Bottle feeding tips for when it is not going well

A bottle feed that keeps failing usually has one fixable cause: a teat flowing at the wrong rate, a position that makes swallowing hard, or a baby who is tired rather than hungry. Work through them singly. The NHS puts typical intake at 150 to 200 ml per kilogram of body weight a day in the first months.

Why is my baby refusing the bottle?

Start with hunger. Rooting, hand-to-mouth and stirring are cues a baby gives for comfort as well as food, and a baby who has fed 40 minutes ago is often asking for something else. Offer a cuddle, a change, a quieter room, then try again.

Then look at the teat. Milk that arrives too fast makes a baby gulp, pull back and cough. Too slow and she works hard, tires out and gives up halfway. A slow-flow teat suits newborns, and you move up only when she is draining a bottle easily and still hungry.

Then look at the position. A baby tipped too far back has to swallow uphill. Semi-upright, head above the stomach, the bottle close to horizontal rather than vertical.

A tired baby is the hardest case. A feed attempted during a meltdown rarely works. Settle her first, even if that means a short nap and a late feed.

How much milk should a feed hold?

The NHS guide of 150 to 200 ml per kilogram a day until around six months gives you a daily total, which you then divide by the number of feeds.

A baby of 4 kg, on that guide, takes somewhere around 600 to 800 ml across the day. Across eight feeds that is roughly 75 to 100 ml at a time.

Treat it as a sanity check and not a target. Weight gain at the polyclinic reviews, wet diapers, and a baby who stops of her own accord tell you more than a measured bottle does. Pushing the last 20 ml in is how overfeeding and spitting up start.

How do you pace a bottle feed?

Paced feeding means letting your baby control the flow, the way she would at the breast. It matters most if you are combining breast and bottle.

• Hold her semi-upright, supported, never lying flat
• Stroke her lip with the teat and wait for her to open, rather than putting it in
• Keep the bottle nearly level, with milk just filling the teat
• Pause every 20 or 30 seconds, tip the bottle down, let her breathe
• Stop when she turns away, even with milk left
• Switch which arm you hold her in, as you would switch sides

Never prop a bottle against a cushion. A propped bottle keeps flowing when she stops swallowing, and the American Academy of Pediatrics links the practice to choking and to ear infections.

Also read: breastfeeding compared with formula feeding

How should formula be made up and stored?

Formula powder is not sterile, and the heat of the water is what deals with that.

The NHS advises boiling fresh water, then letting it stand for no more than 30 minutes so it is still at 70°C or above when it hits the powder. Add the water first, then the scoops, levelled off and never heaped.

Singapore tap water is drinkable straight from the tap, and that does not change the rule, because the organism being killed is in the powder rather than in the water.

The CDC says to discard whatever is left in the bottle within an hour of the feed starting. A bottle made up and not offered can go straight into the fridge and be used within 24 hours, and fresh at each feed is better.

Sterilising runs until at least 12 months, says the NHS. In this climate, drying is the step people get wrong. Teats left on an open rack in humid air stay damp, so dry everything properly and store it covered. Guardian, Watsons and Unity all carry sterilising tablets and steriliser bags if you are travelling.

What if it is colic?

Colic is defined by the crying rather than the cause. The American Academy of Pediatrics describes a healthy, well-fed baby crying for more than three hours a day, on more than three days a week, for more than three weeks.

Feeding changes that sometimes help:

• Smaller, more frequent feeds
• Winding halfway through as well as at the end
• A teat that lets less air in, and a bottle held so the teat stays full
• Holding her upright for 20 minutes afterwards

What does not help is switching formula repeatedly on your own. Each change takes days to judge, and a flat refusal of a new taste can look like worsening colic.

Also read: signs of colic and how to relieve it

Also read: how to relieve baby gas

Introducing a bottle before you go back to work

Eligible mothers in Singapore get 16 weeks of Government-Paid Maternity Leave, under the scheme the Ministry of Manpower administers, which is why so many first bottles happen in week 12 or 13.

Give yourself longer than that. Offer a bottle once a day for a couple of weeks before the handover, let somebody else offer it, and leave the room. Many babies take it from a grandparent or a helper and refuse it from the person who usually breastfeeds.

Write the instructions down for whoever feeds her while you are at work. Amount, how to make it up, how long a bottle may stand, how she likes to be held. A note on the fridge settles more arguments than a conversation does.

Also read: pumping at work

When should you ask for help?

See a doctor at a polyclinic, or ask for a lactation appointment, if your baby:

• Is losing weight, or has stopped gaining
• Has fewer wet diapers than usual, or a dry diaper for many hours
• Coughs or chokes during most feeds
• Arches and screams through every feed
• Has refused all feeds for several hours

Call 995 or go straight to a hospital emergency department if your baby turns blue or grey, goes floppy, or is struggling to breathe.

KK Women's and Children's Hospital and National University Hospital both run lactation and infant feeding clinics, and your polyclinic doctor can refer you. Feeding problems get easier to solve the earlier somebody watches you do one.

Also read: how to end a nursing strike