How do I feed the milk to my baby?

Ensure that supplies are clean and wash your hands before handling breastmilk.

Babies have been fed milk by an at-the-breast tube system, cup, finger, (curved tipped) syringe, saucer, spoon, dropper, or bottle.

At-the-breast lactation aid
The act of nourishing a baby at one’s breast (breastfeeding) is ideally not separated from the sustenance the baby is receiving (milk). Therefore, when someone does not produce (enough) milk, an already latching baby would preferably get all additional breastmilk via an at-the-breast system.1 See this video for an explanation:

Expensive equipment is not required for this. It does not have to be an official at-the-breast system that you purchase/use. All that is needed is a long length of No. 5 French feeding tube (which can be purchased or ordered at your local pharmacy), and some sort of container (like a bottle) to hold the breastmilk in.2

Benefits of at-the-breast feeding
Using an at-the-breast feeding system keeps your baby at the breast, thus minimizing the risk of jeopardizing supply (as the breasts and supply are still being stimulated while the baby is latched on and drinking).3 4 This type of supplemental feeding can also be used for someone who is re-lactating, inducing lactation, and/or chestfeeding.

Cup-feeding
When at-the-breast feeding is not possible, or until breastfeeding and/or feeding with an at-the-breast system can be established, other methods have benefits to feeding with a bottle, like using a cup or a curved tipped syringe. Avoiding bottle feeding can be important in order to prevent nipple confusion and nipple pain if someone hopes to fully breastfeed their baby eventually.5

Newborns can easily drink from a cup, as can premature babies. Cup-feeding can help premature babies maintain a more stable blood oxygen level than bottle-feeding.6 7

Benefits of cup-feeding
Cups are easy to clean with soap and water if boiling is not possible. They are less likely than bottles to be carried around for a long time, giving bacteria time to breed. A cup cannot be left beside a baby, for the baby to feed itself. The person who feeds a baby by cup has to hold the baby and look at the baby which allows for close eye contact as well as physical proximity. Just like an at-the-breast system, a cup does not interfere with suckling at the breast.

How to cup-feed

  • Hold the baby sitting upright or semi-upright on your lap.
  • Hold the small cup of milk to the baby’s lips.
  • Tip the cup so that the milk just reaches the baby’s lips.
  • The cup rests lightly on the baby’s lower lip, and the edges of the cup touch the outer part of the baby’s upper lip.
  • The baby becomes alert and opens his mouth and eyes.
  • An LBW [Low Birth Weight] baby starts to take the milk into his mouth with his tongue.
  • A full-term or older baby sucks the milk, spilling some of it.
  • Do not pour the milk into the baby’s mouth. Just hold the cup to the lips and let the baby lap up the milk.
  • When a baby has had enough, they close their mouth and will not take any more. If they have not taken the calculated amount, they may take more next time, or you may need to feed them more often.
  • Measure the intake over 24 hours –not just at each feed.8

Bottle feeding
If choosing to use a bottle, there are some very important things to consider:

  • Watch the baby. Babies will cue us when they are hungry. Hunger cues include (but are not limited to) rooting, chewing on their fists, and rapid eye movement as they are about to wake. Respond to the baby’s hunger cues and not the clock.
  • Hold the baby in an upright, seated position. It is very important that babies not be fed from a bottle while lying on their backs. Having a baby in a more upright position allows them to better control the flow of milk into their mouths.
  • Just like switching sides while nursing, switch sides while nursing, switch baby from one arm to the other. It is important that the baby has the opportunity to develop both eyes and both sides of their body.
  • Never push or force the bottle nipple into the baby’s mouth. Allow them to explore and draw the nipple in on their own.
  • Pace baby’s feeding. Even with a low-flow or slow-flow nipple (preferable for all babies), the milk can enter the baby’s mouth much quicker than they are able to take it in. If a nursing session would take 20 minutes, expect that a bottle-feeding session would take the same amount of time.
  • Babies breastfeed with a certain suck and swallow rhythm. Often they suck 2 or more times before swallowing. We can mimic this by encouraging frequent pauses. Allow the baby to suck and swallow according to their rhythm and then tip the baby forward a bit (to empty milk out of the bottle nipple) to simulate the pause. Tip them back slightly and allow the suck and swallow rhythm to happen again.
  • Watch the baby. By allowing them control over the feeding rhythm, we allow them to let us know when they are finished. Never force a baby to finish a bottle. Allow them to dictate when the feed is over.

It is critically important that babies and their caregivers are able to engage together during feeding. It is never safe to ‘prop’ a bottle for a feeding. It is not only unsafe but contrary to our human nature.

For support and guidance with implementing any of these alternative feeding options, please find a professional lactation consultant9 or look in Resources for support for referral suggestions.

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  1. Please know that the company that manufactures one of the at-the-breast systems is not WHO code compliant. World Health Organization – International Code of Marketing of Breast-milk Substitutes ↩︎
  2. Breastfeeding Committee for Saskatchewan – Breastfeeding with a Feeding Tube ↩︎
  3. Other important benefits of feeding at the breast include proper jaw and facial development which reduces both ear infections and bite issues, by preventing malocclusion. The skin-to-skin contact that breastfeeding provides helps babies acquire the beneficial bacteria that protect them from diseases and builds their immune system. Skin-to-skin also provides relaxation for both parent and child due to the effects of oxytocin. There are also long-term benefits of breastfeeding that affect blood pressure, type-2 diabetes, serum cholesterol, overweight and obesity, and intellectual performance. Bernardo L. Horta, Cesar G. Victora. World Health Organization. 2017. Long-term effects of breastfeeding ↩︎
  4. Please also see Why breastmilk? ↩︎
  5. Jay Moreland, Jennifer Cooms. 2000. Promoting and Supporting Breast-Feeding: Nipple confusion occurs when a baby has not had the opportunity to establish the correct mouth movements for proper breast-feeding. Early and subsequent use of pacifiers, water, glucose water, and formula supplementation have been shown to promote early weaning and nipple confusion. The frequent use of an artificial nipple early in life has been shown to promote a less effective mouth movement; this was demonstrated with ultrasonography over a decade ago. For this reason, the physician should encourage the staff and the patient to address breast-feeding problems first, with direct observation of breast-feeding, before considering the use of supplementation. ↩︎
  6. International Breastfeeding Center – Finger and Cup Feeding ↩︎
  7. AskDrSears – Bottle Alternatives to Consider ↩︎
  8. How much expressed milk does my baby need? ↩︎
  9. There can be vast differences in training and expertise. Not every lactation consultant is an IBCLC. IBCLCs are International Board Certified Lactation Consultants who work in lactation clinics attached to hospitals and/or in private practice. They are healthcare professionals who specialize in the clinical management of breastfeeding. IBCLCs are certified and regulated by the International Board of Lactation Consultants Examiners. Find/verify an IBCLC. ↩︎