Side-lying Bottle-Feeding

Look in most magazines and you see examples of the most recognized position for bottle feeding your baby. You know the pose, holding the baby in a cradled position lying on their back in the person’s arm with the bottle tilted so milk is filling the entire nipple, and feeding the baby until the bottle is empty.

If we break down what’s going on in that position, it makes more sense why this is not the best position for your baby to have a bottle and what we can do to make bottle feeding better. 

Let’s start by considering if we were the baby. Picture yourself lying on the couch reclined in the same way as the baby in our scenario. Your partner or friend comes over with a drink. They hold it for you with the liquid continuously flowing. You keep swallowing because that really is your only option. You may gulp and sputter a little, but you drink it all. Your friend smiles and assumes you are happy, satisfied, and now content.

Side-lying bottle-feeding slows the pace of feeding and follows the baby’s cues. When a baby stops eating when they are full and satisfied and the parent can see that cue more clearly and stop the bottle feeding, the baby is less likely to be overfed. Over time, they have a lower risk of obesity and will develop a healthy metabolism. This method of bottle feeding allows your baby to be an active rather than a defensive eater.

Babies don’t always drink the same amount at every meal, just like we may not eat the same amount of food each time we sit down to eat. Sometimes, we just want a snack, and other times, we want a bigger meal. Babies typically drink between 1.5-4 oz per feeding. If they only had 1.5 oz, they may ask to eat again sooner. Other times, they will take a larger bottle feeding and be content for 2-3 hours. Make sure to talk with your baby’s other caretakers about how to bottle feed and educate them on what is a reasonable amount of milk to expect your baby to take.

Side-lying bottle-feeding

  • Side-Lying paced bottle feeding gives the baby more control over the feeding
  • A slower way to feed the baby
  • Reduces the pooling of milk in the baby’s mouth. Instead, excess milk will drip out the side of their mouth
  • More baby controlled
  • More closely mimics breastfeeding position 
  • Baby can pause as they desire during the feeding
  • Baby’s body is fully supported and has greater postural stability
  • Allows the baby to actively feed rather than passively feed
  • The bottle is held horizontal to the floor and can be tipped up to make milk available to the baby or down to stop milk flow when the baby pauses their suck pattern
  • Supports breathing and swallowing coordination
  • Supports digestion
  • Very comfortable for the person feeding the bottle

Steps to side-lying bottle-feeding

  1. Sit somewhere you are comfortable and place your feet on a stool, table, couch, or bed with your knees bent and your legs from your hips to your knees at about a 45-degree angle
  2. Place your baby on their left side on your lap with their bottom against your belly and their head towards your knees. Your baby’s legs should be in front of them and their ear, shoulder, and hip in a straight line. The stomach’s natural position is on the left side and food is more easily digested when we lay on our left side. Gravity aids waste removal traveling from the small to the large intestine.
  3. Your baby’s arms can be out in front of them 
  4. With the bottle horizontal to the floor, place the base of the nipple on your baby’s chin and wait for them to open their mouth nice and wide. Waiting for them to open wide mimics how they get a deep latch at the breast.
  5. When your baby’s mouth is open wide, put the nipple in their mouth with the bottle still horizontal to the floor. 
  6. Follow your baby’s cues, if they stop sucking, tilt the bottle towards you to slow the flow of milk. When your baby begins to suck, after a couple sucks, tilt the bottle away from you for milk to enter the nipple.
  7. After giving about half the bottle, stop to burp your baby and then switch them to lie on their right side and feed until they show cues they are done.

Bottle flow rate

Don’t believe the marketing! Just because a bottle is marketed as slow flow, that doesn’t mean it actually is. Even among the same bottle nipples, not each one has the same flow rate.(2) In a study of 45 different nipple brands, testing 10 of each, showed there is a range of flow rate from 2 mL/minute to more than 80 mL/minute.(1) Another study of 26 different brands showed similar results with a range of 1.68 mL/min to 85.34 mL/min.(2)

Bottle nipple shape

  • Choose a bottle nipple shape that has a gradual slope from the tip of the nipple to the base. 
  • You want your baby to mimic breastfeeding while taking the bottle. 
  • With a nipple that has a sharp angle from nipple to base, they will slide their lips down the nipple shaft and have a more shallow gape. 
  • That type of nipple encourages a shallow latch and sucking on the nipple more like a straw.
  • A gradual slope from nipple to base encourages the baby’s lips to flange and have a deeper latch using more of the muscles used during breastfeeding.

Footnotes:

  1. http://pediatricfeedingnews.com/know-the-flow-dont-go-with-the-flow-by-britt-pados-phdc-rn-nnp-bc-bpadosemail-unc-edu/
  2. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5033656/

Other Resources:

https://nebula.wsimg.com/a03e8aeb7de27e300b93eafca5d2dffa?AccessKeyId=CB80718871C9FF21998F&disposition=0&alloworigin=1


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