This is a guest post by Registered Dietitian, Gabriella Goodchild.
However you choose to feed your baby, you may decide to introduce a bottle at some point.
With so many brands and baby bottles to choose from, how do you know which bottle to choose? And what are the best baby bottles when breastfeeding?
Why introduce a bottle if I’m breastfeeding?
This really is a personal choice and introducing a bottle to a breastfed baby can be for a number of reasons. Child care, when going back to work is one reason or being able to share the feeds with Dad or grandparents is another. Many mums enjoy the flexibility of combined breast and bottle feeding.
Some breastfeeding Mums choose to express milk for bottles and others choose to use formula, which is known as combination or combi feeding.
You may also be looking to gradually move your baby from the breast to the bottle.
Is there a best time to introduce a bottle?
There’s no definite best time to introduce a first bottle but it’s often recommended to wait until your baby is at least 4-6 weeks old, if you plan to continue breastfeeding. This is to allow breastfeeding to become established and to build up your milk supply (1).
Will my baby take a bottle easily?
Some babies take to a bottle straight away and others may need some help adjusting.
Here are some tips to help your breastfed baby to adjust to a bottle (2);
Get somebody else to feed your baby. if your baby can smell your breast milk it can be confusing for them.
Your breastmilk supply will reduce if your body thinks you need to feed your baby less. If you want to keep up your supply of milk make sure you express at the same time you’d normally be feeding (2).
Breastmilk is warm so your baby is likely to prefer the bottle (whether breast or formula) at a similar temperature.
Feed at roughly the same time as usual. Make sure your baby is ready for some milk but not overly hungry.
Keep things as relaxed as possible, try tickling your babies mouth to encourage an open mouth and bring your baby towards the teat, aim the teat towards the top of their mouth (2).
Take time to find the right bottle and teat for your baby. Some babies prefer a particular style of bottle. So if one baby bottle isn’t right, don’t give up.
It can take a while for your baby to fully accept the bottle so a little perseverance may be needed (1).
What are the challenges when switching between breast and bottle?
Some parents are concerned that introducing a bottle may discourage their baby from breastfeeding. This is because your little one has to use a different technique when feeding from the breast compared to the bottle (3). With breastfeeding, your baby controls the flow of milk by suction and pauses to swallow and breathe. Breastmilk doesn’t flow instantly as it takes a minute or two to stimulate the let-down reflex (4).
With bottle feeding, babies don’t generally have to work as hard and there is a continuous flow of milk (3). Switching regularly between breast and bottles can cause ‘nipple confusion’.
What is nipple confusion?
Nipple confusion occurs when your baby switches back to the breast but expects the milk to flow in the same continuous way as a bottle. This can cause some trouble with latching on and maintaining effective breastfeeding (3).
Signs of nipple confusion when breastfeeding (4):
Babies may thrust their tongue up while sucking which can push the nipple out of their mouth.
Not opening their mouth wide enough to latch on.
Being frustrated because the milk isn’t instantly flowing.
How can nipple confusion be avoided?
Follow the tips above on introducing a bottle to your breastfed baby.
Choosing a bottle designed for breastfed babies and as similar as possible to the breast may help your little one switch between more easily.
A slow flow teat on a bottle may also help. A fast flow teat can cause the milk to flow too fast and continuously. A slow flow nipple may be more similar to breastfeeding as it helps the milk to flow more slowly and also allows your baby to pause feeding, in the same way as breastfeeding.
You don’t need to move up a teat size as your baby gets older, many babies are quite happy with slow flow teats right up until cup drinking.
Tips to help when switching back to breastfeeding:
Try not to choose times when your baby is very hungry as they will be more inpatient for milk (4)
If your baby is getting very frustrated that the milk isn’t instantly available. Try pumping a bit to start off the let-down reflex (4).
Your Health Visitor or a Lactation Consultant can provide further advice if needed.
Which bottles are best for breastmilk?
If mums are choosing to express milk, bottles that are compatible with breast pumps may be useful. Here are two of my favourites:
Nanobebe Breastmilk Bottles
These bottles come with a breast pump adapter so you can express milk directly into the bottle. The bottles have a ‘breast like’ shape which Nanobebe says warms and cools quickly. Not only is this convenient but they also claim this preserves breastmilk nutrients and reduces bacterial growth.
They also have a ‘triple channel venting system’ which they claim helps to reduce colic.
Nanobebe replied to our request for further information on their claims, saying the bottle warms up 2-3 times faster than normal bottles due to the bottle design, which spreads out the area of the milk, allowing it to warm more quickly and evenly.
They did not provide any further evidence for this.
Medela Breast Milk Bottles
These bottles are compatible with the Medela breast pump and can be used for storing and transporting milk as well as feeding. They are available with slow flow teats.
What else is important in a bottle?
Many parents are also looking for their bottles to help with symptoms of colic and many bottles claim to do so.
What is colic?
Colic is when a baby cries a lot but there’s no obvious reason. All babies cry but colicky babies are those that often cry for more than 3 hours per day (5).
This can be very distressing for parents. Colic can start when a baby is only a few weeks old but usually stops by 6 months (5). Some babies with colic have excess gas and so the theory behind anti colic bottles is to minimise the amount of air swallowed. Effective winding can help too.
Signs your baby may have colic (5);
It’s hard to soothe or settle your baby
Clenching their fists
Going red in the face
Bringing their knees up to their tummy or arching their back
Their tummy rumbles or they’re very windy
See your GP if you’re concerned about your baby and nothing seems to help or if your baby is more than 4 months old with the symptoms of colic.
Which bottles are best for breastfed babies?
Most bottles who market themselves as good for breastfeeding babies, tend to promote their similarity to breastfeeding and anti colic mechanisms. Here is the low down on the most popular brands and their claims.
Claims made by brands must be backed up with some research. Below we describe how strong the evidence is behind these claims so you can make an informed decision.
Nuk First Choice Bottle
Good for breastfed babies: Nuk claim to have developed a range of bottles to make the transition between breast and bottle easier. The Nuk First Choice bottle has a soft ‘nipple shaped’ slow flow baby teat.
Anti colic: These bottles have what Nuk calls an ‘anti colic air system’ which reduces air swallowing.
The claim: Nuk claims the teat adapts to your baby’s palate and also has an extra wide lip support to stimulate breastfeeding.
The evidence: Nuk claims independent market research in Germany in 2016 found that 92% of babies accepted the natural-looking teat and 99% of mothers would recommend the bottle to others. 98% of mothers also confirmed the bottle created a ‘natural drinking experience’.
We should remember that opinions are subjective and as we have not had access to the research, we have not seen the questions asked or how many mothers took part.
Nuby Easy Latch Bottle
Good for breastfed babies: Nuby claims these bottles have a ‘breast like teat’ to mimic mum’s breast. The soft teat is designed to feel and look like a nipple.
Anti colic: They claim that these bottles have three ‘advanced anti colic valves’ to prevent ingestion of air.
The claim: The bottle promotes easy latch on and ‘flexes and stretches like a breast’.
The evidence: We contacted Nuby for the evidence surrounding this claim but unfortunately we did not hear back from them.
Tommee Tippee Closer to Nature baby bottle
Good for breastfed babies: This bottle claims to have the most breast like teat ever made, which flexes and feels like mum. The super wide teat is designed to be shaped like a breast and the teat mimics the flex, stretch and shape of a nipple.
Anti colic: These bottles have an anti colic valve in the teat to reduce the amount of air swallowed.
The claim: 92% of parents who used Closer to Nature® teats with their babies, recalled that they accepted it within the first 3 attempts.
The evidence: This claim was based on 1200 parents questioned. One thing to note is that this was based on parents’ recall and we don’t know how long after testing the teats, parents were asked. We contacted Tommee Tippee who said all the information we need is on their website but they couldn’t supply any more information.
MAM Easy Start Anti-colic bottle
Good for breastfed babies: MAM claims these bottles have a ‘skin soft silicone surface’ accepted by 94% of babies. The flat shape also mimics a nipple shape.
Anti colic: These bottles also have a vented base which they claim allows babies to drink at their own pace. They claim this reduces gas and regurgitation.
The claim: MAM claim that their teats have a 95% acceptance rate.
The evidence: MAM report this was from market research between 2009-2014 with 1,349 babies. We contacted MAM for more details but they told us they were unable to provide any more information.
Market research is about gathering information from people who agree to participate. There are limitations to this type of research as this is simply people’s opinions, whether you feel your baby accepts a teat is subjective. We also don’t know what the criteria was for ‘acceptance’.
Born Free Classic Bottle
Good for breastfed babies: The bottles are described as having a natural milk flow, which can be controlled by the baby. They claim this creates an experience close to breastfeeding.
Anti colic: The bottles have ‘Active Flow Venting Technology’. Born Free claims that their bottles improved colic symptoms more than anti-colic bottles from other brands (7).
The claim: Born Free claim their bottles showed more improvement in colic symptoms than other anti-colic bottles.
The evidence: A research project was carried out with 30 babies with colic type symptoms in 2010. 20 babies were given the Born Free bottles and 10 babies continued with their usual bottles. 85% of the 20 babies showed improvement with their colic symptoms.
What we should also note from this research:
85% is equivalent to 17 babies. This was a very small research study, not big enough to be conclusive evidence.
The 5 colic symptoms they looked at included; crying, folding legs up to stomach, frowning and discomfort, face turning red and pain spasms.
80% of symptoms had improved by 7 days and 85% by 14 days.
Whether the symptoms had improved was decided by questionnaires (with 7 questions) completed by the parents.
Parents’ opinions could have been influenced by knowing they were using a ‘special’ colic bottle.
Munchkin Latch Baby Bottle
Good for breastfeeding babies: They claim that the bottle is designed to mimic breastfeeding, claiming to have ‘reinvented the bottle to be more like the breast’. The bottle has an ‘accordion style teat’ which stretches like the breast.
Anti colic: The teat is designed to flex as your baby moves their head, which Munchkin claims allows your baby to maintain the latch and decreases the ingestion of air.
The claim: Munchkin claim the baby can control the flow of milk by pushing against the teat base, mimicking breastfeeding.
The evidence: We contacted Munchkin in regards to the evidence available but unfortunately we did not hear back from them.
Vital Nurture Breast Like Bottle
Good for breastfeeding babies: Vital claim this is a ‘breast like’ bottle designed to mimic mum’s breast. The soft teat is designed to flex and feel like mum’s nipple and make it easy to latch on.
Anti colic: Vital claims the ‘advanced triple anti colic valves’ reduce air intake.
The claim: Vital Baby claim the teat reduces the confusion between breast and bottle.
The evidence: We contacted Vital Baby in regards to the evidence available but unfortunately we did not hear back from them.
Lansinoh Feeding Bottle with Natural Wave Teat
Good for a breastfeeding baby: Lansinoh claim the ‘natural wave’ teat has been designed especially for breastfeeding babies. The teat, they claim encourages babies ‘wave like’ tongue movements and also allows baby to control the milk flow. The soft silicone teat is designed to feel like a nipple and the wide textured base is designed for easy latch on and suction.
Anti colic: The ‘air ventilation system’ is designed to reduce intake of air.
The claim: Clinically proven to avoid nipple confusion in babies.
The evidence: Lansinoh carried out an ultrasound study looking at the sucking style of breastfed babies compared to when using their natural wave teats. They concluded that the babies had similar styles of feeding, whether they were on the breast or their bottles.
One of the main things to note here is that researchers couldn’t be sure that it was the Lansinoh teat creating the similar type of feeding or something else?
Dr Brown Options + with level 1 teat
Good for breastfeeding babies: Dr Brown says the contoured breast-like shape of the teats have been designed to encourage a proper latch and mimic breastfeeding. They claim the soft silicone teat also offers a ‘more comfortable feeding experience’ and is designed to help babies switch between the breast and bottle. The level 1 teat provides a slow milk flow.
Anti-colic: The bottle has an ‘anti colic internal vent system’ and a wide neck which Dr Brown claims gives ‘vacuum free feeding’ and their research has proven this can reduce symptoms of colic (6).
The claim: Dr Brown claims that research has proven their bottles reduce colic symptoms.
The evidence: Dr Brown carried out a research study with a total of 88 babies initially taking part in an online research study. Parents were asked to record their babies symptoms for 3 days on their normal bottles and then for 2 weeks with either the Dr Brown bottles (treatment group) or other bottles (placebo group).
They conclude there was a reduction in crying and fussing by the babies using the Dr Brown bottles.
What we should also note from the research:
This was an online diary completed by parents and the parent’s opinion on whether symptoms improved. Parents had to document minutes spent fussing, sleeping or crying.
The babies who took part had been diagnosed by their parents as having colic rather than a medical professional.
Babies could take part up to 7 months old and we know colic symptoms resolve themselves in older babies. Colic often improves by 6 months (5).
Quite a few parents and their babies withdrew from the research 67% of the placebo group withdrew and 50% of the treatment group due to not fully completing the diary.
This means there were only 36 babies left in the study.
Philips Avent Natural baby bottles
Good for breastfed babies: Philips Avent have a range of bottles described as ‘natural baby bottles’. The teat has a soft, flexible ‘petal design’ to recreate the nipple shape and a wide shape to promote natural latching on.
Anti colic: Philips Avent claims these bottles have an advanced anti colic system with an ‘innovative twin valve’. This colic valve is designed to reduce colic by venting air into the bottle instead.
The claim: Philips claim the design of their ‘natural bottles’ means they are easy to combine with breastfeeding.
The evidence: We contacted Philips regarding the evidence available but unfortunately we did not hear back from them.
Minbie have a baby bottle that they report to support instinctive breastfeeding latch-on and motion. Their teat has an anti reflux and anti colic functionality.
Anti colic: Minbie claims that colic is reduced because of the proper latch that their bottles encourage.
The claim: Minbie say that the shape of the teat avoids nipple confusion for your baby as it nurtures a proper latch. Because of this proper latch, they report it helps baby’s control of the feed which supports good digestion helping with reflux and colic. They also say it works to prevent lazy feeding.
The evidence: We contacted Minbie to ask for the research that backed up their claims, after multiple emails they advised us that their research was in fact not research but feedback from parents and all the information we’d need was available on their website. We could not find this information, just a lot of customer reviews.
It’s worrying however that they claim their bottles help with reflux. Reflux is a medical condition caused by an immature digestive tract and no bottle can make this better. Reflux often resolves as the gut matures and in severe cases a combination of medication and thickened formula is the established treatment.
Is there such a thing as a ‘natural baby bottle’?
Natural baby bottles claim to be as close as possible to breastfeeding. The word ‘natural’ is used to mean the bottle is designed to mimic the breast as closely as possible, this could be in terms of shape, width, nipple shape or flow speed.
Breast feeding is natural and this has led to brands making these claims about their ‘breast like’ bottles. However some people may disagree that bottles can truly mimic the ‘real thing’.
Using the word ‘natural’ for some bottles is slightly uncomfortable in that it suggests other bottles can be labelled as ‘unnatural’.
Designing a bottle to mimic the breast could be useful for some babies, especially those who switch between breast and bottle. However the word ‘natural’ is clever in it’s marketing as it may influence parents to choose something they deem to be the natural alternative.
With the most important thing being that you feed your baby (however you choose to do so), parents should make sure they choose the right bottle for themselves and their baby, regardless of how it is marketed.
There’s now an excellent range of bottles available. However none of the bottles had good quality research to back up their claims and so it is not possible to conclusively say that one type of bottle is better than another when it comes to choosing a bottle for a breastfed baby.
To avoid buying and trying lots of different bottles, try talking to other parents and finding out what works for them. Be objective and try not to be influenced by marketing claims. If you’re looking for an anti-colic bottle, most now offer some anti-colic features.
Some babies are very adaptable and would be happy with any bottle. Others need a bit of time with just one type to learn the new skill and switching between too many different bottles could be confusing for them and slow down their skill development and progress.
Deciding what you’re looking for most in a bottle, for you and your baby, could help you narrow them down. Remember that adapting to a bottle is a new skill for your baby and will take some getting used to, allow them time to adapt and don’t worry if this doesn’t happen straight away.