# data[].attributes.body
This short video describes a technique which helps you mimic the rhythm of breastfeeding when bottle feeding. Highly recommended.

# data[].attributes.attachment_link.title
Baby Led Bottle Feeding - Wendy Lever IBCLC

# data[].attributes.attachment_link.title
Giving a breastfed baby their first bottle

# data[].attributes.body
This article also includes tips on getting a baby to take a bottle

# data[].attributes.attachment_link.readable_text
When it comes to feeding their baby, some parents decide to exclusively breastfeed and some to exclusively formula feed. Many families decide to combine breastfeeding and formula feeding; this often called combination feeding or mixed feeding (NHS, 2019).

What is mixed feeding?

Mixed feeding usually means mixing breast and bottle feeding. The content of the bottle can be either breastmilk or formula milk.

Watch our video to find out more about mixed/combination feeding.

Why do some families combination feed?

You might start mixed feeding for a variety of reasons.

If you and your baby have some difficulties getting breastfeeding established or if there are concerns about your baby's weight, you might be advised to give some formula feeds alongside breastfeeding.

You might need to leave your baby for periods of time (for example, if you are returning to work).

Your partner might want to be involved with feeding.

You might be bottle feeding and want to start or resume breastfeeding.

It can be helpful to talk to a breastfeeding counsellor, a midwife or health visitor about your options and the potential impact on breastfeeding of mixed feeding (see below). You could also call our infant feeding line on 0300 330 0700.

How do I combine bottle feeding and breastfeeding?

Some families choose to express milk and feed it to their babies through a bottle. They might do this if someone else would like to feed the baby or if the mum has to be away from their baby for a while.

Others choose to substitute some breastfeeds for formula. If you want to do this, you and your baby will adjust more easily if you reduce the number of feeds gradually (NHS, 2019).

You can offer formula feeds before, during, after or instead of a breastfeed. Talk to your midwife, health visitor or a breastfeeding counsellor about this, as different options will suit different circumstances. And will also depend on what you wish to achieve ultimately.

There are some cases when formula might be given before a breastfeed (for example, with babies who are not breastfeeding well). In other cases, the formula feed might be given instead of a breastfeed. This might happen if you're not with your baby and can't breastfeed or if someone else is sharing the feeding.

Gradually cutting down breastfeeding reduces the chance of your breasts becoming uncomfortably engorged. It will also reduce your risk of developing mastitis (NHS, 2019). It helps to reduce the number of breastfeeds slowly, starting with the one which is convenient for you (NHS, 2020). If you substitute a breastfeed with a formula feed, it may take around five to seven days for the amount of milk your breasts are producing to adjust to missing that one feed (NHS, 2017).

If you 'top up' with formula during one or more feeds, rather than replacing an entire feed, this is likely to extend the gap between breastfeeds. It will also signal to your breasts to make less milk (NHS, 2020).

On the other hand, if you've been advised to 'top up' as a temporary measure and want to return to exclusive breastfeeding, it is important to express milk between feeds to prevent a decrease in the amount of milk you make (NICE, 2017). Try and feed your baby any available breastmilk before each formula feed.

What effect will combining breastfeeding and formula feeding have?

Your baby will enjoy the benefits of breastmilk, even if you're not exclusively breastfeeding. For instance, they will still gain some of the antibodies that will protect them against infection (NHS, 2019).

If you want to feed your baby with both breastmilk and formula milk, it is recommended to wait until feeding is firmly established before introducing a bottle (NHS, 2019). This can take up to a month (La Leche League, 2019).

It's best to wait until breastfeeding is established because breastmilk supply is generally driven by frequent, effective removal of milk from the breasts. Giving your baby formula reduces your milk supply, which is particularly important when you are both getting used to breastfeeding. If your baby breastfeeds less often, your breasts produce less milk (Daly and Hartmann, 1995).

You might have heard that babies can get 'nipple confusion' but there is no evidence that this exists (Kotowski et al, 2020).

How many breastfeeds does an older combination-fed baby need?

Older babies, beyond the newborn stage, can maintain your breastmilk supply alongside formula feeding as long as you breastfeed several times a day. Much older babies - from eight or nine months - can breastfeed just a handful of times a day, and there is still a supply.

Very well-established breastfeeding, with a baby who is one year or older, can continue with as few as one or two feeds in 24 hours.

If your baby is over six months they can use a beaker or cup rather than a bottle (NHS, 2020).

Tips to introduce a bottle to a breastfed baby

You might find your baby does not want to take a bottle at first. The different sensations may confuse them and they don't know the bottle contains food. But there are lots of different things you can try to help your baby:

Offer a bottle when your baby is relaxed and happy, rather than very hungry.

Maybe ask someone else to offer a bottle so they can't smell their mother's milk.

Try softening the teat with warm, boiled water.

Hold your baby in a different position from their usual breastfeeding one. It might help your baby get used to the new way of feeding.

Try a different bottle or teat, this might make a difference.

(La Leche League, 2019)

Unicef (2016) recommend feeding responsively, which means following your baby's cues, whether breastfeeding or bottle feeding. They also recommend using paced bottle feeding. The way a baby is fed with the bottle can affect their comfort, their control of the amount of milk they drink, and the transition between breast and bottle (Kotowski et al, 2020).

Tips for paced bottle feeding

Hold your baby upright, close to your body. (If your baby is lying back, they are less able to control how much milk they swallow, so they can overfeed.)

Touch the teat against the baby's top lip to encourage them to pull it into their mouth.

Hold the bottle horizontal, so that when the baby is actively sucking, they get milk and when the baby is pausing, they don't get milk.

Give the baby several breaks by removing the bottle from their mouth.

Watch what the baby is doing, rather than how much milk they have drunk. End the feed when the baby is no longer drinking.

(UNICEF, 2016; La Leche League, 2019)

This all helps to build a close, loving relationship, a responsive feeding relationship, and avoids overfeeding your baby.

Where can I go for breastfeeding support?

If you have questions, concerns or need support, you can speak to one of our breastfeeding counsellors by calling our infant feeding line on 0300 330 0700, whether you are exclusively breastfeeding or using formula milk. Breastfeeding counsellors have had extensive training, will listen without judging or criticising and will offer relevant information and suggestions.

Further information

Healthtalkonline.org has a comprehensive library of face-to-face interviews where parents share their experiences about breastfeeding, birth, parenting and many other issues.

Best Beginnings has video clips from the 'Bump to Breastfeeding' DVD.

UNICEF have produced a summary guide for parents on how to responsively bottle feed babies.

# data[].attributes.attachment_link.title
Mixed feeding: combining breastfeeding and bottle feeding | Baby & toddler, Feeding articles & support | NCT

# data[].attributes.attachment_link.description
Here we look at mixed feeding your baby, which is combining breastfeeding and bottle feeding

# data[].attributes.headline
Breastfeeding counsellors can help with these issues

# data[].attributes.subject
Breastfeeding counsellors can help with these issues

# data[].attributes.body
If you need information or support we can help, so do seek help - ca.. me 07472 795916 or the nct helpline 0300 330 0700

# data[].attributes.body
Parents are sometimes recommended to give supplements of formula milk to their baby. This article explores the practical issues with lots of useful information

# data[].attributes.attachment_link.readable_text
Babies sometimes need more milk than they can take at the breast. This may be because they were born early or small, and don't yet have enough energy to do all the work of breastfeeding. Sometimes, mothers don't have as much milk as their baby needs. It is important that babies get enough milk to be healthy and to grow normally.

La Leche League groups welcome anyone who is breastfeeding or providing their own milk for a baby, or trying to do so. Please don't feel awkward about needing to give your baby extra milk at an LLL meeting! We would love to meet you and your baby!

Get support from LLLGB here.

Why a baby might need extra milk
How to tell if your baby is getting enough milk
Normal growth
Why protecting the milk supply is urgent
Why a mother might not be able to make a full milk supply
Giving extra milk - what kind of milk
Mothers' feelings about using formula milk
Extra milk - how to give it
Extra milk - when to give it
Extra milk - how much to give
Reducing the amount of extra milk
What if you need to keep using formula milk?

Why a baby might need extra milk

The most common reason for a baby to need extra milk is a slow start with breastfeeding, when not enough milk was removed from the mother's breasts in the early days after birth. This can happen when a baby is early, small, unwell, very sleepy, or unable to breastfeed at first. It can also happen when a baby isn't taking a deep enough mouthful of breast tissue to breastfeed effectively. In this case, the mother may get sore, damaged nipples and the baby may seem unhappy and unsatisfied, never wanting to let go of the breast. When not enough milk is removed, the mother's milk supply doesn't get a strong enough signal to increase to the level the baby needs.

You can read more about this here: My baby needs more milk.

How to tell if your baby is getting enough milk

When young babies aren't getting as much milk as they need, the first sign is usually that they don't poo as much as expected. A baby over 3 days old who isn't doing at least 3 yellow poos - the size of a 2p coin or larger - every 24 hours needs to be checked by a healthcare provider. After about 6 weeks, babies find their own pooing pattern, which may be less often. As long as the baby is well and growing normally, it doesn't matter by this stage how often they poo.

Weight loss is another important way to tell whether a baby is getting enough milk. Babies usually lose up to 7% of their birth weight in the first 3-5 days after birth. If they lose more than this, or keep losing weight after day 5, they need to be checked by a healthcare provider.

You can read more about this here (is my baby getting enough milk?) and here (what's in a nappy?).

Normal growth

Babies usually get back to their birth weight by 10-14 days after birth. In the first 3-4 months of life, boys grow at an average of about 40g a day, and girls at an average of 34g a day. A baby who puts on less than 30g a day on average, or whose growth curve drops down across more than one "centile line" on their weight chart, needs to be checked by a healthcare provider.

Why protecting milk supply is urgent

Whatever the reason, when a baby isn't taking as much milk as she needs at the breast, the mother's milk supply may not increase enough to meet all the baby's needs. Milk supply usually increases quickly in the early days after birth, reaching its peak level by the end of the first month. Most of this increase happens in the first 2 weeks, so the amount of milk that is removed at this time is really important. If too little is removed, it may limit how much milk a mother can make later.

When breastfeeding is going well, a baby nursing at the breast will remove milk much more effectively than any breast pump. However, if your baby isn't breastfeeding at all yet, or isn't taking as much milk as he needs at the breast, it is important to start expressing your milk as soon as possible. This will ensure that your body gets the signal it needs to make more milk. Babies who are not breastfeeding effectively may want to spend a lot of time at the breast, so it can be difficult to find time to express milk. Given the importance of protecting your milk supply at this stage, it may be necessary to limit the baby's time at the breast to free up enough time to express. This is an investment of time to make sure you have enough milk later. Find good breastfeeding support as soon as possible.

You can read more about expressing and storing milk here.

Why a mother might not be able to make a full milk supply

Occasionally, a mother may have a medical history or health issues which limit the amount of milk she can make. These reasons can include:

A history of infertility due to hormonal imbalances

Past breast surgery, especially breast reduction

Breast hypoplasia/Insufficient Glandular Tissue (IGT) - breasts may be unusually small, unevenly-sized, long and thin, with a wide space between them and there may be no breast changes (such as increase in size and tenderness) during pregnancy

PCOS (polycystic ovary syndrome)

Thyroid problems (over- or under-active)

Obesity (BMI over 30)

If any of these apply to you, you may still be able to make milk normally. However, if your breastfed baby isn't growing well it is important to find good breastfeeding support quickly.

Giving extra milk - what kind of milk

The first choice when extra milk is needed is your own expressed milk, which is tailor-made for your baby. The second choice is donated milk from another mother. This may be available from a Milk Bank if your baby is still in hospital.

You can read LLL's policy on informal sharing of breastmilk here.

When none of these is available in the amounts needed, infant formula milk may be necessary. If you are not sure what kind of formula milk to use, check with your midwife or health visitor. You can find independent information about infant milks in the UK here.

Mothers' feelings about using formula milk

When you were looking forward to breastfeeding your baby, it can feel disappointing to realise that he needs formula milk as well. You might even wonder whether it is worth carrying on breastfeeding, or whether your baby will come to prefer formula milk. It can help to think of formula milk as a kind of medication, to give your baby the energy he needs to breastfeed well. Babies are "hard-wired" to breastfeed and even a small amount of breastmilk can have a significant positive effect on health outcomes that no formula can provide. Even if your milk supply is very low, you and your baby can still enjoy the cuddly, calming, comforting aspects of breastfeeding, for as long as you want to. Breastfeeding is about much more than just milk!

Extra milk - how to give it

There are several options for giving extra milk to a baby.

In the first 1-2 days after birth, when the baby needs small amounts, a teaspoon can work well. You could express your own milk directly into the spoon and use it to feed the milk to your baby. On day 1 after birth, a full feed is about 7ml (1 ½ teaspoons), on average. On day 2 after birth, this doubles to about 15ml (3 teaspoons) per feed. Newborns need at least 8-12 feeds in 24 hours.

By day 3, something larger is needed. Cup-feeding can work well, with practice. You can use any clean cup - a small one, such as a shot glass, can work well. Trying to feed your partner or support person with a cup of water and having them feed you in return can help you quickly learn how far to tip the cup so that your baby can sip from it.

A nursing supplementer (also known as a lactation aid) is a tool that lets you feed extra milk (either expressed milk or formula milk) while your baby breastfeeds. It can be useful if you want to breastfeed but don't have enough milk. The extra flow of milk can encourage your baby to breastfeed. You can read more about supplementers here.

If bottles are used, it is important to know how to use them in a way that supports breastfeeding. It is easy to feed a baby too much, too fast by bottle, and this can be unhelpful for a baby who is finding breastfeeding difficult. You can find out how to do "paced" bottle feeding - at a good speed for your baby, letting him choose how much to take - here.

Extra milk - when to give it

It is often suggested that you breastfeed first, before giving the extra milk. This often means that the baby is at the breast when he is hungry and least happy, which can make breastfeeding stressful for both of you.

An alternative might be to try ending feeds with your baby at the breast. This may mean starting with some extra milk, to calm your hungry baby enough to help him breastfeed. Or you could start with one breast, give the extra milk in the middle, and finish on the second breast. It's much nicer for your baby to fall asleep at your breast than with a cup or bottle!

Even if your baby isn't breastfeeding much or even at all yet, spending happy time being at or near your breast will make it easier for him to breastfeed when he is ready. Carrying your baby in a sling, cuddling him skin-to-skin, taking a bath together and lying down together in a prepared bed ( if it is safe for you and your baby to do so) are all good ways for him to spend relaxed time at the breast. Babies who feel comfortable at the breast are more likely to try breastfeeding when they are ready. You might like to give the extra milk with your baby's cheek resting on your breast, letting him fall asleep on the breast as he finishes.

Extra milk - how much to give

Healthy, full-term babies are usually very good at knowing how much milk they need. If you are giving extra milk by cup or bottle, carefully watch your baby for signs that he wants more or has had enough. Your baby can show you how much they want.

Sometimes, though, a baby is so early, unwell or sleepy that they are not able to ask for as much as they need. A baby who has been getting less milk than he needs for a while may act as if he is not hungry, because he doesn't have much energy. He may look as if he is finished after a very short feed, but he will not be pooing or growing as expected.

When this happens, it is important to encourage the baby to take more milk. Keep your baby close, doing skin-to-skin as much as you can. This will encourage your baby's interest in feeding, and help you to notice the first signs that he is waking up and getting ready to feed. Your baby may only be able to feed for a short time, so he needs to do it very often. Feeds don't have to be equally spaced, but they need to happen at least 8-12 times in 24 hours. It can be helpful to record the number of feeds, along with the number of wet and dirty nappies he has done each day.

When your baby is growing and pooing as expected, he is taking as much milk as he needs.

It is important to keep in close touch with your healthcare provider during this time. If your baby starts doing fewer wet nappies, or it is getting more difficult to wake him to feed, please contact your midwife or doctor straight away.

Once your baby starts to take more milk, his energy will increase. He will start to catch up with his growth, and he might want a lot more milk. Don't panic! Give him as much as he wants, making sure that you feed carefully if using a cup or bottle, so that he can stop when he has had enough. Once his growth has caught up with where it needs to be, his appetite will calm down.

Reducing the amount of extra milk

If your goal is to feed your baby only with your milk, you will be wondering how to reduce the amount of donor or formula milk your baby is getting. It is important to work with your healthcare provider and your local breastfeeding supporters to come up with a plan tailor-made for you and your baby.

Read our article on Weaning from Supplements here.

What if you need to keep using formula milk?

Sometimes, however hard you try to increase your milk, your baby might need to keep having some formula milk. This might be an important part of his diet, or even most of it, but remember that breastfeeding is about much more than just milk. If you ask mothers of older breastfeeding babies or toddlers what they and their babies value about breastfeeding, they usually forget to mention milk! They talk about how much their babies enjoy it, how useful it is for calming them down and getting them to sleep, and how restful it can be for the mother to sit or lie down to feed. Breastfeeding can still work really well in all these ways, whether or not the baby is also having some formula milk.

It is sometimes possible to stop using formula milk after the baby has started eating other foods, usually from around 6 months. As your baby eats more food, he will need less milk. It is often possible to reduce the amount of formula he takes while still breastfeeding as much as you like. After a year, babies can drink unmodified animal milk (such as cow's milk or goat's milk) and no longer need formula milk. You can continue to breastfeed for as long as you and your child want to. Many mothers who have needed to use formula milk in the early months of their child's life find that the later months and years of breastfeeding are much more enjoyable, because they no longer need to think about how much milk their child is getting.
Written by Jayne Joyce, LLL Oxfordshire, June 2018

# data[].attributes.attachment_link.title
Using donor milk and formula to support breastfeeding - La Leche League GB

# data[].attributes.attachment_link.description
Babies sometimes need more milk than they can take at the breast. This may be because they were born early or small, and don't yet have enough energy to do all the work of breastfeeding. Sometimes, mothers don't have as much milk as their baby needs.

# data[].attributes.body
This is an article for twin parents, but the suggestions are just as useful for singleton parents

# data[].attributes.body
A program which explores whether there is any difference between different brands of formula. It also looks at advertising and marketing of formula milk and influences on medical staff.

# data[].attributes.body
This video includes explanations too

# data[].attributes.attachment_link.title
Baby Led Bottle Feeding - Wendy Lever IBCLC

# data[].attributes.headline
Why does water need to be hot when you make up powdered formula?

# data[].attributes.subject
Why does water need to be hot when you make up powdered formula?

# data[].attributes.body
This detailed article explains the importance of making up formula milk correctly

# data[].attributes.attachment_link.readable_text
Q. Dear Armadillo
Would you consider an article about making up infant formula please? I've read you have to use water hotter than 70 degrees and make the feeds up as required, but a lot of mums I speak to don't do this as it's quite new information and babies have been fine for years without it and over cleaning is just as bad. Who is right?
Sarah

A. Hi Sarah
You are correct that Department of Health guidelines are to use water of at least 70 degrees and discard a bottle after two hours (some sources suggest one if baby has been drinking from it) but there does generally seem to be quite a lot of confusion over the guidelines and whether they are applicable to countries such as the UK & US where water contamination is not an issue. I wanted to answer this question as for mums not breastfeeding, it's important to make the alternatives as safe as possible. I should add at this point that I generally had quite a laissez-faire attitude to sterilisation of things when mine were little - I mean once they were crawling on the floor and chewing things that had been on it, I didn't really see much point ensuring toys were sterilised. I do also think generally that over use in the home of things like antibacterial sprays on every surface, bleaching floors constantly etc carries more risk than the germs they protect from. Breastmilk substitutes however are a little bit different.

Unlike ready to feed liquid milk, a tin of powder is not sterile and there are risks of contamination all the way through the process - starting with the raw ingredients, during production after pasteurisation and thirdly in the reformulation or in the can at home. Because of this there are different problems associated with reconstituting incorrectly.

Let's start with the most serious risks.

Without a doubt these are are Enterobacter sakazakii and Salmonella. The first is a bit of an interesting one as it is found in the gut of healthy humans (probably as an intermittent guest) as well as in the gut of animals and in the environment. A 2005 study found the prevalence in infant formula varied from 0 to 12% in samples from five different companies. To give more of an idea of frequency, a 2010 study found 9 out of 149 samples were contaminated with E Sakazakii.

When it strikes it can be extremely nasty, and there are strong links with meningitis, septicemia, and necrotizing enterocolitis. In the outbreaks reported 50-70% of the infants who contracted the disease died; for those who survive, severe lasting complications can result in various problems including neurological disorders

The trouble with breastmilk substitutes is that they provide the perfect environment for bacteria to grow and thrive, and in 50-80 % of cases powdered infant formula is both the vehicle and the source (direct or indirect) of E. sakazaki induced illness, whilst no exclusively breastfed infants have to date been reported to have Enterobacter sakazakii infections (WHO).

Because of the high mortality rate, when links with disease were made investigations immediately began as to how to best minimise risks; scientists discovered boiling water at 70 degrees resulted in a more than 4-log reduction in E. sakazakii levels. Furthermore, not leaving the made product to sit around prevented any remaining pathogens from increasing to dangerous levels, a risk that increases further once the enzymes from baby's saliva have entered the mix. This is really important as in the above mentioned study, 8 of the 9 cases of contamination were low and therefore mixing with water of an adequate temperature and using immediately is likely to reduce this risk to a nominal level. However using water that is too cool, then leaving the milk to sit around can very quickly lead to high levels of harmful bacteria.

Although found less frequently in breastmilk substitutes, more people have heard of Salmonella; it can cause anything from mild diarrhoea, vomiting and cramps to the rarer Salmonella bacteremia which can result in septicemia and meningitis. Again using water at 70 degrees minimises risks.

Because formula contamination rarely hits the news unless it's a large "official outbreak" which is less common, many people are under the impression that the risk of formula contamination is negligible; but WHO feel differently:

Is the risk similar in all regions and countries?

There have been reported cases of Enterobacter sakazakii infections due to contaminated infant formula in only a few developed countries. It is likely that there is a significant under reporting of infections in all countries. The absence of reports is probably due to a lack of awareness of the problem rather than an absence of illness. In general, the limitations of current surveillance systems in most countries would add to the explanation for the lack of reported cases. Since infant formula is widely used, the presence of Enterobacter sakazakii in infant formula and its potential effects in infants could well be a significant public health problem in most countries.

Another condition heavily linked with incorrect preparation of infant formula is gastroenteritis, often called stomach flu. Symptoms include diarrhoea, sickness and stomach cramps - in people able to consume enough fluids it is generally not serious; however infants and young children are at risk from loss of fluids and may need to be hospitalised for treatment to correct or prevent dehydration.
Sue Battersby, a midwife stated in a 2009 report:

Formula is not sterilised and bacteria can be present. When it is made up or stored incorrectly there is a big risk that it could cause gastroenteritis. "Formula fed babies are five times more likely to be admitted to hospital with gastroenteritis, which in the majority of cases is preventable."

It's as usual all about risks rather than certainties - not every baby who drinks milk prepared incorrectly will become ill and nor is meticulously following the guidelines a guarantee baby will remain well; but for the sake of the extra few minutes is it really worth the risk? Of course good hygiene such as sterilisation of bottles and other equipment (domestic dishwashers usually are not hot enough), effective hand washing and careful storage all contribute too . My personal experience is that gastroenteritis is still common at 9-24 months, when many parents relax a little - whilst this may be ok for other items such as toys, things that come in contact with breastmilk substitutes are still prime breeding ground.

For people who say they didn't do it with other children and theirs have always been fine, I always think that given the advancements in what we know about bacteria and how to reduce the risks of it - why ignore this?

Is it hard to do in practice?

Guidelines suggest using water that has been boiled and left for no more than around 30 minutes. For a couple of pounds it's worth buying a thermometer and checking the temperature of your water a couple of times to get a feel for how fast it cools. It is just as important not to add boiling water to the powder as manufacturers suggest this may damage vitamins/nutrients.

If baby has a rough feeding routine, you can then build in cooling time when at home. If going out and about, carrying the powder in a sterilised container, water in a flask and then combining the two when required works - again worth checking the temperature a few times if there's risk it could have cooled. I've heard a lot of mums do this at night too! Another option is to keep cooled boiled water in the fridge, and work out how much needs to be added to the boiling water to get an appropriate temperature. If you decide to use thermal bags for carrying ready made bottles, it's even more important to check temperatures after storage as many mums report large differences in how long milk remains at temperature.

Hope that answers your question - it also neatly dispels the myth infant formula is a handy, convenient alternative!

http://www.dh.gov.uk/prod_consum_dh/groups/dh_digitalassets/documents/digitalasset/dh_084165.pdf

# data[].attributes.attachment_link.title
Ask the Armadillo - making up infant feeds, what's the deal?

# data[].attributes.attachment_link.description
Q. Dear Armadillo Would you consider an article about making up infant formula please? I've read you have to use water hotter than 70 degrees and make the feeds up as required, but a lot of mums I speak to don't do this as it's quite new information and babies have been fine for years without it and over cleaning is just as bad.

# data[].attributes.headline
Independent information on formula milks

# data[].attributes.subject
Independent information on formula milks

# data[].attributes.body
This website gives information on the range of different kinds of milk available and when the should be used

# data[].attributes.attachment_link.description
First Steps Nutrition Trust is an independent public health nutrition charity that provides information and resources to support eating well from pre-conception to five years. You can sign up to receive a monthly newsletter.

# data[].attributes.headline
How formula milk companies market their products

# data[].attributes.subject
How formula milk companies market their products

# data[].attributes.body
This article from a trusted publication gives an insight into the marketing practices of formula milk companies

# data[].attributes.attachment_link.readable_text
A new international investigation has revealed a shocking lack of science behind the infant formula ranges sold by baby milk companies - and some questionable marketing practices as well.

Exclusive breastfeeding for the first 6 months of life - a practice recommended by every health organisation in the world - provides a baby with everything it needs to grow and thrive. Not just nutrition, but hundreds of non-nutrient factors which cannot be synthesised in the lab and which help protect against illness and promote optimal growth.

For those women who don't or can't breastfeed, being able to trust that infant formula is providing the best possible nutrition is very important.

But a new report, , from the non-profit, UK-based Changing Markets Foundation notes that while there is a single global standard for what ingredients should be in infant formula, the top 4 manufacturers, Nestlé, Danone, Mead Johnson Nutrition (recently acquired by Reckitt Benckiser), and Abbott sell a mind-boggling number - more than 400 individual products - between them globally.

Too often, according to the report, manufacturers add unnecessary ingredients with no proven benefits - so that they can charge a premium price for their products. This isn't illegal but it is unethical and in breach of a voluntary World Health Organization code on the marketing of breastmilk substitutes.

Added fats, pre- and pro-biotics and certain nutrients, may make more plausable manufacturers' claims to make formula which is closer to breastmilk, represents the latest developments in nutritional science, or satisfies hungrier babies, to promote better digestion, or to aid sleep.

But, says the report: "There is little nutritional science and few beneficial health considerations behind their extensive product ranges."
Paying a premium
These premium products do not cater to mothers' or babies' needs but instead exist to create a market that capitalises on mother's anxiety around feeding their children, and their willingness to pay a premium for what they think is scientific certainty.

In analysing the retail prices that companies around the world charge for infant formula, the report found that manufacturers charge whatever they can get away in individual markets - a fact underscored by the wildly different prices that the same brands sell for in different parts of the world.

The most expensive products, for instance, were found in China and Hong Kong, where families can spend US $286 and US $304 per month to feed a 2-3-month old baby, respectively, based on using the most expensive product in those markets.

In 2008 infant formula made in China was found to be contaminated with toxic melamine, deliberately added to some formulas to make them appear as if they contained more protein than they did. Many infants were made ill and some died from drinking the adulterated formula.

Today Chinese mothers still seek big Western brands believing that they are better, or purer, than Chinese brands. The big brands capitalise on this fear by charging exorbitant prices for their products.

As a result, parents in China can spend up to 40 percent of their average salary on infant formula. In comparison, the most expensive formula in European countries will only cost 1-3 percent of an average salary.
Trusted friends?
The report also highlighted the extent to which formula companies listen in on mothers' social media posts in order to learn about their hopes, fears and desires - and then tailor their marketing outreach around that.

Manufacturers use internet platforms such as Facebook, as well as online mother and baby clubs (often financed by formula manufacturers themselves), to collect vital information on mothers, and to portray themselves as trusted 'friends' on the 'mother's journey' in order to sell their products.

"Our report found that instead of nutritional science, companies are basing their selling strategies on market research and consumer preferences," said Nusa Urbancic from Changing Markets Foundation.

"Product differentials are carefully and deliberately designed to appeal to the tastes and lifestyle preferences of parents, or their natural desire to give their babies the best possible start in life. As such, manufacturers can package these products in 'premium' ranges and charge high prices accordingly."
Better regulation and legislation required
The report calls for a comprehensive overhaul of global infant milk products and the introduction of stricter regulation, so that only those products based on unequivocal scientific advice, and with the highest quality of nutritional ingredients, are sold.

It also calls on governments to introduce and enforce national legislation that fully implements the WHO marketing Code and to ensure that the safety and nutritional quality and completeness of products is regularly verified.

To coincide with the report Sum of Us, the global online campaigning platform, launched a petition on November 1 calling for Nestlé to make sure their infant milks are safe, nutritionally complete and based on science. It gained nearly 60,000 signature son its first day.
This Author
Pat Thomas is a The petition can be journalist, author and campaigner and former editor of the Ecologist. signed and shared at this link. The fully referenced report, Milking it, along with its executive summary, can be downloaded here.

# data[].attributes.attachment_link.title
Infant formula companies put profit before science

# data[].attributes.attachment_link.description
A new international investigation has revealed a shocking lack of science behind the infant formula ranges sold by baby milk companies - and some questionable marketing practices as well. Exclusive breastfeeding for the first 6 months of life - a practice recommended by every health organisation in the world - provides a baby with everything it needs to grow and thrive.

# data[].attributes.headline
Why there needs to be better regulation of formula milks

# data[].attributes.subject
Why there needs to be better regulation of formula milks

# data[].attributes.attachment_link.readable_text
In the UK, MP Alison Thewliss is calling for tighter regulations around formula milks for babies and children. She is asking the government to make changes to current legislation by establishing a regulatory body responsible for independently monitoring the content and safety of formula milk, whilst also ensuring that any advertising is accurate and within the law.

But why do we need such changes? Don't these regulations already exist? Isn't this just added bureaucracy? Is this about preventing families from accessing formula milk?

No... no... and most definitely not. In fact it is the very opposite.

What this bill is seeking to do is to introduce a source of fair and accurate information about formula milks, outside of those who are trying to sell a product. It aims to reduce its cost, by preventing false claims and reducing advertising charges. Overall it plans to hold manufacturers accountable for their claims.

In the UK there is no statutory body who monitor the formula milk industry. This means that there is no requirement for the product to be independently tested for safety, content or efficacy. Manufacturers do research their product but generally for their benefit, with no requirement for them to publish negative results. And this is research that needs to be done. For example, no independent body has tested the shelf life of formula ingredients.

Consumers - families - deserve to have this information. Babies get their sole source of nutrition from milk. They deserve the best possible products and parents deserve the best possible information about what is in them. The bill seeks to improve this by setting standards for their efficacy and safety. If a claim is independently proven, brilliant. If not, the bill will prevent false claims (and associated price increases) being made.

The bill is NOT about restricting formula sales, but instead providing parents who use formula with better information about its content. If parents wish to buy a car they can refer to independent comparisons of products on the market but the same information does not exist for feeding their babies. Charities such as First Steps Nutrition have sourced this information and provide an excellent website for parents and professionals. However the health of infants should not be left to a voluntary organization.

The lack of regulation means that formula companies can justify price hikes by making inaccurate claims. Cost is already a considerable issue for families. A tin of infant formula can range from around £8 - £14 and will last around 5 days. It is logical to think that for the same weight, a £14 tin of formula is superior in content to an £8 tin of formula. However, in truth there is very little difference in content of the lowest and highest priced formulas. All formulas have to include certain ingredients under European regulations. Yet despite the powder used in Aptamil and Cow and Gate being the same, Aptamil costs around £2 more.

Others add unnecessary ingredients with no proven benefit, that are marketed as providing an important, unique element. Take prebiotics for example. There is no evidence to show these have a benefit to babies and the European Food Standards Agency considers them an 'unnecessary ingredient' yet they are still included, and the price raised - over and above what the inclusion costs.

Similarly, claims that 'comfort milk' reduces colic and constipation are recognised by the NHS as simply untrue, yet manufacturers continue to claim this and hence these products cost more. Manufactures are playing on natural parental desire to have the best for their baby, and at the moment they are getting away with it.

The lack of a statutory body means that it is currently easy for industry to get away with this as there is no agency to challenge them. Organisations such as Baby Milk Action do a fantastic job in challenging inaccurate or unlawful claims, but again, there should be a statutory body who has this role. Families deserve proper, unbiased, independent information about the content and claims of these milks.

Ultimately the bill will ensure that parents can access the information they need, that companies will not be allowed to make misleading claims and importantly that pricing of formula milks will be fair. It will enable parents more control, choice and power in making decisions for their baby.

This is not about the choice to breast or formula feed, but the information that is available to parents if they choose or need to use formula milk. It is vital that our future generations health is put in the hands of a statutory independent body rather than those who seek to make money from it.

# data[].attributes.attachment_link.title
Don't We Deserve Fairer Priced Formula Milks?

# data[].attributes.attachment_link.description
In the UK, MP Alison Thewliss is calling for tighter regulations around formula milks for babies and children. She is asking the government to make changes to current legislation by establishing a regulatory body responsible for independently monitoring the content and safety of formula milk, whilst also ensuring that any advertising is accurate and within the law.

# data[].attributes.body
This is a situation where talking to someone can help, so do contact me or another bfc so we can help you talk through strategies. In the meantime. . . .

# data[].attributes.attachment_link.readable_text
Our video is presented by Melissa Little, Paediatric Dietitian
The Department of Health, UNICEF UK Baby Friendly, paediatricians and midwives all agree it's best to exclusively feed breastmilk for the first 6 months.

However, there are all sorts of reasons you may decide to switch your baby from breastfeeding to bottle feeding. You might be going back to work for example. Ideally, you will carry on feeding your baby expressed breastmilk even when you switch to a bottle by expressing your milk. You can also still offer your baby breastfeeds when you get home from e.g., work and your milk supply will adjust to feed when you are able to.

You may decide to give your baby some expressed breastmilk and some formula which is sometimes referred to as 'mixed' feeding. Remember any breastmilk you give to your baby is beneficial and will provide lots of immune boosting and developmental constituents.

As with most things to do with babies, it's different for all of them! Some babies seem not to even notice switching over. Others will put up a determined fight. If your baby won't take a bottle, go back to square one and start again, following these top tips.
Here is a video showing how to bottle feed sensitively and responsively:
The absolutely top tip is to do it slowly. Don't expect your baby to give up the warmth and cuddliness of breastfeeding overnight. Start well in advance of when you need to make the switch, say around a month before you need to go back to work.

Let him get used to the teat as a dummy before you even start with the bottle.

Begin by using expressed milk. If you decide to use formula Don't switch both to a bottle AND formula milk in one go. It's too much for your baby and chances are he'll flat-out refuse.

Start using expressed milk you have just expressed so it's still naturally warm and fresh. If you warm it from the fridge it won't taste quite the same, switch over gradually so your baby doesn't notice the change.

Put some of the warm expressed milk on the bottle teat so it smells like you.

The first time you try with the bottle, choose a time when your baby is hungry but not desperately so. You don't want him stressed out, or the bottle could be the last straw.

You can try doing a little bit of bottle, with expressed milk, just for a few seconds or minutes, in the middle of a breastfeed, and then go back to the breast. You then build up the time on the bottle slowly. This is a very unthreatening method, your baby knows the breast will come back, so there's nothing to worry about, and then you change over slowly.

Which teat to use, is really a matter of trial and error, but generally speaking, a slow flow teat is good to start with, since your baby might get overwhelmed by the volume let through by a fast flow teat. Remember your baby has to suck pretty hard on your breast to get the milk, so they're used to slow flow. Also sucking on a nipple and sucking on a bottle teat are not the same as the teat is much harder in their mouth.

It's important not to be too forceful if your baby is at all reluctant. You can tickle around your baby's upper lip and encourage them to open their mouths and then gently place the bottle inside. If they resist strongly or become upset, it's better to stop and try again later. Your baby may also pick up if you are feeling stressed and worried so give yourself plenty of time and stay calm.

If it's a total disaster and your baby won't take a bottle, you can switch straight from the breast to a sippy cup at around 6-9 months. Start with one with a soft flexible spout, not a hard plastic one.

Some people find that asking someone else to do the bottle feed can help, so there's no smell of you nearby and therefore the chance of a breastfeed. This has pros and cons, the pro is your baby might agree to feed, the con is he won't be bonding with you through that feed. So ask the person feeding them to remember to give them lots of cuddles, eye contact, and to recognise their feeding cues, i.e. especially when they've had enough. People mustn't insist your baby finishes the bottle if he doesn't want to. So you need to find someone sensitive and patient. They may need to give your baby a break and a burp halfway through as well, then see if he wants more.

The more you can be involved in the bottle feed, the better. Then your baby will still be getting all the cuddles they want. Howeverm you may find that your baby roots for the breast in skin to skin contact

If you introduce your breastfed baby to a bottle, use expressed milk, and do it very slowly.

Don't be surprised if it takes a long time, babies are instinctively programmed to breastfeed and they need to learn new skills to bottle feed. The more time you allow for the change the more successful it will probably be.

Every baby is different and very few don't take a bottle in the end if their parents want them to. Take your time. Ask your friends and family what worked for them and don't be tempted to buy lots of different types of bottles in desperation. It's usually more about giving your baby time to get used to a change.

If it's a total disaster and your baby won't take a bottle, you can switch straight from the breast to a sippy cup at around 6-9 months. Start with one with a soft flexible spout, not a hard plastic one.

Some people find that asking someone else to do the bottle feed can help, so there's no smell of you nearby and therefore the chance of a breastfeed. This has pros and cons, the pro is your baby might agree to feed, the con is he won't be bonding with you through that feed. So ask the person feeding them to remember to give them lots of cuddles, eye contact, and to recognise their feeding cues, i.e. especially when they've had enough. People mustn't insist your baby finishes the bottle if he doesn't want to. So you need to find someone sensitive and patient. They may need to give your baby a break and a burp halfway through as well, then see if he wants more.

The more you can be involved in the bottle feed, the better. Then your baby will still be getting all the cuddles they want. However, you may find that your baby roots for the breast in skin to skin contact

If you introduce your breastfed baby to a bottle, use expressed milk, and do it very slowly.

Don't be surprised if it takes a long time, babies are instinctively programmed to breastfeed and they need to learn new skills to bottle feed. The more time you allow for the change the more successful it will probably be.

Every baby is different and very few don't take a bottle in the end if their parents want them to. Take your time. Ask your friends and family what worked for them and don't be tempted to buy lots of different types of bottles in desperation. It's usually more about giving your baby time to get used to a change.

# data[].attributes.attachment_link.title
What do I do if my breastfed baby won't take a bottle?

# data[].attributes.attachment_link.description
As with most things to do with babies, it's different for all of them! Some babies seem not to even notice switching over from breast to bottle. Others will put up a determined fight. If your baby won't take a bottle, try following these top tips.

# data[].attributes.headline
Bonding with your baby when you are feeding with bottle

# data[].attributes.subject
Bonding with your baby when you are feeding with bottle

# data[].attributes.attachment_link.title
How do I use the time I spend bottle feeding to help me bond with my baby?

# data[].attributes.attachment_link.description
Watch this film to find out how to use the time you spend bottle feeding to help bond with your baby.

# data[].attributes.body
How you give a baby a bottle can make a big difference

# data[].attributes.body
Detailed information on making up milk in different circumstances

# data[].attributes.attachment_link.description
Eating well in pregnancy Infants & new mums Eating well early years Composition, claims and costs Working within the Who code What you can do Making infant milk safely Marketed food for children Infant milks for health workers Infant milks for parents & carers Additives Eating sustainably Conference 2016 Conference 2017 Sign up for newsletter

# data[].attributes.body
A short guide on choosing and making up formula milks

# data[].attributes.attachment_link.title
Guide for parents who formula feed - Baby Friendly Initiative

# data[].attributes.attachment_link.description
This simple, concise guide provides parents who are formula feeding with an overview on how to choose infant formula, and how to bottle feed as responsively as possible to help develop a close and loving relationship with your baby.

# data[].attributes.headline
Choosing a teat and bottle for a breastfed baby

# data[].attributes.subject
Choosing a teat and bottle for a breastfed baby

# data[].attributes.attachment_link.readable_text
There is a vast selection of bottles and teats available online or in the High Street. Many of them claim to be closer to breastfeeding in some way, whether it is the shape or size of the teat, the rate of flow of milk, the softness of the material or something about the sucking mechanism. Unfortunately, most of these claims are poorly researched and simply a ploy to increase sales. Although there is no single "best bottle" for breastfeeding, and we can't rely on advertising claims, there are certain bottle teat characteristics that seem to help preserve a baby's breastfeeding technique.

Find an IBCLC

Search for a breastfeeding expert near you

This article discusses pros and cons of a selection of newborn teat shapes with respect to how they might influence breastfeeding. The information should be read alongside Tips to Bottle Feed a Breastfed Baby and try to check customer reviews from other breastfeeding mothers before you buy.

The aim of the game

When choosing a bottle teat for a breastfed baby, the goal is to try to recreate the same mouth position and tongue action with the bottle that your baby uses at the breast:

Choose a short or medium length teat (artificial nipple), with a rounded tip (not flattened on one side) and a medium-wide base. The aim is for your baby to take most of the bottle teat in his mouth all the way to the screw cap. This will give him a wide open mouth around the base of the artificial nipple and the tip of the bottle teat will be deep in his mouth, close to the junction of his hard and soft palate. This recreates the deep latch wide-mouthed jaw position that is desirable when your baby breastfeeds.

Comparing bottle teats

Expensive branded teats with fancy packaging are not necessarily any better than cheaper unbranded makes. Many lactation consultants recommend starting with a cheaper teat and see how that works before spending more money on expensive brands.

#1 The wide based bottle teat

A popular choice with manufacturers is to make a bottle teat that looks like a breast i.e. a short bottle nipple protrudes from a wide base. However when the angle between the nipple and base is very steep, it makes it more difficult for a baby to make a wide mouth on the teat because they can slip off it and be forced to make a narrow mouth on the nipple tip. If the artificial teat is also made of a relatively inflexible or rigid silicone, this will be even harder for the baby to shape and hold with their tongue and will feel very different to a breast. The particular teat photographed has multiple rings of ridges on the inside surface of the nipple base which will make it more difficult to keep clean.

#2 The long narrow nipple

Some bottle teats have a very long nipple compared to the base. If the length of the nipple is too long this might be longer than a newborn baby's mouth possibly making them gag. If the nipple is too long, it will also prevent the baby opening their mouth wide on the base of the teat. Whether this style will suit your baby will depend on the gradient between nipple and base, the size of your baby's mouth, and the height of the teat. The greater the number of parts inside the teat, the more difficult it will be to keep clean.

#3 The small based teat

When the base of the teat is smaller, the contrast between the nipple and the base of the teat will be less severe. A baby is more likely to be able to get both the nipple and base in his mouth up to the screw cap to mimic a deep latch (attachment) at the breast, however, if the base is too small, this will result in a smaller gape. Also be aware with small teats that if the total height is too short it might not reach deep enough into baby's mouth to mimic the correct position for breastfeeding and may encourage a shallow latch when baby returns to the breast. Ideally the material used for the teat will not be too soft that it collapses in baby's mouth, nor too rigid.

#4 The very soft teat

Some teats are made of very soft material. The teat in the following picture is made of latex and has a slanted nipple tip. The softness of this type of teat has proved popular with premature babies or babies with neurological issues who are having difficulties with a regular teat. However if the teat is so soft that it collapses in baby's mouth when they feed, this can create a very closed, clenched mouth position which is not desirable for breastfeeding. Slanted or "orthodontic" bottle nipples may cause a baby to retract and hump the back of his tongue during bottle feeding which if repeated at the breast will compress the mother's nipple . A mother's nipple should not be compressed or distorted during a feed-this indicates the nipple has been rubbing in baby's mouth causing pain, soreness or vasospasm.

Latex is an allergenic material and some babies could be allergic to latex .

#5 The flattened teat

If a teat is sculptured on two opposite sides it will create a slightly flattened, angular teat. Depending how deeply a baby can take the teat in their mouth the flattened shape may prove difficult for baby to get a good seal with his lips and the edges of the sculptured areas could contribute to lip blisters. However if the silicone material is soft and the sides are not too steeply graded with a medium wide base, this style may suit some babies.

#6 The medium based teat with a medium height nipple

In theory the medium based teat with a short to medium height nipple is a shape thought to work well for a breastfed baby. Success will vary depending on the softness of the material used for the teat (not too firm, not too soft), the gradient between nipple and base, and the size of your baby's mouth.

#7 The gently sloping teat

Some bottle teats do not have a clearly defined difference between the nipple and the base, they look more like a nipple shield. Depending on the slope between nipple and base and the height of the teat, this shape could allow a baby to have a wide open mouth on the teat base to recreate the deep latch position desired in breastfeeding. According to reviews, some mothers found their breastfed babies accepted these when they refused other bottle teat shapes.

What about the bottle?

The bottle shape and size are not as important to preserving breastfeeding technique as the bottle teat. However the size of the bottle is worth considering. Some bottles have a very large capacity e.g. 260ml (9oz) or 330ml (11oz) yet a newborn breastfed baby typically does not take anything like these volumes at each feed. In the first few weeks, volumes per feed might be around 60-80ml (2-3oz) and between one month and six months of age, it is estimated that breastfed babies take an average 89-148ml (3-5oz) per feed . Smaller capacity bottles (e.g. 150ml/5oz) will give a more realistic estimate of both your baby's appetite and the volume of breast milk you might expect to pump in one go. See Tips to Bottle Feed a Breastfed Baby for ideas to help control the flow of milk to your baby to resemble what happens during breastfeeding.

Cleaning bottles and teats

Bottle feeding equipment needs to be kept scrupulously clean to avoid being an infection hazard. Ridges, crevices and internal parts in teats make them much more difficult to keep clean. See Sterilising Baby Bottles (National Health Service website, 2016) for comprehensive information on how to clean your baby's feeding equipment.

Alternatives to bottle feeding?

When introducing bottles to your breastfed baby, there is a risk that your baby could start to prefer a bottle teat over the breast (sometimes called nipple confusion or bottle preference) and this could undermine breastfeeding. Particularly if the reasons they are having bottle feeds are to do with difficulties breastfeeding or low milk supply. While the choice of teat shape and our Tips to Bottle Feed a Breastfed Baby can help to minimise problems, there are other feeding methods to consider such as Cup Feeding, or Breastfeeding With a Supplemental Nursing System. An IBCLC lactation consultant can help you decide on the best choice of feeding method for your baby's situation.

Low milk supply?

If you are struggling with low milk supply, contacting an IBCLC lactation consultant or other breastfeeding specialist for help can be invaluable, and see How to Make More Breast Milk. If you're considering using industrially made milks, Supplementing With Formula includes information on preparing formula safely and answers other frequently asked questions.

Summary

There are many different bottle teat shapes made of different materials with differing flexibility and flow rates. Manufacturers' statements that their bottles are "closer to breastfeeding" are just marketing claims designed to sell their products. Expensive brands are not necessarily better than cheap ones. Certain features of a bottle teat such as the length of teat, or width of the base can help mimic breastfeeding more closely. Babies come in different shapes and sizes with different sucking skills so one teat is not going to suit all babies making it difficult to recommend specific brands. Parents may have to try a few different styles to find the best bottle teat for their baby that doesn't seem to interfere with breastfeeding, and recreates the same open mouth position needed at the breast. The ideal shape will likely be a medium wide base with a short to medium nipple. Using bottles could undermine breastfeeding for some babies and cup feeding or supplementing at the breast are other feeding options to consider. This article should be read in conjunction with Tips to Bottle Feed a Breastfed Baby.

# data[].attributes.attachment_link.title
Best Bottle for a Breastfed Baby? - Breastfeeding Support

# data[].attributes.attachment_link.description
Which is the best bottle for breastfed babies? This article discusses pros and cons of a selection of newborn teat shapes in relation to breastfeeding.

# data[].attributes.body
And links to further information

# data[].attributes.attachment_link.readable_text
Following are some resources for alternative feeding methods, including bottle feeding, cup/dropper/spoon feeding, finger feeding, supplementing at the breast, and ideas for older babies.

Bottle | Cup, Dropper, Spoon | Finger Feeding | At Breast | Back to Breast | Older Babies

Now infants can get
all their vitamin D
from their mothers' milk;
no drops needed with
our sponsor's
TheraNatal Lactation Complete
by THERALOGIX. Use PRC code "KELLY" for a special discount!

Bottle feeding

Alternatives to bottles for younger babies (including preemies)

Cup, dropper, syringe, and links with various methods

Alternatives to bottle from AskDrSears.com

Refusing a Bottle: Dropper & Cup Feeding by Paula Yount

Finger and Cup Feeding by Jack Newman, MD, FRCPC

Cup Feeding from the Breastfeeding Committee for Saskatchewan

Cup Feeding Instructions and FAQs from foleycup.com

Comparison of the Safety of Cup and Bottle Feedings in Premature Infants Whose Mothers Intend to Breastfeed information on study by Kathleen A. Marinelli, MD, IBCLC; Georgine S. Burke, Ph.D; Virginia L. Dodd, MS, RNC. The full article can be found here.

Feeding by cup, paladai or spoon (see p. 206 of PDF file - note that this file is very large and will likely take a long time to load if you have a slow connection) from the WHO document Managing Newborn Problems: a guide for doctors, nurses and midwives.

Physiologic Stability of Newborns During Cup- and Bottle-feeding by Cynthia R. Howard, et al., from Pediatrics, Vol. 104 No. 5 Supplement, November 1999, pp. 1204-1207.

SoftFeeder (with link to Instructions) from Medela

Finger feeding

Options for supplementing baby at the breast

Weaning back to the breast from other feeding methods

Additional options for older babies (4+ months)

After 4-6 months, there is really no need to introduce a bottle - babies this age can generally handle a cup just fine (expect to help out in the beginning, though). If you need to, try different types of cups to see what works best for you and baby: regular cup (try different sizes), sippy cup, no-spill sippy cup, cup with straw (or a cup with a built-in straw), and sports bottle are all options that different babies use.

Occasionally a baby will refuse to drink from any type of cup or bottle. In this case, try feeding baby breastmilk with a spoon, dropper or syringe. If baby has started solids, mix the solids with lots of breastmilk. You might also try a momsicle, ice cream, yogurt or a smoothie made with breastmilk.

# data[].attributes.attachment_link.title
Tools for Feeding: Bottles & More * KellyMom.com

# data[].attributes.attachment_link.description
There are a number of options for feeding baby when you are unable to directly breastfeed - a bottle is only one of them. Following are resources for alternative feeding methods, including bottle feeding, cup/dropper/spoon feeding, finger feeding, supplementing at the breast, and ideas for older babies.

# data[].attributes.body
A useful guide for parents on the importance of keeping your baby close and responding to his/her needs - however you are feeding your baby.