Flow preference in breastfed babies - Evidence Based Babies
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Flow preference in breastfed babies

Sometimes mothers have to introduce bottle feeding while breastfeeding for various reasons. Whether they have to for medical reasons or because they’re going back to work, there are many reasons for mothers to make this choice. But when a breastfed baby receives bottle feedings while breastfeeding, a phenomenon known as flow preference can happen.

Understanding flow preference

Flow preference is when a breastfed baby becomes used to the consistent and steady or fast flow of milk from a bottle’s nipple, which is different from the natural breastfeeding rhythm. This preference can make it challenging for the baby to switch back to breastfeeding or to switch between bottle feeding and breastfeeding and it can lead to breast refusal and sometimes even complete weaning from the breast.

Why flow preference happens

Flow preference often happens due to the differences in milk delivery between the breast and a bottle. Bottles typically deliver milk at a constant and often a fast rate, while breastfeeding involves a process where the baby needs to work to extract milk. When a baby gets used to the milk flowing faster and continuously at the bottle, they often get frustrated when they have to work at the breast.

Factors Contributing to Flow Preference

– Consistency

Bottles offer a consistent milk flow, which may be perceived as more convenient by the baby.

– Effortless Feeding

Babies don’t need to exert much effort to get milk from a bottle, unlike breastfeeding where they need to coordinate suckling, swallowing, and breathing.

– Instant reward

The flow from a bottle can provide instant milk flow, unlike breastfeeding, which demands patience and effort for the milk to flow.

Reducing the risk of flow preference

– Paced Bottle Feeding

Mimic breastfeeding by practicing paced bottle feeding. Hold the bottle horizontally, allowing the milk to flow only when the baby actively sucks, pauses, and swallows. This promotes a rhythm similar to breastfeeding, which reduces the risk of flow preference. Give frequent breaks and change sides during the feed, just like when a baby may feed from both breasts during a breastfeed.

– Choose the slowest flow nipples

Choose slow-flow nipples that closely resembles the natural breastfeeding pace. These nipples require the baby to work a bit harder, promoting proper feeding coordination.

– Combining Breast and Bottle

Introduce bottle feeding gradually, ideally when breastfeeding is better established around 4-6 weeks of age. This can prevent early confusion and make it easier for the baby to adapt to both feeding methods.

– Only use bottles if will be necessary

If you’ll be separated from your baby on a frequent basis such as returning to work, bottle introduction is a good idea. But if you won’t be separated from your baby on a frequent basis, or you’ll only be separated occasionally, there’s no need for a bottle, you can give cup feeding a try.

– Skin-to-skin contact

Prioritize skin-to-skin contact during feeding times. Not only does it enhance the bonding experience, but it also encourages the baby to associate food and comfort with the breast rather than a bottle.

– Responsive Feeding

Pay attention your baby’s hunger cues and feed on demand. Responsive feeding promotes a positive feeding experience and helps your baby to feel in control of their feedings and the pace of their feedings.

– Seek support

Consult with an International Board Certified Lactation Consultant (IBCLC) if you’re facing challenges with flow preference, breast refusal or any other breastfeeding related issue. They can provide education and support based on your and your baby’s individual needs.

In most cases, flow preference can be avoided and when babies do get flow preference, it can usually be resolved. Ensure that whoever feeds your baby a bottle (or other methods) is aware of things like paced feeding and that cup feeding is a great alternative to bottle feeding when possible.

Additional information and resources:

Milk Flow Rates From Bottle Nipples Used for Feeding Infants Who Are Hospitalized

The impact of teat and bottle design on nipple confusion: a double-blind randomized controlled trial


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