Do lactation consultants help with bottle feeding?

After a long nursing career, I found myself deeply invested in the field of Lactation. This grew out of a passion to demystify infant feeding and connect this with parents' intuition. I started my experiences in a hospital environment but quickly moved into private practice. In this new expansive world of lactation, I found myself overwhelmed and excited with all the new learning experiences and ways I could support families on their feeding journey.

I still find many people who don't know what a Lactation Consultant (IBCLC) actually does. We assist, evaluate, and partner with dyads (parent and baby, and partner if applicable) to improve breastfeeding, milk supply, breast care, pumping, flange fitting, baby and parent comfort (improve multiple symptoms), and latch techniques. But we do sooo much more! We help you navigate weight gain issues, milk storage, back to work, weaning, starting solids too. And we answer your questions and concerns and educate on what is normal.

We also address bottle feeding issues! I would say that more than 70% of my consults involve instruction of bottle feeding techniques, choosing ideal bottle and teat types and flow rates and an assessment of bottle feeding challenges. And for my practice and philosophy it does not matter what is in that bottle! I work with formula feeding families and combination feeding families as well. 

Most people don't know they can reach out to a Lactation Consultant about the following issues:

Choosing a bottle and ideal nipple (teat) and flow rate

Gas discomfort surrounding bottle sessions

Leaking

Clicking

Long feedings (generally more than 5-7 minutes per ounce)

Fast feedings 

Frequent feedings

Baby is having difficulty “latching” to the bottle teat (nipple)

Difficulty finding a bottle that works well

Baby pushing the bottle away

Baby is only taking small amounts at a time

Poor weight gain

Fast weight gain

Bottle Refusal (baby is not accepting the bottle, usually in a breastfed baby)

Bottle Aversion (baby was previously taking the bottle consistently as their main source of nutrition, and now is starting to refuse)

***The above are very brief definitions of bottle refusal and aversion, and deciding if your baby has bottle refusal or aversion should be explored with you and your lactation consultant as this requires a full in-depth assessment

Bottle Refusal

If your baby is struggling with bottle refusal, an experienced IBCLC can help identify some causes and give you a step by step plan to try to improve feeding. We have the background and knowledge of the baby's developmental and anatomical changes that may be contributing to the situation and how to address this. We can answer your questions and alleviate your worry as there are many stresses and fears when babies won’t take a bottle. It’s much less scary when we understand the why and we can then create a care plan to move forward. This challenge is best addressed with a professional IBCLC who is skilled in this specialty. Having clear understanding and direction can lower anxiety, give you a path forward and save you time. 

Choosing a bottle

Oftentimes, choosing the right bottle/nipple(teat) and flow rate combination helps tremendously. In general you want to avoid bottle nipples that look like a breast and choose one that looks like a triangle. The nipple shape below on the right is much easier for a baby to latch onto correctly. There are various widths and flow rates. 

Left image is a breast like shape VS right image is a Triangle shape

Flow rate is more tricky because a newborn level in one brand is not the same rate as the newborn level in another brand. You can observe for signs that the flow is too fast: leaking, your baby is moving away from the bottle, your baby is raising their hands up, your baby has a furrowed brow, is choking, gagging or milk is spilling out of their mouth. (Keep in mind that if you are holding an appropriate bottle at the wrong angle then you may see some of these symptoms.  (see paced feeding below)

Usually choosing the first level is a good place to start but it may not work for your baby. Your IBCLC will have the knowledge to guide you on this factor. There are many brands and many differing textures and sizes of nipples. An IBCLC can help you discover which one may work well with your baby’s oral anatomy. 

Paced Bottle Feeding

Practicing Paced Bottle feeding or Responsive Bottle Feeding helps many babies feel more comfortable and improve their feeding skills. This method allows the baby to pull in the milk themselves and to take natural pauses with no milk flowing in and resume. They can organize their suck, swallow, and breathe pattern much easier.

Trying side-lying paced bottle feeding is usually the most successful as this provides postural support for your baby allowing them to focus on eating. When small or new babies are held upright, they tend to slouch or move a lot or sink their chin to their chest. These changes make it hard to eat. Try right now to swallow some water with your chin on your chest. Ack! 

You can find multiple videos showing paced bottle feeding online. Here are my two favorites: Paced bottle feeding for the newborn in side lying although I usually state that 5-7 minutes per ounce is common and expected. In the first week of life babies are slower. Side Lying Bottle Technique an alternative to paced feeding

If you’ve tried the basics and are still struggling with some challenges, it's never too early or late to reach out to an experienced Lactation Consultant. 

I want to take this moment to encourage you to connect with an IBCLC (International Board Certified Lactation Consultant), the gold standard in lactation care. You can read my blog describing the differences in education and preparation in the Lactation world here: What is the difference between a lactation counselor and a lactation consultant?

Also, as with any profession, not everyone is experienced or is an expert with every problem or condition. Do your research and find an IBCLC who lists bottle skills and bottle refusal in their wheelhouse. You can also find certifications on their websites showing the courses they've taken in this specialty or inquire about them. 

And remember babies are adaptable and smart! Even if things aren't perfect, they mostly will figure it out and do really well. If you observe symptoms that concern you, then you know we have your back!

I offer one on one bottle Skills consultations. Can't wait to meet you!

You can book online here: https://www.lactationconsultantathome.com/

Cathy Walker, MA, RN, IBCLC, PMH-C