NCT Information Sheet: Bottle feeding for breastfed babies?

If you’re breastfeeding your baby, there may be circumstances when you want to offer your baby a bottle, or perhaps when you have been advised to do so by a healthcare professional. This NCT Information Sheet will help answer your questions about your choices.

It covers:

The use of bottles which your baby has because you are not there to feed him

• The use of bottles as an addition to or replacement for breastfeeding because of breastfeeding difficulties.
• Bottle-feeding with infant formula milk.
• Bottle-feeding with expressed breastmilk.

Do all babies end up using a bottle at some stage?

Many do, but it’s by no means always necessary. Lots of babies go from breastfeeding to drinking from a cup or a beaker without ever taking a bottle – this is worth remembering if you are planning on going back to work, for example, and have a baby who doesn’t seem to want to use a bottle.

Sometimes mothers are advised to give a bottle to ‘get your baby used to it’ before going back to work, or because they plan on leaving the baby with a sitter at some point, but there’s no evidence that babies have to be able to take a bottle by a certain age in order to avoid rejection later on. In any case, even quite young babies can be helped to take milk from a cup if necessary. Dietitians recommend that babies stop using a bottle and change to a cup before 12 months.

What goes into the bottle?

Expressed breastmilk (EBM) or formula milk are the only milk feeds suitable for a baby under six months (younger babies normally don’t need any other foods or liquids, and that includes water).

You can express milk by hand or by using a breastpump. Have a look at the NCT booklet Breastfeeding – how to express and store your milk for more detailed information. You may need to express over a number of sessions in order to collect enough milk to leave for your baby. Don’t worry that this means you don’t have enough milk: babies are more adept at reaching the milk than any breast pump.

If your baby does not have EBM, then of course formula milk is the only recommended alternative. The best short and long term health outcomes are seen in babies who breastfeed with nothing else for six months, and even a small amount of formula may have an impact – but it’s not true that it ‘wipes out’ all the health effects of breastfeeding, and breastfeeding with some formula is better for your baby than full formula feeding.

Research shows that, on average, babies fed formula have more infections and other illnesses, such as diabetes, later in life. However, many formula-fed babies are well and grow up healthy. Similarly, breastfeeding your baby doesn’t mean he will never be ill. Only you can decide what is the best option for you and your baby in your circumstances.

If you use formula, ask your health visitor or midwife to talk to you about preparing it properly. Guidance on safety changes from time to time and you can get up to date advice from the Department of Health’s website here: http://tinyurl.com/2fwhy7 or from the NCT information sheet Making up a formula bottle safely. If the formula is too dilute your baby will go short of calories, while too much powder may cause dehydration. Containers and teats will need to be sterilised, whether you are giving formula or expressed breastmilk, as all types of milk can attract bacteria.

Will using formula mean I make less milk?

Yes. Milk supply is driven by frequent, effective removal of milk from the breasts. The more often you feed, the more quickly milk is replaced. Milk supply is affected by how often you feed, by the amount of milk your baby takes and by the amount of milk you can store in your breasts (which is very individual). If you replace any breastfeeds with other fluids (including expressed breastmilk), in the short term the milk will stay in your breasts, which slows down and decreases your production, so longer term, you make less milk. If you give your baby ‘top-ups’ of formula or EBM in addition to breastfeeds, it could mean he comes to the breast less often – and this slows down and decreases production, too.

Once breastfeeding is established, your supply will be harder to disrupt; for many women this appears to be after about six weeks. Babies get the occasional bottle of EBM or formula and it makes no great difference.

You will still not be able to miss feeds without discomfort, so you may need to express. Going for long periods without feeding your baby can cause problems like mastitis. However, this seems to be less likely to happen when breastfeeding has been going for several months. The whole production line is flexible - if you go back to work you may well be able to breastfeed frequently at weekends and still manage to go longer between feeds on workdays. Even if you stop breastfeeding, it is possible to start again if you change your mind, but it takes time and patience.

But sometimes babies need something extra…

Yes, when there is an unresolved problem with breastfeeding, and the baby’s health is affected, formula may be needed alongside help with the breastfeeding. This doesn’t have to mean breastfeeding comes to an end, though.

But frequent top-ups, or mixed feeding (where a lot of formula is given), almost inevitably lead to a dwindling breastmilk supply. If you want to offer bottles and maintain breastfeeding, then speak to a breastfeeding counsellor about how best to do this. It might be a question of timing – as we’ve seen, the longer you breastfeed, the more flexible it all is. Mixed feeding is likely to lead to full formula feeding within quite a short time if you begin it at a few weeks, but a few months later you may be able to keep the breastfeeding part of the ‘mix’ going well.

Can I avoid my baby getting to prefer bottles?

Sometimes breastfed babies show a preference for bottle-feeding, especially if they have been having difficulties breastfeeding. Skilled help may be needed before your baby breastfeeds happily again. You can offer formula or EBM on a spoon or with a cup, though there’s confusing evidence as to whether this is any better than bottles when it comes to the baby’s continued breastfeeding.

If your baby is newborn or pre-term, use a special feeding cup and ask a midwife to show you how to use it, as cup feeding a small baby is not like feeding an older child.

What about babies who refuse to take a bottle?

Experiment with different teats. Sometimes softening the teat with boiling water helps (but allow it to cool before putting it in your baby’s mouth). Some babies will only accept a bottle when it is obviously not a breastfeed. You could try not heating the milk or holding your baby in a different position from the one you usually feed in. You could also ask another person, such as your partner or your childminder, to give the bottle. Your baby will not expect them to breastfeed and may be more willing to accept a bottle from them. Let your baby play with the bottle and try to avoid any fights! Once your baby starts to make a huge fuss, or to show distress, then forget about persuasion – just leave it for a few days and try again then. Or think about using a cup. Your baby may manage a cup far more easily – and a baby of five months or so onwards can practise holding their own spouted cup. If it’s formula she dislikes, she may prefer expressed breastmilk.

I’ve heard that bottle-fed babies sleep longer at night. Is this true?

Yes, on the whole it is. One reason might be that formula milk takes longer to digest, so babies will go longer between feeds. However, it may also be the case that preparing bottles at night is harder work, and so mothers of bottle-fed babies are more keen to encourage their babies to sleep through, while breastfeeding at night is relatively easy, so mothers don’t mind feeding so often. If you are finding night-feeding very disruptive, talk it through with a breastfeeding counsellor.

Whether you are breastfeeding, formula feeding or mixing the two, try to look after yourself during this transition; eating a healthy diet and drinking enough will help you cope. Breastfeeding costs less than formula, but if you are on Income Support you should receive vouchers to help with the cost of food for yourself or formula milk.

For further information or references contact the NCT Information Officer, Lynn Balmforth, at l_balmforth@nct.org.uk or phone 0870 444 8707.

What to do next:

If you are still undecided about whether to introduce bottles, you could phone a breastfeeding counsellor and talk through your options. She will support you whatever decision you make, and it can help to have a listening ear.

• NCT Breastfeeding Line 0870 444 8708 (This is a free service run by NCT-trained volunteers.)
• Breastfeeding Network Supporter Line 0844 412 4664
• La Leche League 020 7242 1278
• Breastpumps can be hired via NCT volunteer agents.
• Call the NCT Enquiries Line on 0870 444 8707 to find details of your nearest agent.

NCT Sales stock a variety of practical goods designed to help make breastfeeding easier, these include the NCT booklet ‘Breastfeeding – how to express and store your milk’ (£2.50). NCT Sales can be contacted on 0870 112 1120 or www.nctsales.co.uk

See also

Using infant formula: your questions answered

If you would like further copies of this information sheet (Code 1704), click here; other sheets in the series can be obtained from NCT Shop at www.nctshop.co.uk or on 0845 8100 100