The Bottle Window

I got an interesting call from a mom today. She was wondering if we had any written information about how to introduce a bottle to her breastfed baby. Although I often address this issue, I realized I had never written about it. So I promised her I would put my suggestions into writing tonight!

Why Introduce a Bottle?

Honestly, not every mother even needs to worry about introducing a bottle. If you are going to be home with your baby and really don't want to be separated until baby is several months old, then I wouldn't even worry about reading the rest of this post! By the time your baby is about 6 months old, you can begin introducing a cup with expressed breastmilk, so if you're cool with hanging out with baby for those first six months, then you don't need to concern yourself with "the bottle window."

However, if you know that you will be going back to work, or if you want your baby to be able to accept an occasional bottle of breastmilk, then it is really important to understand when and how to introduce a bottle. Sometimes Mom just wants to be able to have an occasional date with Dad or night out with the girls. And many dads do indeed look forward to the time when they can participate in feeding.

When Should I Introduce the Bottle?

There is a small window of time for introducing a bottle to your baby. You need to make certain that beastfeeding is well established. Baby should be latching on well, and your milk supply should be sufficient for baby's needs. However, if you wait too long, your baby may completely refuse to take a bottle. If you really need baby to take a bottle, waiting too long can present tremendous challenges.

The ideal time to introduce a bottle is between four weeks of age and one month.

The ideal time to introduce a bottle is between four weeks of age and one month. That's a pretty small window. But in my experience with hundreds of babies and moms, it seems to be the perfect time. I have almost never had a baby who is one month old or younger refuse a bottle. Likewise, if breastfeeding is going well by four weeks, introducing a bottle is highly unlikely to cause any kind of problem with baby's suck.

How Should I Handle Pumping?

The ideal time to pump is right after the first feed of the morning. You have the most abundant milk supply at that point. I generally encourage mothers to wait until baby is a couple of weeks old and their supply is somewhat stabilized to begin pumping. The easiest way to pump is with a double pump, and with the changes from the Affordable Health Care Act, most policies cover a breast pump. 

The easiest way to store your milk is in Milk Trays. You don't have to keep buying bags or filling your freezer with bottles. The milk tray will freeze your milk in one ounce cubes which can be stored in ziplock bags after they are frozen. Be sure to write the dates on the bag (you will probably have several days or a week's worth of milk per bag). 

Once you have introduced the bottle, you will also want to pump during the time that the bottle is being given so that your breasts will continue to receive the same amount of stimulation. Skipping a feed without pumping could also lead to engorgement, plugged ducts and mastitis - NOT fun!!

How Do I Introduce the Bottle?

First of all, YOU aren't going to be the one to give baby a bottle! Let Dad , Grandma, your bestie or even an older responsible sibling be the one to give the bottle. Remember that while someone else is feeding baby, you are pumping!

It is important that baby receive a bottle at least every 2-3 days. I can't tell you how many moms call me distraught because their baby who took a bottle or two really well at one month won't take any kind of bottle at 2 months. When I investigate a little bit, I discover that baby hasn't had any bottles for about 3 weeks. That's a problem. Babies are creatures of habit, and the bottle is a habit you have to continue to cultivate if you want baby to accept it.

What Kind of Bottle Should I Use?

Generally when mothers introduce the first bottle during "The Bottle Window" just about any bottle will work. However, you really want to find a bottle that requires baby to suck using the same basic motion that he uses at the breast. You also want to find a slow-flow nipple. 

Just about any bottle will work

Several good options that have worked well for our moms include the First Years BreastFlow bottle, the Mimijumi bottle, The Tommy Tippee bottle and both the Medela Calma and the Medela standard slow-flow bottle. Each has pros and cons. I would just buy one bottle of a particular brand at first to see how your baby does with it. Don't make a real investment into a particular brand until you know that they are going to work.

No Judging!

I feel like I need to close a discussion of the use of bottles with a final caveat. Whether you decide to introduce a bottle or not, you need to be comfortable with your decision. Every situation is unique, so there is absolutely NO ROOM for any mom to judge another mom based on how she decides to handle this issue. The most important thing we can do as moms is get in the habit of affirming each other every chance we get!

Bottles, Pacifiers and Sippy Cups May Pose Risks

In a Pediatrics article published online yesterday, researchers from The Research Center at Nationwide Children's Hospital in Columbus, Ohio, found that bottles, sippy cups and pacifiers are a significant source of injury in children under 3. Bottles are the most significant source of injury, causing 65.8% of all injuries, followed by pacifiers (19.9%) and then sippy cups (14.3%).   The most common injury was to the mouth, and the most common type of injury was laceration.

The researchers note that both the American Academy of Pediatrics and the American Academy of Pediatric Dentistry have issued recommendations about transitioning to a lidless cup by 12 months of age to prevent dental caries (note that in both referenced articles above, they say 18 months is the upper limit for complete cessation of bottle usage). Furthermore, in this article from the journal of the American Academy of Family Physicians, pacifier use after one year of age is linked to an increased incidence of otitis media (ear infection). 

They also make the point that in 2010, there was a 29.6% decrease in injuries from 1991. They note that, 

"This trend was largely driven by a decrease in bottle-related injuries over time; we speculate that either bottles were involved in fewer or less serious injuries or fewer children used bottles over time (because they transitioned increasingly earlier to a sippy cup or cup or because more children were breastfed or breastfed longer)."

So what does all this have to do with you? Based on the evidence gathered in this retrospective analysis, it  appears that it is very important to teach your child to remain seated when drinking. Allowing a toddler to run around with a bottle or sippy cup isn't a good idea. It is also important to note that babies and toddlers who are breastfeeding instead of using a bottle or sippy cup are not at risk for any of the types of injuries noted in this study.

Some babies really do seem to have a stronger suck need than others. A breastfeeding mother who's baby is nearing the one year mark might decide to continue nursing a little longer to help baby through the many stresses of toddlerhood. An in-tune, attached mother is the real expert on her baby. You are the only one who can make the decision about what your little one needs, so do the research and follow your gut!