|Always make sure that supplies are clean and wash your hands before handling breastmilk.|
Babies have been fed milk by an at-the-breast tube system, by cup feeding, saucer, spoon, dropper, or by bottle.
The act of nourishing a baby at one’s breast (breastfeeding) is ideally not separated from the sustenance the baby is receiving (milk). Therefore, when a mother does not produce (enough) milk, an already latching baby would preferably get all additional breastmilk via an at-the-breast system.1
Expensive equipment is not required for this. It does not have to be an official at-the-breast system that you purchase/use. All that is needed is a long length of No. 5 French feeding tube (can be purchased or ordered at your local pharmacy), and some sort of container (like a bottle) to hold the breastmilk in. The following DIY version is perfectly adequate and keeps baby at his/her own mother’s breast, thus minimizing the risk of jeopardizing supply (as the breasts and supply of the woman are still being stimulated while baby is latched on and drinking).2
If this is not possible, and until breastfeeding and/or feeding with an at-the-breast system can be established, other methods are best used before giving a bottle, like using a cup. Avoiding bottle feeding is important in order to prevent nipple confusion if a mother hopes to fully breastfeed her baby eventually.3
On AskDr.Sears it is stated that “research has shown that not only is it possible for preemies to drink from a cup, but they also maintain a more stable blood-oxygen level during cup-feeding than during bottle-feeding.” The participant’s manual of the WHO’s Breastfeeding counselling (p.124) states:
“Why cup feeding is safer than bottle feeding:
- Cups are easy to clean with soap and water, if boiling is not possible.
- Cups are less likely than bottles to be carried around for a long time, giving bacteria time to breed.
- A cup cannot be left beside a baby, for the baby to feed himself. The person who feeds a baby by cup has to hold the baby and look at him and give him some of the contact that he needs.
- A cup does not interfere with suckling at the breast.
How to feed a baby by cup:
- Hold the baby sitting upright or semi-upright on your lap.
- Hold the small cup of milk to the baby’s lips.
- Tip the cup so that the milk just reaches the baby’s lips.
- The cup rests lightly on the baby’s lower lip, and the edges of the cup touch the outer part of the baby’s upper lip.
- The baby becomes alert, and opens his mouth and eyes.
- A LBW [Low Birth Weigh] baby starts to take the milk into his mouth with his tongue.
- A full term or older baby sucks the milk, spilling some of it.
- Do not pour the milk into the baby’s mouth. Just hold the cup to his lips and let him take it himself.
- When the baby has had enough, he closes his mouth and will not take any more. If he has not taken the calculated amount, he may take more next time, or you may need to feed him more often.
- Measure his intake over 24 hours –not just at each feed.”4
If choosing to use a bottle, there are some very important things to consider:
- Watch the baby. Babies will cue us when they are hungry. Hunger cues include (but are not limited to) rooting, chewing on their fists, and rapid eye movement as they are about to wake. Respond to baby’s hunger cues and not the clock.
- Hold the baby in an upright, seated position. It is very important that baby not be fed from a bottle while lying on their back.Having a baby in a more upright position allows them to better control the flow of milk into their mouths.
- Just as a breastfeeding mom would switch sides while nursing, switch baby from one arm to the other. It is important that baby has the opportunity to develop both eyes and both sides of their bodies.
- Never push or force the bottle nipple into the baby’s mouth. Allow them to explore and draw the nipple in on their own.
- Pace baby’s feeding. Even with a low-flow or slow-flow nipple (preferable for all babies), the milk can enter the baby’s mouth much quicker than they are able to take it in. If a nursing session would take 20 minutes, expect that a bottle feeding session would take the same amount of time.
- Baby’s breastfeed with a certain suck and swallow rhythm. Often they suck 2 or more times before swallowing. We can mimic this by encouraging frequent pauses. Allow the baby to suck and swallow according to their rhythm and then tip baby forward a bit (to empty milk out of the bottle nipple) to simulate the pause. Tip them back slightly and allow the suck and swallow rhythm to happen again.
- Watch the baby. By allowing them control over the feeding rhythm, we allow them to let us know when they are finished. Never force a baby to finish a bottle. Allow them to dictate when the feed is over.
It is critically important that babies and their care givers are able to engage together in a feeding. It is never safe to ‘prop’ a bottle for a feeding. It is not only unsafe, but contrary to our human nature.
For support and guidance with implementing any of these alternative feeding options, please find a professional lactation consultant or look in ‘Resources for support’ for referral suggestions.
Please see this section for information about handling and storing.
- Please know that the company that manufactures one of the at-the-breast systems is not WHO code compliant. More information on the ‘International Code of Marketing of Breast-milk Substitutes’ here. [↩]
- Other important benefits of breastfeeding include proper jaw and facial development which reduces both ear infections and bite issues, by preventing malocclusion. The skin to skin contact that breastfeeding provides helps babies acquire the beneficial bacteria that protects them from diseases and builds their immune system. Skin to skin also provides relaxation for both mother and child due to the effects of oxytocin. Long term benefits are laid out in this WHO publication. Please see ‘Why breastmilk?’ for references. [↩]
- From AAP’s Promoting and Supporting Breast-Feeding: “Nipple confusion occurs when a baby has not had the opportunity to establish the correct mouth movements for proper breast-feeding. Early and subsequent use of pacifiers, water, glucose water and formula supplementation have been shown to promote early weaning and nipple confusion. The frequent use of an artificial nipple early in life has been shown to promote a less effective mouth movement; this was demonstrated with ultrasonography over a decade ago. For this reason, the physician should encourage the staff and the patient to address breast-feeding problems first, with direct observation of breast-feeding, before considering the use of supplementation.” [↩]
- See ‘How much expressed milk does my baby need?’ [↩]