The Ultimate Guide to Bottle-Feeding Your Baby - Part 1

Introduction

Bottle-feeding can be a convenient and essential part of parenting, whether you're using formula or breast milk. This comprehensive guide will walk you through everything you need to know about bottle-feeding your baby.

Selecting Formula

Types of formula available to buy:

Standard First formulas: most formulas are made from cow’s milk. There are various different brands of standard infant formula. There are no brands that are better than others, and despite their claims, there is no evidence that any of them have health benefits over each other. Those that are sold within the UK have to follow strict guidelines to ensure they are safe and nutritionally complete.
Soy milk formulas: these formulas are made from soya beans, not cows' milk. They are not recommended for babies under 6 months old, since there are some concerns about the fact that soya contains phytoestrogens. These are found naturally in some plants. The chemical structure of phytoestrogens is similar to the female hormone, oestrogen. Because of this, there are concerns that they could affect a baby's reproductive development, especially in babies who drink only soya-based infant formula. Babies' low body weight means they take in much higher amounts of phytoestrogens than older children or adults who eat soya products as part of a varied and balanced diet. Also, soya formula is more likely than cows' milk to harm a baby's teeth. Soya formula is suitable from 6 months onwards, but only under medical supervision.
Goat’s milk formulas: these formulas are produced to the same nutritional standards as cow's milk-based formula. Goats' milk formula is not less likely to cause allergies in babies than cows' milk formula, and it is not suitable for infants with cows' milk protein allergy, as the proteins that goat and cow’s milk contain are very similar.
“Anti-Reflux” formulas: these formulas are thickened with the aim of preventing/reducing reflux in babies (when babies bring up milk during or after a feed). Although it's available in pharmacies and supermarkets, it's recommended you only use it on the advice of a health professional.
“Hungry Baby” formulas: these formulas are marketed as being more “filling” than the standard formulas, and generally contain more casein protein than whey protein. Casein becomes clots or curds in the stomach; while whey remains as a liquid and is easier to digest. Thus, the companies that market these formulas claim that these formulations that contain more casein keep your baby fuller for longer, since casein is harder to digest. However, there is no evidence that babies settle better or sleep longer when fed this type of formula.
“Comfort” formulas: these formulas contain cows' milk proteins that have already been partly broken down (partially hydrolysed). This is supposed to make it easier to digest and help prevent digestive problems such as colic and constipation. However, there's no evidence for this.
Lactose-Free formulas: these formulas are marketed for infants who are lactose intolerant, however this is exceptionally rare in infants, since infants are born with the enzyme, lactase, which breaks down lactose. Lactose intolerance is defined as the lack of lactase, and usually only develops as a person ages, as they start to lose the amount of lactase in their body, which happens in certain populations more than others. It is possible, however, for infants to have temporary lactose intolerance as a result of illness, such as gastroenteritis, since the lactase enzyme is made in the villi cells in the small intestine, which can be damaged during illness that affects the GIT. This type of lactose intolerance is temporary, since as the villi recover, lactase production is restored. Thus, there is no need for babies to be put on lactose-free formula, unless they are losing weight. Contact your doctor or dietitian for more information.

Types of formula available on prescription:

Extensively Hydrolysed formulas: these formulas contain cow’s milk proteins that are broken down into smaller pieces, called peptides, so that the immune system can’t recognize them and therefore don’t react to them. Thus, these types of milks are used in some types of Cow’s Milk Protein Allergy, like non-IgE mediated CMPA. They are also sometimes used in malabsorption-related conditions, since they are more easily absorbed in the digestive system than their whole-protein counterparts. They can/should only be used under medical/dietetic supervision, and are only available on prescription.
Amino Acid formulas: these formulas are not made directly from cow’s milk, and the proteins within them are lab-derived. These milks are amino-acid based, meaning that the proteins in them are in the form of amino acids, which are the smallest building blocks that make up protein, and therefore, the immune system doesn’t recognise and react to them. Thus, these types of milks are used in some types of Cow’s Milk Protein Allergy, like IgE-mediated CMPA, as well as severe forms of non-IgE mediated CMPA. They are also sometimes used in malabsorption-related conditions, since they are more easily absorbed in the digestive system than their whole-protein counterparts. They can/should only be used under medical/dietetic supervision, and are only available on prescription.
High Energy formulas: these formulas have a higher calorie content than standard formulas and are generally used in infants that have faltering growth, and/or those that have medical conditions that prevent them from taking adequate volumes of milk. They can/should only be used under medical/dietetic supervision, and are only available on prescription.
Preterm formulas: these formulas are specially formulated to provide the higher calorie and micronutrient requirements of preterm infants. Post-discharge preterm formula should be used until maximum 6 months corrected age, but can generally be stopped even immediately after discharge, if the baby is growing well, provided they are given micronutrient supplementation in the correct dosage.
Other formulas: there is a wide range of other types of infant formulas that are available on prescription for various medical reasons/conditions. Speak to your doctor/dietitian about the reasoning behind a prescribable infant formula if you have any concerns or questions.

Selecting Bottles and Teats

Types of bottles:

Plastic Bottles:
- Material: These bottles are usually made from polypropylene or other types of plastic. Plastic can contain a harmful chemical called BPA, so it is important to look for bottles that are BPA-free.
- Pros/Cons: Plastic bottles are inexpensive and convenient. However, Polypropylene is unstable and can result in microplastics leaching into the milk. Little is known about the health effects of human exposure to microplastics. Plastic bottles can also be difficult to clean.
Glass Bottles:
- Material: These bottles are made from glass, which is a sturdy and chemical-free option.
- Pros/Cons: Glass bottles do not contain any harmful chemicals that can leach into the milk, and they are easy to clean and sterilize. However, they are heavier and more fragile than plastic bottles.
Silicone Bottles:
- Material: Silicone is a soft, flexible material that is another chemical-free option.
- Pros/Cons: Silicone bottles are lightweight and durable, and are naturally free from BPA and other harmful chemicals, but are generally more expensive than glass and plastic bottles.

Types of teats:

Optimal teats:
- The most recommended teat shape is one with a gentle sloped neck, which encourages a deeper latch, promoting proper oral development, tongue cupping and a more comfortable feeding experience for your baby.
- Examples:
  - Dr Brown Standard Bottle
  - Lansinoh Bottle
  - Pigeon Nursing Bottle
  - EvenFlo Balance Standard Bottle

Suboptimal teats:
- We would recommend avoiding bottles with narrow nipple tips and wide bases. Babies will usually either stay on the tip and suck it like a straw, or they will try to fit the base of the nipple in their mouth and end up with air pockets where the tip meets the base.
- Examples:
  - Tommee Tippee Closer to Nature Bottle
  - Avent Natural Bottle
  - Nuk Simply Natural Bottle

Teat flow rates:

Flow rates are very variable amongst brands and even within the brands themselves. Thus, they are not very comparable. It’s best to start off on the slowest flow you can find, especially with a newborn, and then adjust up, depending on how your baby does.
You don’t want the flow rate to be too fast, which would make it too easy for the baby to suck, meaning that they might develop a flow preference for the bottle, which for breastfed babies, can impact on breastfeeding. A fast flow rate can cause milk to leak out the sides of the mouth, and overwhelm the baby.
You also don’t want the flow rate to be too slow, which can cause your baby to become frustrated at the bottle, and can cause them to expend a lot of energy trying to suck.
We generally recommend that bottle feeding takes a baby about 5 minutes per ounce (30 ml).

Feeding Techniques

Paced feeding:

It’s important to allow your baby to control the pace of feeding to prevent overfeeding and encourage healthy eating habits. We want to allow them to take breaks when they need to, just as they would do at the breast. Most teats, even those with a slow flow rate, will still drip milk into their mouths when the bottle is inverted or when the teat is chewed on and the baby is not actively sucking.
To pace-feed, try not to tilt the bottle towards your baby. Instead hold the bottle horizontally, perpendicular to your baby’s head. Allow only half of the teat to fill with milk. Milk should not drip from the teat freely. Now place the bottle in your baby’s mouth and allow them to actively suck the bottle. Keep the bottle in the same position while your baby feeds and try to avoid tilting it forwards. If they look like they are taking a break from sucking, help them further by tilting the bottle away from them, allowing the milk to fall out of the teat and back into the bottle. When they start to suck again, you can return the bottle to its original horizontal position.
See a helpful video on paced bottle feeding here.

Holding techniques:

It’s best to hold your baby semi-upright (60 to 90 degree angle) or in a side-lying position when bottle feeding.
Use this opportunity to bond with your baby; looking into their eyes and talking to them.

Conclusion

Bottle feeding is a rewarding experience that allows you to nourish and bond with your baby. By following the tips and information in this guide, you can ensure that your bottle feeding journey is safe, enjoyable, and beneficial for both you and your little one.

Remember that every baby is unique, so be attentive to your child's cues and needs throughout the bottle feeding process. Enjoy this special time of nurturing and nourishing your baby as they grow and develop.

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