Best Bottle for the Breastfed Baby

Don’t fall for the marketing. There are so many bottle systems out there that are marketing themselves as “just like the breast” and even “shaped like the breast”. In truth the ones that look like a boob often function the least like it.  The good news is there are some really good bottles out there that even though they don’t work LIKE the breast, they can PROMOTE a latch similar to it to help baby go back and forth between the two.

There are many bottles marketed as “most like breast.” The bottle part may “look” like a breast, but the nipple typically has a wide neck and and short nipple, which is how some nipples look like at rest before a baby latches. I call these shoulder nipples. The baby tends to latch just to the short nipple in a straw-like latch because they can’t latch deeply to the wide base (breast tissue expands and fills baby’s mouth, but the rigid silicone of the bottle nipple doesn’t). If baby’s lips are super rounded and there’s dimpling in baby’s cheeks while they suck, they are in a shallow latch. They may still pull milk from the bottle, but this shallow latch back at the breast results in painful nipples and leas efficient feeding. 

 

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Bottle nipples that have a more gradual slope from tip to base and a cylindrical shape are preferred for all babies, whether breastfeeding or not. Why cylindrical? We want your nipple to go in and out of baby’s mouth round. If your nipple is coming out pinched, creases, or flat, we’re talking about improving a shallow latch or releasing a tongue tie. Bottle nipples that are lipstick shaped, flat, creased, or pointed are going to promote incorrect sucking patterns which can transfer back to breast. Now hear me on this: while a round, tapered nipple are optimal, there are times when a different shape nipple is appropriate, especially if they’re the only shape baby will successfully take. We want all babies to have a wide latch to the bottle for more efficient feeding and better use of their facial muscles for skill development. I usually prefer the narrow neck to the wider versions for the majority of babies, as it helps promote better lip flanging, although some babies they will do just fine on the wider version. If your baby is struggling to take a round, tapered nipple, please seek the help of a qualified and specially trained IBCLC lactation consultant, occupational or speech therapist.

 

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When a baby is at the breast, they create a vacuum in their mouth with negative pressure by making a seal with their tongue to the palate. They then use positive pressure by compressing the breast as their tongue moves in a wave like pattern from front to back called peristalsis. Positive and negative pressure are essential for a baby to efficiently feed from the breast. They need to maintain the tongue protruded over the bottom gun line and in that vacuum seal through the duration of the feeding, and the middle of the tongue needs to pump up and down to help compress out milk. This is why babies with tongue ties can struggle to feed both breast and/or bottle. Bottles work totally different than the breast and many only need the compression piece for baby to move milk. Some bottle nipples do a better job of approximating the breastfeeding latch and do require more suction in order to remove the milk. In general, bottles that require a combination of suction and compression to remove milk better promote breast feeding by using a more natural and functional sucking pattern. Those systems that use compression only promote a chomping sucking pattern or the baby squeezes the nipple harder to move milk, which can make it difficult (and painful) when transitioning back to breast.

What nipple “level” should my baby take? Nipple flow levels are not standardized across the bottle industry. Each company has their own set rate and it is completely different from company to company.  A level one will flow simple tell different across every brand of bottle. What is “slow” on one nipple can be very fast compared to “slow” on a different nipple. Britt Pados has done multiple research studies that measure flow rates. Turns out there are some brands “Slow” that are actually faster than other brands “Level 3” . Remember: don’t fall for the marketing. If your baby is coughing, choking, leaking milk or struggling to drinking from a nipple, try going to a slower flow nipple in the same brand and if that doesn’t work, switch brands. Do you ever need to go up a nipple level? No. They are marketing nipple levels by age like Carter’s does with onesies. If it fits, use it. No need to level up if your baby is content. Ever.

From a lactation perspective, we generally want breastfed babies to use a nipple that matches the flow of their mothers milk back at that breast. This is USUALLY the slowest flowing nipple (remember, this will vary from brand to brand). We want them to take a bottle slowly since breastfeeding is usually a slow process, and we want them to actively suck to get milk out. Although for those with a fast let down or over supply of milk, it’s totally fine to use a faster flow nipple that matches the speed at which your baby takes the breast.

 

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Babies are masters at compensating to feed. They learn very quickly what works and what doesn’t to get milk. But sometimes this comes at the cost of them compensating with their muscles which can lead to symptoms like lip blisters, two tone lips, lots of gassiness and reflux. Clicking while swallowing, leaking milk, coughing and eating too fast are all symptoms that something isn’t right: either with the nipple shape, flow level or their latch OR something else may be going on in their mouth like a tongue and lip tie. If baby is doing well with their bottle and you have no concerns, keep doing what you’re doing! No need to start fresh and buy new. Some babies do a really nice job of going back and forth from breast to bottle, despite requiring different mechanics. If you are seeing any red flags and something doesn’t feel right about your baby’s  bottle feeding skills, either breast or bottle, schedule a consultation. There is help and guidance for you to get things back on track.

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How to get my baby to suck on a bottle. They’re just chewing the nipple

Reflexes are neurological blueprints that help us do movements for survival and to learn skills. Reflexes are triggered by certain movements, touch or sound. Sucking and swallowing are primitive reflexes present at birth to help us learn how to feed. These reflexes are triggered by touching baby’s lips, tongue, and palate. If you put anything in baby’s mouth, they will suck on it and if there is any kind of liquid in their mouth, they reflexively need to swallow it. These reflexes are there for the first 3-4 months while babies are learning how to suck and swallow on their own. Around 3 to 4 months they have practiced sucking and swallowing so many times that these reflexes integrate into the brain and they can suck and swallow by choice. They now move to a more mature oral motor pattern of chewing. If you are going to introduce a pacifier or bottle, do so around 3-10 weeks while baby is reflexively sucking. After 3 months babies now have more volitional control of their tongue and get to choose what they suck on. From 3-4 months babies now reflexively like to practice chewing. If you touch their gums, the reflex is to chew which helps them practice the next essential skill of getting ready for solid foods. Babies start putting everything in their mouth at this age including hands and toys. Hands in the mouth is no longer a hunger cue, but a way to trigger the bite reflex to help practice chewing. If you introduce a pacifier or bottle at this age, you may find that the baby will prefer to chew on it. This is the next stage of development and is normal. If you try multiple bottles, and they refused to take them, you could move to spoon or cup feeding that milk instead. This toy is one of my favorites to practice chewing at this age. It’s called a Wrinkel Rattle & Sensory Teether Toy. I also love O balls this kind of practice.

Why do I need to transition my toddler off formula and a bottle at 12-18 months?

It is recommended that babies transition off bottles and formula at 1 year old. Why, then is it recommended to still continue breastfeeding and breast milk until 2+ years? There are several things at play: oral development and nutrition.

Breast and bottle feeding work completely different. As a baby breastfeeds, the human breast/nipple changes shape in baby’s mouth. Breastfeeding requires baby to coordinate their orofacial muscles to form a vacuum to extract milk from the breast. The back of the tongue firmly rests on the palate, which allows the tongue to shape the upper jaw, and naturally expand the palate (widening the upper jaw so the tongue fits in it perfectly). Once milk is released, the tip of the tongue pushes the breast against the front of the palate, stimulating the forward development of the front part of the upper jaw and midface. As the lower jaw moves back and forth, it stimulates forward growth of the lower jaw too. Forward growth of the jaws and face help in forming the airway. The firm nipple of a bottle does not change shape in baby’s mouth, and some bottles work on compression only where the vacuum does not need to be as strong. Cup feeding uses muscles more similarly to breastfeeding than a bottle. When we transition a baby to an open cup, we are promoting a more mature swallow and oral motor pattern. You can transition a baby to an open cup at 6 months, but should definitely try to transition off the bottle between 12-18 months for optimal facial and swallowing development.

Nutritionally human milk is constantly changing based on the age of your little one. It’s hormones, stem cells, and antibodies are tailored to meet the needs of a growing toddler. Human milk is phenomenal for development and immunity. Infant formulas are designed to meet the nutritional needs of a child on an exclusive milk diet prior to eating table food. They are designed to grow a baby from 0-12 months based on what we know those babies need nutritionally. Once a toddler moves to eating table foods, they can get all of their nutrients and calories from a balanced diet.

Best bottle for the breastfed baby

DON’T FALL FOR THE MARKETING

There are lots of bottles on the market. And so many of them are marketed to be “most like the breast”. Let me tell you a secret. There is no bottle that works like the breast. Don’t fall for the marketing. The breast is a complex organ that works with hormones, compression, suction, positive and negative pressure. It is controlled by the baby and how the baby sucks. Baby can make your milk flow or not depending on how they suck. It is never empty and constantly making more. It is hormone driven. A bottle is passive. It has a hole that will drip when turned over. Your nipple changes shape to fill baby’s mouth. Your nipple can help fill a high palate. your nipple and a good portion of your areola/breast also need to be in baby’s mouth in a deep latch for milk to be transferred. Your nipple should go in round and come out round. Baby’s tongue should cup and protrude past the lower gums and stay out to massage your nipple/breast in their mouth Baby has to change the shape of their tongue to accommodate the firm bottle nipple. Baby can chomp or mash the nipple and doesn’t need to keep the tongue out because they can compress milk out. Baby can also latch just to the tip of the bottle nipple and still get milk.

We can make the bottle work like the breast, though. By slowing the feeding down or “pacing” the feeding, we can help baby go back and forth between bottle and breast. You want a straight nipple that tapers wide at the base for a “deep” latch. If your baby is just latched to the tip of a bottle nipple they can still get milk. But then their muscles will learn to latch shallow and that’s often why you’ll get a shallow latch with a “small” mouth at the breast. The bottle nipples that are already pinched or tapered are also not good choices. If your nipple came out of baby’s mouth looking like, that you’d have damage within a few days. If your baby struggled at the breast and will only take a bottle nipple that looks flat and pinched there is usually something going on in baby’s mouth and the bottle nipple is compensating for it. Tongue tie is the most common culprit.

LATCHING TO A BOTTLE

Having an optimal latch at the breast reduces nipple pain and prevents damage. Your nipple should go in baby’s mouth round and come out round. If we want to encourage good latch when breastfeeding, we want to do the same when bottle feeding. This helps baby go back and forth without “confusion”.

This can be difficult when a bottle nipple abruptly changes in shape from narrow to wide. Bottle nipples like the Playtex Baby Ventaire Bottle,Tommee Tippee, Avent Natural, Nuby Comfort, and Chicco Naturalfit have narrow nipple tips and wide bases. Babies usually end up latching onto the tip and sucking it like a straw. If baby’s cheeks dimple or suck in when feeding from these bottles, they’re drinking but not demonstrating a wide latch and optimal mouth posture. If they had that same mouth posture on your nipple, they would cause pain and damage. Baby’s don’t drink from the breast like a straw. Conversely, they may try to fit the base of the nipple in their mouth and end up with air pockets where the tip meets the base. This can result in breaking the suction and swallowing excess air while feeding. Nipples like the Nuk Simply Natural and Mam are not round, but pinched or flat. If your nipple looked like that coming out of baby’s mouth we’d be talking about deeper latch or tongue tie.

Bottle nipples that gradually change in shape from narrow at the tip to wider at the base promote a deeper latch. If the nipple stays narrow at the base, like the Similac nipples many hospitals give at birth for supplementing, you’ll want baby’s lips to be able to come up almost to the collar (plastic o-ring base). If the nipple is sloped to gradually widen at the base, baby will be able to get the nipple deeper into their mouth with no air pockets. My favorite sloped nipples include the Pigeon SS Nipple, Lansinoh, Dr Brown’s Original Narrow, Dr Brown’s Wide Neck, Munchkin Latch, and Evenflo Balance, which promote a deeper latch mouth on the nipple.

So what does this mean?! If your baby is already bottle feeding and going back and forth from bottle to breast, don’t sweat it! No need to change anything! If your baby is struggling at the breast and preferring a narrower or non-round nipple, having a full oral motor assessment may help you get back to breast.