Bottle feeding your baby

Research has shown that breastfeeding is best for babies. However, sometimes breastfeeding doesn't work out. Another safe feeding alternative is for babies to have expressed breast milk (EBM) or infant formula from a bottle.

Some mothers are unable to breastfeed or choose not to. Breastfeeding may also not be recommended for women who are taking medication that could be transferred to the baby and cause harm. These can include cytotoxic, some antipsychotic and immunosuppressive medications. Women who have had breast cancer, breast surgery or who have certain health conditions may also be advised not to breastfeed.

An alternative to fully formula feeding can be mixed feeding — offering breastfeeds followed by a bottle with EBM and/or formula to meet the baby's nutritional needs.

You have choices about what type of bottle you use to feed your baby. Although many manufacturers claim their bottles and feeding equipment are superior to others, the fact is that all bottles sold in Australia need to meet stringent safety and manufacturing requirements. Some babies may prefer a particular style and shape of bottle and teat.

Remember — it's important to enjoy your baby's feeding times. Follow their cues, which will let you know when they're hungry and when they're satisfied.

What are hunger cues?

Hunger or feeding cues are signs that your baby is giving you that they are hungry and ready for a feed. It's better to follow your baby's cues rather than watching the clock and feeding to a schedule.

Early signs that your baby is ready to feed include:

• turning their head from side-to-side
• opening their mouths
• stirring
• rooting (turning their head and opening their mouth when the side of their mouth is touched — to help them find your nipple and start feeding)

Mid signs that your baby is hungry include:

• stretching
• moving around and getting restless
• putting their hand in their mouth

If your baby has started crying and has become more agitated, you may find it more difficult to calm them down before feeding. If you are breastfeeding, you can try putting them on your breast to see if that calms them down, but if they are still crying or you are bottle feeding, you can:

• try skin-to-skin contact with either you are your partner
• walk around to help calm them
• place some milk on their lips
• gently stroke your baby's mouth

How to bottle feed your baby

Feeding your baby should be an enjoyable experience for you and your baby. Here are some tips:

• Unwrap them so they can move around, touch and explore when they're feeding.
• Sit comfortably and make sure your back is well supported.
• Talk gently to your baby and hold them close so they can see you.
• Check the temperature and flow of milk is right for your baby.
• Hold the bottle at an angle, making sure the teat and neck of bottle contain milk. This will help to reduce the amount of air your baby swallows.
• Gently place the teat into your baby's mouth and let them start sucking when they're ready. Place the teat on top of their tongue and far enough back in their mouth so they can suck effectively.

If your baby starts to fuss or turns their head away, they may need a break. They might also be showing you they're full or need to burp. Follow their lead to offer the bottle again, or to stop feeding. Never force your baby to finish a bottle.

If you have more than one baby, try to feed them one at a time. Doing this will give them important individual time.

Formula and expressed breast milk can be warmed in the same way. Here are some bottle-warming tips:

• Stand the bottle in a container of hot water for a few minutes. You can use a bottle warmer if you want to.
• Check the temperature of the milk by putting a few drops onto the inside of your wrist — it should feel just warm.

Paced feeding supports bottle-fed babies to control the flow of milk they take at each feed. Breastfed babies are used to doing this; however, when babies feed from a bottle they have less control. This means they're more likely to swallow the milk quickly. Paced feeding helps to prevent choking and for babies to be given too much milk.

To pace feed your baby:

• Wait until they show signs that they're hungry, rather than feed to a timed schedule.
• Hold them so they're more upright, rather than lying down. Support their head and neck with your hand, not your arm.
• Use a slow-flow teat.
• Gently brush the teat down the middle of your baby's lips, this will encourage them to open their mouth. Let them draw the teat into their mouth themself.
• Tip the bottom of the bottle up just enough for the milk to fill the teat. As your baby feeds, let them lean backwards so the teat stays filled with milk.
• Keep their head and neck aligned. At the start of your baby's feed the bottle will be more horizontal and towards the end, the bottle will be almost vertical.
• Let your baby pause and have a break every few minutes. Follow their lead to let you know they've had enough.

Babies are very good at judging how much milk they need, but it's important to make sure that they're growing well, gaining weight and reaching their developmental milestones. In the same way that an adult's appetite varies, babies may be hungrier on some days than others. If your baby goes to sleep when they're feeding, try burping and changing them.

Check to see they are having regular wet, clear, nappies, 5 or more each day. Their poos should be soft, pasty and not hard or dry.

Throw away any formula or expressed breast milk that is left at the end of the feed, or after one hour.

If you are bottle feeding, you will need to sterilise the bottle and teat before each use. It's recommended bottles are sterilised until your baby is 12 months.

Learn more about to clean and sterilise bottles and expressing equipment.

If your baby does not want to feed, stop offering the bottle and re-offer in an hour or so. Feeding in a quiet, distraction-free environment sometimes helps. Think about how much milk and solids they've had already and if they're likely to be hungry. Check the milk temperature and teat flow is fine. If there are changes in their feeding behaviour or you're worried, have your baby checked by a GP.

Newborn babies generally have between 6 to 8 feeds in 24 hours. Older babies from around 3 months are generally satisfied with around 5 to 6 bottles in 24 hours. But there's no one right number of feeds and every baby is an individual. Sometimes babies feed more closely together and at other times, further apart. As a general guide, most babies show cues when they're hungry and cry, look for the bottle and then calm when it's offered.

The Australian Infant Feeding Guidelines provides a guide on how much formula is recommended each day. Remember that it is a guide only and may not be exactly what your baby needs, some needing more, some less.

It is possible to overfeed a bottle-fed baby. This is more likely to happen when strict feeding schedules are followed and feeds offered according to time, rather than a baby's cues.

Try to stop offering your baby a bottle once they reach 12 months. This will help to reduce the risk of tooth decay, ear infections and low iron. Instead, offer a training or sipper cup with milk or water. Be patient and encouraging as your child learns what's involved in drinking from a cup.

Feeding can be challenging for many parents and babies. Fortunately, there are many supports available to you.

• Your midwife or child health nurse.
• A lactation consultant.
• Australian Breastfeeding Association on 1800 686 268.