narrow Premie
 Playtex Dropins Silicone
 Playtex VentAire Advanced Narrow

Medium-Slow
 Dr. Brown’s Narrow Level 1
 Playtex VentAire Advanced Wide
 Dr. Brown’s Wide
 Similac Pink
 Similac Brown
 Born Free
 Evenflo Original Clear Silicone
 Avent
 Adiri Natural Nurser
 Gerber Comfort Latch
 Gerber Nuk Orthodontic Narrow, Silicone
 Medela
 Nuby Parent’s Choice
 Evenflo Comfort Select
 Gerber Nuk Orthodontic Narrow, Latex

Fast-Slow
 Munchkin Tri-flow Narrow
 Gerber Nuk Orthodontic Wide
 Munchkin Tri-flow Wide

Excluded (flow rates vary too greatly to categorize)
 Playtex Dropins Latex
 Breastflow