Bottles...

Ok, a tough one to tackle. Bottles are such a 'normal' part of our society. We see them everywhere - in baby books, on pillow cases and sheet sets, receiving blankets, diapers, t-shirts, on the news when they are talking about babies, in the mall to indicate a family room or diaper area, they come with dolls, they are featured in commercials - the ubiquitous bottle cannot be escaped - and why should it be? Well, many a practitioner much more learned than I have written numerous chapters[1] on the bottle and how our exposure to the image over and over does damage to breastfeeding. I would like to take a different approach - why does it, from a technical (i.e. baby's) point of view, interfere with breastfeeding?

Well, we know from some very good research done with electromyography that a baby uses facial muscles differently when sucking on a bottle vs. suckling at the breast. We know that bottles have a consistent flow throughout the feeding, and in this way they flow differently than breasts - breastmilk ebbs and flows with mother's let down and bottles flow one of two ways: either always because the slightest pressure on the teat (even no pressure with some teats) causes the milk to spray or drip out; or, with some of these newer-trying-to-imitate-breastfeeding bottles, they flow as the child puts pressure on the teat. Either way - it is different. The flow of milk from the breast is sometimes easy and fast, sometimes goes a bit more slowly, and sometimes requires intervention from the mother (like having a mother do breast compressions or offer the other side.) So why is that such a problem - this difference in flow? For some babies, it's not.

I have heard and seen many babies go back and forth between breast and bottle for many many months with no trouble at all and no affect on the breastfeeding. I have seen some do this for a few months and then the trouble starts - pulling at the breast, baby seems gassy, baby is fussy between feedings, baby sucks on his hands frequently and teething is blamed'because he is drooling at the same time - baby bites the breast, mother suddenly gets sore nipples, etc., etc. I have had mothers come into our clinic because of sore nipples and say 'my baby takes the bottle with no problem and goes back to the breast with no problem, either.' And she doesn't see that there is a relationship at all. I have even seen babies get one bottle and display the above-behaviours at the breast. And I have seen parents train their baby with a bottle a day since birth and then one day it all goes to pieces. What I ask parents is, how do you know which baby you will have? The answer is: You don't.

So why not just use a cup?

A cup is clean, cheap, easy, can be found anywhere (every restaurant has one), it doesn't need to be a special kind and every kid one day has to know how to use it'you don't see bottles on the prerequisite list for kindergarten do you? With cup feeding, the baby is forced to bring his tongue out and forward - a bit like breastfeeding but not quite. However, as the baby does not have anything to suck on while cup feeding, there doesn't seem to be that flow preference concern. Don't get me wrong, I have seen kids down milk from a cup faster than they take a bottle - but again, it's different and doesn't tend to cause problems.

Lastly, there is much thinking and some research lately on the effects of a bottle on the palate - and I mean permanent effects. We know that babies are born with narrow skulls (and therefore narrow palates) so they can get through the birth canal more easily. We know that with breastfeeding the skull widens as does the palate over time - and this is as it should be. This allows for our airway passages to widen and work as they were meant to work as we move into adulthood. But there have been some correlational findings that suggest bottle feeding, extended finger sucking, and pacifier use may prevent or decrease this widening and cause problems in adulthood, e.g. sleep apnoea. Now, we don't yet have a causal relationship documented in the research, i.e. nothing that says bottle feeding leads to sleep apnoea. Just that there is a correlation between those who were bottle fed as babies and those who have sleep apnoea in adulthood. The problem is, so many who were breastfed (in the 60s, 70s, and 80s) were also later bottle fed. My own mother insisted she exclusively breastfed all of us, but recently I found a picture of my older brother, as a baby around 6 months, who was being given a bottle of water by my father - under the instructions of the paediatrician! So, what damage occurred due to the occasional bottle my brother got? Who knows? We need the research. In the meantime, if mom needs to have someone else feed the baby, for whatever reason, or is slowly transitioning off the breast, or only breastfeeds a couple times a day, then I say, go for the cup!

Posted by: Edith Kernerman, IBCLC

Read more from Edith Kernerman at her blog site www.babylatch.com

[1] Gabrielle Palmer, Jack Newman, James Akre, Infact Canada

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