Kassing Bottle …

1 KassingBottle-Feeding as a Tool to Reinforce BreastfeedingInsights in PracticeBottle-Feeding as a Tool to Reinforce BreastfeedingDee Kassing , BS, MLS, IBCLCA bstractBabies may need supplementation due to difficulty breastfeeding. Others must be fed by alter-native feedin gmethods because they are separated from mothers who have returned to em-ployment or school. Recognizing that mothers and caregivers are often not comfortable usingother alternative feedin gdevices, the author endeavored to develop a method of Bottle -feedin gthat would meet the needs of these mothers and their babies without causin gsuck resultin gbottle-feedin gmethod requires babies to expend effort and use their oral anat-omy in ways very similar to Hum Lact. 18(1) :breastfeeding, Bottle -feeding, alternative feeding devices, dysfunctional suck,supplementationFor years, I received frequent counselin gcalls fromemployed mothers whose babies had been receivingbottles from their caregivers and now were refusing tobreastfeed.

2 The babies had become accustomed to theease of feedin gfrom a Bottle and were refusin gto workfor their dinner at mother s breast. Many caregiversprefer bottles over all other alternative feedin was imperative, therefore, to make Bottle -feedingrequire effort similar to breastfeeding, so that babieswould not mind switchin gback and people are reared to recognize two ways to feeda baby: breast or Bottle . When I worked with womenwhose babies were not breastfeedin gwell, I noticed thatmany of these mothers would give up and turn to Bottle -feedin gwith artificial baby milk rather than attempt touse other alternative feedin gdevices. When new moth-ers are exhausted and overwhelmed with a baby who isnot eatin gwell, they may view an alternative feedin gdevice as somethin gthat will require effort on their partto learn to use it with the baby. These mothers may feelthey do not have the energy (emotional or physical) tolearn how to use somethin gnew.

3 Althou gh a few moth-ers were quite adamant about not usin ga Bottle , many ofthe mothers I worked with viewed the suggestion to usean alternative feedin gdevice as the last straw. Ratherthan use an alternative feedin gdevice, they would chooseto stop breastfeeding. I needed to find a way for thesemothers to supplement when necessary, usingtheirpre-ferred feedin have been able to develop a style of Bottle -feedingthat seems to meet the requirements of these at-riskmothers. The method theoretically requires a similaramount of effort from the babies as breastfeedin gdoes. Idemonstrate the method to all mothers who come to myoffice to obtain a breast pump before they go back towork. Because the method requires the baby to use hisoral anatomy in a manner very similar to breastfeeding,I also use this method to teach many suck-confusedbabies how to has been much discussion amon gbreastfeed-in gsupport workers and in the literature concernin gnip-ple confusion and its babies initiallybreastfeed well but then show difficulty after receivin gabottle or pacifier.

4 Other newborns are unable to breast-feed correctly even though they have had no exposure to56 Received for review, September 5, 2000; revised manuscript accepted forpublication, October 22, Kassing , a private practice IBCLC, is the owner of Breastfeedin gSup-port Services Inc. She is also a long-time La Leche League leader and cur-ently serves in the Professional Liaison Department of La Leche League ofIllinois. Address correspondence to Dee Kassing , 302 Chesapeake Lane,Collinsville, IL 62234, Hum Lact 18(1), 2002 Copyright 2002 International Lactation Consultant Associationan artificial nipple. Both these categories of babies needto learn to breastfeed correctly, and both may needsupplementation. For purposes of this article, bothgroups are referred to as suck confused. I prefer thismethod of Bottle -feedin gfor supplementation versuscup-, spoon-, and syringe-feeding. Although these feed-in gmethods do not cause suck confusion, they also donot teach the baby what he needs to be doin gat thebreast.

5 I have not seen this method of Bottle -feedingcause any confusion in any of the babies I have workedwith. I do try to be sure that the baby has always had anopportunity to breastfeed before any attempt is made tobottle-feed. It is important that the baby s first opportu-nity to suck be at the breast whenever suggest this method to employed mothers and tomothers whose babies are feedin gpoorly or suckin gincorrectly, after a change in positioning or latch-ondoes not solve the problem. For mothers with delayed orinsufficient milk supply and adoptive mothers whosebabies know how to suck correctly, but needsupplementation, I suggest the choice of this style ofbottle-feedin gor the use of a Supplemental Nursin gSystem or Lact-Aid. For babies who have lost a largepercentage of birth weight and are too weak to completea feeding, I suggest a feeding or two with an eyedropperor syringe.

6 If supplementation is still necessary whenthe baby is stronger and has more energy, I then suggestswitchin gto the Bottle -feedin gmethod. I am currentlyworkin gon a modified version of this method for pre-mature infants, based on the suggestions of severalnurses who work in special care MethodThe followin gserves as an overview of the Bottle -feedin gmethod I have developed, alon gwith my ratio-nale for each part of the process. Use a straight Bottle rather than a bent Bottle (Figure 1). Milk that is up in the higher, bent partof the Bottle has gravity pulling on it. When babycompresses the nipple with his jaws, he opens thehole(s) in the nipple and the force of gravity canthen help the milk out of the Bottle . This canlessen the baby s effort and can also encouragebaby to chew rather than suck. This problem isavoided by usin ga strai ght Bottle . Use a reusable Bottle rather than a disposable bagsystem.

7 It is important to fill the baby s mouth ina manner similar to breastfeeding. The nipples fordisposable feedin gsystems have very lar ge basesthat the baby cannot get his mouth around. Thebaby is then forced to make a tight mouth aroundthe narrow shaft of the nipple. The base of nip-ples for reusable bottles (Figure 1) is narrowenough that the baby can get the entire nipple inhis mouth. This forces baby to keep his jaws openwhen he makes a seal around the base of the nip-ple, which is very similar to how he holds hismouth for end of the nipple is much farther back in ababy s mouth when the entire nipple of a reus-able Bottle is in his mouth than when the baby isallowed to feed on just the shaft of the baby is reminded that somethin gis alwayssupposed to be in the back of his mouth when heis eating. A baby who is breastfeeding properlywill pull mother s nipple back to the juncture ofthe hard and soft palate (the S-spot2).

8 This mayhelp to stimulate the baby s suckin greflex. No-ble and Bovey3feel that an artificial nipple mustideally be lon genou gh to reach this , there are currently no nipples this longavailable where I work, and I have not found thislength to be necessary if the entire nipple can beinserted into the baby s mouth. Use a round nipple (Figure 1). Weber et al s4andWoolridge s5,6ultrasound studies showed howbabies use the structures of the face and mouth toachieve the suck used durin gbreastfeedin g. Ul-trasound work by Nowak et al7studied babiessuckin gon artificial nipples with an old-fash-ioned round shape and with an orthodontic shape. These studies indicated that the suck elic-J Hum Lact (18)1, 2002 Bottle -Feeding as a Tool to Reinforce Breastfeeding57 Figure style of nipple and Bottle for Kassin gMethod by an old-fashioned round nipple is closer toa breastfeedin gsuck. Use a slow-flow nipple.

9 Regular-flow nipplesflow very easily, even when the Bottle is held in ahorizontal position. A slow-flow nipple requiresthe baby to put forth effort very similar to breast-feedin gto get milk from the Bottle . Low-tone ba-bies may not have the stamina necessary to finisha feedin gwith a slow-flow nipple. For these ba-bies, I recommend usin ga medium-flow nipple(a few brands available in my area offer this op-tion) until they have developed the strength andstamina to use the slow-flow nipple. I explain tomothers that ideally, a Bottle -feedin gshould re-quire about 20 minutes, which is approximatelysimilar to the time spent breastfeedin gwhen all isgoing well: 10 minutes per breast. If the baby canfinish a full Bottle -feedin g(as opposed to a par-tial supplementation after time at the breast) in 5to 10 minutes, the flow is too fast. If it consis-tently takes the baby 30 to 45 minutes to finish afull Bottle -feedin g(not countin gthe first or sec-ond attempt when he might still be learning thenew technique), the flow is too slow for his abili-ties at that time.

10 Try to use a soft nipple when possible. The sili-cone nipples available in my area seem to besofter than latex nipples. Palmer8noted that plac-in ganythin gfirmer than the breast in a baby smouth may cause distortion of the palate. Usin gasofter nipple will hopefully do less damage. It isimportant to remember, however, that if themother gives up on breastfeeding and decides touse bottles full-time because the baby could notlearn how to breastfeed appropriately or becausethe mother felt that other methods of supple-mentin gwere too difficult to learn, the type ofnipple used will become a moot point. Position the baby so that he is sittin gupri ght. Themother or caregiver can use one hand to supportthe baby s head and neck. Hold the Bottle hori-zontally (Figure 2). This position removes grav-ity from the feedin gpicture. Without gravityhelpin gto pour food into the baby s mouth, babywill have to work harder for his meal.