Pumping & Bottles
There are many reasons that infant’s require formula or donor breast milk supplementation including weight loss, maternal engorgement, underlying medical conditions in the mother or infant, and difficulty with breastfeeding. Often this supplementation is only temporary and to ensure the infant can exclusively breastfeed following supplementation, a few steps are necessary. Some babies need to bottle feed with expressed milk until they are able to directly feed at the breast. In this section, we highlight steps for bottle feeding while supporting breastfeeding and review feeding strategies when supplementing.
Maximize your milk supply
When formula is offered, especially in the first few days of life, an infant’s feeding pattern changes. The infant tends to take larger volumes and stretches feeding intervals longer. If the infant is also breastfeeding, she spends less time at the breast, less often. If additional steps aren’t taken, the mother’s milk supply will diminish.
Through breastfeeding research, we’ve learned that the mother’s milk supply is partially determined by the cues her body receives from her infant. More frequent feeding tells the mom’s body to make more milk as the infant is hungry. Fortunately, we are able to artificially mimic the hungry infant by employing a breast pump to stimulate the breasts. The bottom line: Do NOT go more than 4 hours in between a feeding or pumping interval.
Methods of formula feeding
Formula can be provided to the infant via a syringe, bottle, or supplemental nursing system. Each method has appropriate uses and advantages and we want to work with you to find the most appropriate choice for your family.
Syringe Feeding
Infants can be fed by sucking on parent’s finger and sliding a small syringe or catheter along the finger to deliver formula or expressed breastmilk. This strategy works well in the first 2 days of life when supplemental volumes are less then 10 milliliters but thereafter this strategy is not appropriate as the infant will require a more efficient feed and be able to take more control of the feed.
Bottle Feeding
Many parents are worried that giving their babies even one bottle will make breastfeeding difficult. However, babies generally prefer to breast rather than bottle-feed! Using the bottle is an efficient and appropriate way to deliver formula or expressed milk. When using the bottle, we recommend a paced-feed with an appropriate nipple (see avoiding nipple confusion). The paced feed slows the overall feed so the infant does not become accustomed to a fast feed and then become frustrated at the breast. Watch this video for an example of proper bottle feeding and the paced feeding technique. Your nurse and physician will also make sure you feel comfortable with this technique.
Supplemental Nursing System
The Supplemental Nursing System (SNS) involves temporarily securing a small tube attached to formula to the breast such that the infant latches and suckles at the breast and simultaneously receives formula. This strategy can take a little more time to set up each feed yet it can feel very rewarding for the family and keep the infant oriented toward the breast as the source of nutrition.
What is Paced Bottle Feeding?
This refers to slowing down a bottle to make the flow more closely mimic breastfeeding. If your baby is small or early, and your baby’s doctor is worried about his or her weight, or jaundice, you will want to rely on an easy flow of milk until goals have been met. If you still need to give a bottle, you may want to adopt some pacing techniques, such as:
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Breasts usually don’t flow at baby’s first suck. Start out with the bottle dipped down so that the nipple is empty for about 10 seconds.
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Breasts may not flow consistently. Instead, milk releases in pulses. You may want to dip the bottle down again after a couple of minutes and give your baby a pause of about 5 seconds. Repeat from time-to-time so that the feed takes about 20 minutes.
Avoid pacing the feed so much that your baby gives up and falls asleep before a complete feed.
Avoid Nipple Confusion
The infants latch is a key component of successful breastfeeding. Certain bottles and pacifiers can promote a variation in the sucking technique that makes a proper latch at the breast more difficult.
Our lactation consults :
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Dr. Brown’s standard (level 1-slow flow)
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Playtex VentAire Slow Flow
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Wide Neck Gerber Nuk (avoid the Narrow Neck Nuk).
Avoid the following nipples until breastfeeding is well established as these have a long, narrow nipple portion on a flat base:
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BornFree
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Avent
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Playtex VentAire wide-neck
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Dr. Brown’s wide-neck
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Playtex NaturalLatch
Avoid regular pacifier use until the breastfeeding is well established.
The feeding-pump sequence
Developing an efficient feeding routine is important for your own sake so you can get a little sleep but it is also important so that the infant can get the sleep she needs. In general, if you are putting the infant to breast, you will want to breast feed on each breast until the breast is drained but no more than 10-15 minutes.
If using a SNS, the supplemental feed will occur concurrently. If not, then immediately following the feed, one should supplement with expressed milk, pumped from the prior session, and then with formula. If another caregiver is available to feed the infant, mom should pump simultaneously so that the entire feeding regimen is less than 45 minutes.
Guidelines for Storing Your Pumped Milk
Freshly expressed milk at room temperature
- Up to four hours at 80 degrees Fahrenheit
- Up to 10 hours at 70 degrees Fahrenheit
- Up to 24 hours at 60 degrees Fahrenheit, e.g. in a cooler with ice packs
Milk storage in the refrigerator
- Five days at 39 degrees Fahrenheit
Milk storage in the freezer*
- Six months in a home freezer at 5 to 15 degrees Fahrenheit. Store away from the door.
- Twelve months in a deep freeze at -20 to 0 degrees Fahrenheit.
- Two weeks in small interior freezer.
* In order to make sure your milk is storing well, defrost a bottle after a week and make sure your baby accepts it. See the last paragraph regarding lipase problems.
Frequently asked questions about pumping milk
Can I combine milk from different pump sessions?
Yes, but cool each batch first and store according to the age of the oldest milk. It is best to freeze your milk in small quantities (2 to 4 ounces depending on the age of your baby) within two days of expressing. Leave room in the container for expansion when freezing, and date each container. As your milk cools, the cream may form a thin layer on the surface. Swirl to redistribute the cream when you warm the milk.
How do I heat breast milk?
Microwaving destroys some of the anti-infective properties of the breast milk and may create “hot spots” that could burn your baby. Your baby may accept milk straight from the refrigerator, but this can reduce the core body temperature of a small infant. Place the container of milk in a bowl of warm water, or place under the hot water faucet, and bring to room temperature.
Can I reuse leftover milk?
Many mothers refrigerate milk the baby did not finish and use it at the very next feed. If you have any doubt, discard the milk.
How do I thaw frozen milk?
Thaw overnight in the fridge, or place the container of breast milk in a cup of warm water. Use the milk immediately or refrigerate for up to 24 hours. Do not refreeze.
Why does my frozen milk smell unpleasant when I thaw it?
Lipase, the enzyme that digests fats, stays active when milk is frozen. Some mothers have a high level of this enzyme and their milk smells and tastes soapy when thawed. The milk is not harmful but the baby may refuse it. If you have this problem you will need to scald your milk before storage.