Updated: 21 hours ago
by Alissa Pemberton – Midwife, International Board Certified Lactation Consultant & Holistic Sleep Coach| www.motherandmilk.co.uk
Many parents are advised to 'top their babies up' in the first weeks or months of life (see our separate post here for a much more in depth look at top ups). Often this comes in the form of giving a bottle - but there are a number of other alternatives which will help support you breastfeeding journey, rather than hinder it. Firstly - lets look at why bottles might cause an issue.... The mechanics of breastfeeding involve baby taking a deep mouthful of breast, drawing the breast right back to the soft palate at the rear of their mouth. They need a good seal with their lips to create suction and rhythmic motion of jaw and chin to get milk flowing. Without suction and sucking, there isn't adequate milk flow. Baby's tongue holds the breast against the roof of their mouth, whilst the movement of their jaw puts pressure on milk sinuses within the areola to control the flow of milk. Rapid sucking when they begin feeding stimulates a release of oxytocin which contracts muscle fibres around the milk ducts and causes a 'let down' of milk. When baby ceases sucking or breaks that nice seal/vacuum the milk flow stops. This allows baby's to very effectively regulate their milk intake and slow down when they are getting full, this also helps prevent them overfeeding at the breast. At a bottle (with the majority of bottle teats) milk will flow on it's own, without the suction and rhythmic jaw movement needed at the breast. Because the teat holds it's shape, baby doesn't need to open a wide mouth, or use the muscles of their tongue to hold the breast deeply in their mouth. If the milk is flowing too quickly, a baby may thrust their tongue forward against the teat of the bottle to try to stop the flow. It's also very easy for baby's to use small, gentle sucks to obtain milk, as it flows so easily. For a baby who is having difficulties with breastfeeding (and if there's issues with weight gain, causing the need for top ups - then we know something isn't quite right) using a bottle regularly may only make these issues worse. There are some situations where using a bottle may be recommended or even preferable, and advice from a breastfeeding specialist will be invaluable, but for the most part we know that bottles can hinder the breastfeeding relationship - but can other means of supplementation actually help it? So - what's the alternative? In this blog we'll explore three different methods of feed which you can use to supplement (top up) your baby where required. Once again if you've been advised to top up, without any specialist support to explore the underlying feeding issues I'd encourage you to contact an IBCLC/Breastfeeding Specialist and also to view our blog on newborn weight loss. Cup Feeding
Many parents will come across this method during their hospital stay/the first few days after birth if it's recommended that their baby receive formula for any reason. Cup feeding involves placing expressed breast milk or formula into a small plastic cup (about the size of a shot glass) and allowing the baby to lap at the milk. How does it work? - start by placing a small amount of expressed breast milk (or formula) into a clean sterilised small cup. There are speciality cups available for cup feeding but in general these aren't necessary. A small plastic cup (like the kind which are often available for measuring liquid medications, or disposable plastic shot glasses are all good options). - for young babies it may be beneficial to swaddle your baby so they don't knock the cup over with flailing arms! - place your baby in front of you, facing towards you with their bottom resting on your lap and one ahnd supporting behind their head. - always sit your baby upright (about a 45 degree angle) when cup feeding, never lay them down and pour the milk in. - rest the cup on baby's bottom lip, and tilt it slightly so that milk comes to the edge of the cup (remember we are not aiming to pour the milk in, but keep a small amount of milk close to the edge of the cup to entice baby to extend their tongue and lap at the milk).
- you should be able to observe baby extending the tip of their tongue and lapping at the milk like a cat. When would cup feeding be the best option? - cup feeding is definitely preferable to bottle feeding in most instances. This will work well for parents who need to provide small amounts of supplementation to a baby (perhaps mum and baby are separated for a period of time after birth, or mum is unwell and is only able to express and not to physically be with baby). - it is also a great alternative to giving bottles if mum needs to spend some time away
from baby during the first six months, and wishes to leave the baby with another carer. For older babies (4 months +) an alternative like the Doidy cup is a great option for cup feeding. Older babies need never have a bottle for milk feeds as they can be cup fed (using correct technique) from a very young age. When should I avoid cup feeding? - cup feeding may not be the best choice for supplementing a baby who is having significant difficulties with breastfeeding or where there is suspicion of a tongue tie. - babies with tongue restriction may find the action of cup feeding difficult (as tongue tie will often result in restrictions in tongue extension beyond lower gum). - babies who are premature, or have neurological conditions resulting in poor muscle tone may not be suitable for cup feeding.
Finger Feeding Finger feeding can be done via two methods - using a syringe, or using a feeding tube. Both provide a very helpful method for supplementing a breastfed baby, and one which actually supports a baby to develop skills for breastfeeding and return to the breast sooner. As the name suggests this technique is achieved by parent/caregiver placing a finger into baby's mouth, allowing them to suck on the finger whilst they either take supplement via a syringe or feeding tube. By allowing baby to take a supplemental feed whilst sucking on a finger mimics (about as closely as we can) the action baby needs at the breast - a good seal, deep latch, rhythmic suck/swallow patterns. How does it work? - start by washing your hands and preparing your supplemental feed either in a syringe (particularly for colostrum) or in a bottle/supplemental nursing system (if using feeding tube). - place baby on your lap, on a diagonal with head towards one of your knees, and feet towards your opposite hip. - place a clean finger upside down in your baby's mouth (fingernail side down) and encourage to suck on your finger (a little wiggle or pulling your finger slightly out of their mouth and then back in will entice baby).