Breast to bottle: How to transition

Baby smiling while drinking from bottle

What to Know

  • When formula feeding may be beneficial
  • Learn proper formula preparation, bottle selection and feeding technique

Research confirms that breast is bestEven so, there are plenty of situations in which the introduction of formula makes sense: whether out of medical necessity or by choice, you can certainly support your baby’s growth and sustain a nurturing relationship by learning how to prepare and feed formula safely. Here are some of those situations where supplementing with formula or switching from breastmilk to formula is indicated for mom and baby:

  • Prolonged separation (when pumping to provide expressed breast milk isn’t an option, e.g. due to maternal illness)
  • Mom must take a medication that will cross into the milk and isn’t safe for baby
  • Baby has an inborn error of metabolism (e.g. galactosemia, a rare genetic disorder where infants are unable to metabolize the sugar in human milk or standard cow’s milk based formula)
  • Baby’s ability to feed at the breast is compromised for physiologic or developmental reasons
  • Mom has a delayed milk production
  • Mom has had a prior breast surgery or physiology resulting in poor milk production
  • Mom has intolerable pain during feedings which could not be relieved by interventions

Formulas come in ready-to-use, concentrated liquid, or powdered forms. Take care to follow the formula to water ratio listed on the instructions for preparation carefully, as adding too much or too little water can have health consequences for your little one. Make sure to wash your hands before any preparation. Formula instructions included on packaging are minimal. Read on to learn other important steps.

Preparing Infant Formula

You’ll also need bottles. Some bottles are marketed as being ergonomic or most like the breast, but ultimately every baby has a distinct way of taking a nipple, so different systems will work best for different babies. You may have to try a few different bottles and nipples before you land on the right one. If baby is 4 months or older, you can also consider trying a transitional or training sippy cup. Open cup feeding, spoon or using a straw are other options. Our infant nutritional experts can help you explore them all. Of course you can also offer a bottle to an older baby, but often, older babies are resistant to trying a bottle and will need some extra coaxing. Now that you have the formula and equipment picked out, when do you offer the bottle? Your bottle-feeding pattern will mimic your breastfeeding pattern. Offer the bottle in a way that mimics the natural rhythms of breastfeeding to help make the transition from breast to bottle easier. Good bottle-feeding techniques will also ensure that meals remain a time of connection for you and your baby. Hold your baby close to you and make eye contact.

What to Do

Get support to optimize breastfeeding if you can (and want to)

If you are considering introducing formula because you are concerned that your supply is inadequate, or because breastfeeding is painful or challenging, consider contacting a lactation consultant first. These breastfeeding experts will observe you nursing, and help perfect your technique so that baby is satiated and you are comfortable. A lactation consultant can also help you assess your milk supply. If your baby’s frustration is due to milk supply issues, she can recommend techniques to build your supply and for any supplementation needed that allows you to continue breastfeeding. Our lactation consultants are also available to answer any questions you may have. Sometimes moms of fussy babies become nervous and assume they are not making enough milk and feel they should add formula. But milk production is a supply and demand business – you have to empty your breast in order for it to make more. So by giving baby a bottle instead of putting her to your breast or pumping, you do your milk supply no favors.

Try a few different bottles

Every baby is different, and every breast is different – so not all breastfed babies will respond to the same bottle. Try a few different systems with various nipple shapes.

Hold your baby in an upright position while bottle-feeding

Place the nipple against your baby’s lips and wait for her mouth to open. Hold the bottle horizontally, not tilted downward with the milk dripping. When your baby is at your breast, she has complete control, pausing and resuming feeding as desired. Most bottle nipples will drip milk at first when tilted down, whether baby wants it or not. Imagine if water jumped out of your glass and into your mouth at will – you would feel rightfully frustrated! Letting your baby latch on to a nipple that is not dripping and then keeping the bottle horizontal allows your baby to pause as desired, more closely imitating her experience at the breast. Tilt it just enough to fill the nipple with milk. And try to be patient! Remember this is brand new for your baby too.

Remember the basics

Look for the same hunger and satiety cues that you did when breastfeeding to determine when and how much to feed your baby. If bottle-feeding is a new experience, you may feel unsure of how many ounces to offer. Some babies take smaller portions more often, while others take larger amounts less often. At the end of the day, you should look at the total number of ounces taken rather than the quantity of each feeding. Most important is that your baby is gaining weight appropriately and satisfied. You can start on the low end to minimize waste and you can always prepare more.

Consider combination feeding

Breastfeeding is not all or nothing. Your baby will reap the benefits of breast milk for whatever duration you provide it, and in whatever quantity. If there is no medical indication to stop breastfeeding, you may want to breastfeed for one or two feedings, and offer formula the remainder of the day. Choose a time of day that feels right to you. Many moms breastfeed at night or first thing in the morning when the milk supply is highest. This lets the baby continue to receive immune properties and growth factors. Amazingly, your breasts will continue to produce milk for regular feedings, and down regulate for when you offer a bottle. If your need for formula feeding is temporary (due to a medication you must take, for example), you need to pump to maintain your supply so you can go back to nursing when it is safe to do so.