Paced Bottle Feeding vs Responsive Bottle Feeding

When I tried to switch to bottle feeding right before going back to work my daughter always looked like she was drowning in milk and would refuse to eat. It was such a stressful experience and made it so hard for me to want to go back to work. I quickly reached out to an amazing lactation consultant who gave me some amazing information. One of the things she taught me was how to do a paced bottle feeding. It changed everything with our experience.

My daughter no longer struggled as much with feeding (she had a tongue and lip tie that I didn’t actually know about). We changed the flow of the nipple and with one bottle feed she already looked more comfortable and was no longer making these awful gulping noises. We taught our caregivers as well so while I was away at work I knew she would still be fed in a way that was best for her. Thankfully, I felt a lot more peace about heading back to work with my 3 month old baby.

What is Paced Bottle Feeding?

This is a technique that has been studied a lot in premature and NICU babies. These studies showed that paced bottle feeding help them to gain weight appropriately when switch from tube to oral feedings. Paced bottle feeding can be done with either breastmilk or formula.

Paced bottle feeding actually mimics feeding from the breast. When a baby is feeding from the breast it takes some time for the milk to flow (let down). As the baby is sucking the milk does not always flow at the same rate or at all. In paced bottle feeding we copy this technique by how we hold the baby and the bottle. it slows everything down so the flow of the milk is similar to the flow of milk from a breast.

Why is Paced Bottle Feeding Important?

Listen paced bottle feeding isn’t the only way to feed a baby, but it does have a lot of benefits. Research shows that when parents or other caregivers feed baby’s with a bottle we tend to overfeed our infants. When we can monitor how much our infants are eating we tend to feed them past their full level. We often coax our babies to finish their bottles thinking we know how much they need to eat.

The secret is they don’t need us to tell them how much to eat! They come with all the equipment to do it themselves.

The flow of a typical bottle allows a constant flow of milk with every suck. This gives the baby more milk with much less work. Many babies will start to prefer bottles for this reason and reject the breast. Who wants to work that hard. The fast flow of a bottle can also lead to your baby filling up before their body ever gets a chance to tell them they are full. It can take 10 minutes to feel full before their hunger hormones kick in a tell them “I’m done.” If your baby is finishing their bottle in 5 minutes then their body never has enough time to give them the signal they are full.

Overfeeding like this can lead to issues like gas, colic, and reflux.

Benefits to Paced Bottle Feeding

• Helps teach self regulation: this is a skill that many of us as adults don’t even have. Our babies have everything within themselves to tell them they are full. This system trusts their internal cues and helps them develop the skills to follow those cues as they grow. It gives them the time to receive feedback from their body and in turn stop when they are indeed full.
• Avoid stomach problems: When they are eating the right amount of food and not overeating they are less likely to have stomach pain and reflux. They will also take in less air when they are taking milk in slowly instead of gulping. Burping frequently can also help to reduce extra gas in the belly as well. All babies swallow air (why we burp all babies) when they eat, there is just less of it with this paced method.
• Preserve Breastfeeding: Because you baby has to work hard with bottle feeding just like it does when at the breast, you should have less issues with nipple confusion or refusing the breast. Babies who follow this technique also do less overeating so you don’t go through your supply of milk as quickly or give up breastfeeding all together, because “you can’t keep up with your baby’s needs.”

How to do Paced Bottle Feeding

1. Start with a small bottle and a slow flow nipple
2. once your baby shows some hunger cues (sucking on their hands, lip smacking, opening/closing mouth, rooting, fidgeting/squirming/fussing)
3. hold baby slightly reclined, upright while you support the head and the nick with your hand, or side lying.
4. touch the nipple to the baby’s upper lip or chin to encourage them to open their mouth
5. Gently insert the nipple into the mouth
6. Let them suck on the nipple with no milk
7. Then tip the bottle horizontally to allow milk to fill up half of the nipple
8. After about 20-30 seconds stop the flow of the milk by tipping it downward
9. When they start sucking again tip the bottle back up filling half of the nipple
10. take breaks throughout or at least halfway through feeding to burp and get out any excess gas.
11. Repeat until baby shows signs that they are full (starting and stopping the feeding often, spitting out or pushing the bottle away, fidgeting or getting distracted easily, appearing sleepy and relaxed at the end- fists unclenched, jaw relaxed, arms and legs relaxed)
12. End the feeding session.

Removed the Bottle If:

• You see your baby swallowing quickly without taking a breath after each swallow
• Spilling milk from their mouth
• Opening their eyes widely
• Stiffening of their arms and legs
• Flaring nostrils
• Has lips that are turning blue

They May Need to Burps if:

• They are arching their back
• Getting cranky/fussy
• Pulling or bending their legs
• Pulling away from the bottle

What is Responsive Bottle Feeding

Responsive feeding really is quite similar to paced bottle feeding, however, in this particular method the goal is to create a closer bond between caregiver and child and put more of the control in your baby’s hands. It emphasizes that we trust our babies intuition and that we believe they know what they need, and they will communicate that need to us their caregivers. That means even if they show signs of hunger again an hour later we act according to those cues instead of thinking “babies only need to eat every 3 hours she can’t be hungry.” This is truly letting go and trusting their internal cues. The benefits that are found in responsive bottle feeding are very similar to paced bottle feeding.

Research supports that responsive bottle feeding leads to:

• Better self regulation skills
• Better digestion (fewer cases of overfeeding leading to stomach pains and reflux)
• Building parental trust as you respond to their feeding cues and satiety cues.
• Development of close relationships as you hold them close and interact with them during the feeding.
• Reduction in ear infections due to the upright feeding position.

How to do Responsive Bottle Feeding

1. Be aware of feeding cues (sucking on their hands, lip smacking, opening/closing mouth, rooting, fidgeting/squirming/fussing). Once you see those cues prepare to feed your baby. Try not to wait until they are overly hungry and crying. This may make feeding difficult.
2. Position your baby in an upright 45 degree feeding positions held close to you (you can also feed skin to skin to create more bonding).
3. Find the right sized nipple to deliver a slow flow of milk.
4. When offering the nipple hold the bottle at an angle to completely fill the nipple with milk but no higher.
5. Interact with your baby during the feeding. This means watching for cues of fullness or needing or wanting to end feeding. Following those cues will help your baby continue to develop those self regulation skills. Do not encourage them to finish the bottle or continue feeding if they continue to give you cues they are finished.
6. Throughout a 24 hour period they will consume different volumes depending on their needs. One feeding they may eat 2 ounces and the next 4oz. That is okay, again they know what they are doing. Trust them. The volume they consume over the 24 hour period will be fairly similar day to day as they meet their caloric needs.

It is very important that you stay engaged in the feeding. This means putting away your cell phone or turning off the TV. Get rid of those distractions so you can be fully present when you feed.

Frequently Asked Questions

Conclusion

Paced bottle feeding and responsive bottle feeding puts your baby in control and helps them develop important skills. It is often more comfortable and can help you preserve your breastfeeding experience even if you are going back to work. Both techniques can be quite simple but may take a little practice. Get your partners and caregivers involved so your baby gets similar experiences for all of their feedings. At the end of the day you need to choose what works best for you and your baby!