Answers to common questions are found on this page, listed alphabetically. To learn “everything you need to know,” read Balancing Breast and Bottle.  Check it out from your library, or buy a copy.   

Question:  Every time we offer our baby a bottle, no matter which shape, she can’t even try to suck because she chokes.  Any ideas?

Answer:  Is she choking because of milk flow?  Or gagging because the nipple is in her mouth?  Let’s assume it’s choking as you say.  When milk starts dripping into a baby’s mouth before they suck, choking is a natural response, so they pull their tongue back to protect their airway.  With the tongue in this position, sucking is impossible.  Try offering the bottle to your baby in a semi-upright position, where the milk in the bottle stays lower than the nipple hole.  Once your baby starts sucking (assuming it’s a good nipple shape for your baby), then tip the bottle up so the milk is over the hole.  When bottles are offered in this manner, choking is usually avoided.

Feedings too long?
Question:  My baby can’t finish 2 ounces of milk without falling asleep, only to wake up hungry later.  It takes her about 40 minutes and the bottle still isn’t empty.  We use the Dr. Browns narrow preemie nipple.

Answer:  When we tested bottle nipples, we found that the Dr. Browns preemie narrow is one of the slowest flows–too slow for many babies.  If your baby does well with that shape, you might try moving up to a size 1, or even 2.   Another option is to change brands, like Evenflo ProFlow (narrow) or  Nuby slow (narrow).  These nipples are very similar in shape to the Dr. Brown narrow, but flow slightly faster.

Question: My baby breastfeeds fine.  Why does she gag when I offer the bottle?

Answer:  She might be gagging for a couple reasons.  The most likely culprit is milk dripping into her mouth before she’s ready to swallow.  This is remedied by letting her suck on the nipple while the bottle is tipped down, with no milk in the bottle nipple.  Once she starts sucking, tip the bottle part-way up and see if she can get the hang of it when the milk starts flowing.  Another reason for gagging is perhaps the bottle nipple is reaching too far in her mouth.  Allow her to start sucking on the nipple, then slowly work it more deeply in her mouth.  The goal is for her to accept the nipple length and a portion of the base in her mouth (to mimic your nipple and areola).  Depending on the shape of nipple you choose, many wide neck nipples are too long for small babies to accept the nipple length and base without gagging, so you might be better off trying a different shaped nipple.

Leaking? (1)
Question: My baby goes through a couple bibs each feeding with the bottle because so much leaks out.  I think her bottle is slow enough, though, so what else do I try?  We use the Avent Classic slow flow.

Answer:  Chances are your baby cannot get a good seal on the bottle nipple.  That nipple has an “abrupt transition” between the nipple base and tip.  Most babies cannot keep their mouths in contact with the nipple base, so milk leaks out through the corners of the mouth.  If this sounds like your baby, try another shape.  A good first choice would be the Dr. Browns narrow size 1.  This nipple will probably work with your breast pump bottles, too.

Leaking?  (2)
Question: Is the flow too fast or too slow when milk leaks around my baby’s mouth?

Answer:  Depends.  If the flow is too fast, some babies will open their mouths to let the excess milk out.  More likely, though, a baby who is leaking from her mouth is not forming a good seal around the nipple.  It’s important that a baby’s lips remain in contact with the whole bottle nipple, with no gaps in the corners (sides) of the mouth.  Play around with nipple shapes and see if you can find one your baby can seal on.

Narrow Latch 
Question: My baby looks like she’s sucking on a straw when she bottle feeds.  If she does that on me, it will hurt.  How do I get her mouth to open wider on the bottle?

Answer: There are two likely causes.  It could be that you simply need to slightly wiggle the bottle as she sucks and insert it a bit deeper.  Her lips should open to accept a portion of the nipple base, and be near the collar of the bottle (that’s the screw lid the nipple snaps into).  More likely, though, is that you are using a nipple with an abrupt transition (Avent, Playtex wide, and others).  This type of nipple shape has a long, narrow nipple length, then a wide base.  The nipple length is so long that many babies cannot put it deeply enough in their mouths to then also accept part of the nipple base.  They end up sucking on this shape like a straw.  If your baby looks like she’s sucking on a straw, and you’re using an abrupt transition nipple, there’s a good series of pictures on pages 68-69 to help a baby latch more deeply.  If your baby can’t maintain a wider shaped mouth placement, consider using a different shape of bottle nipple.

Practicing with bottle?
Question: You write in your book that babies should practice using the bottle every day or two with a breast milk “snack” so they don’t forget how to use the bottle.  Other breastfeeding books say not to practice.  Why don’t other books agree with you?

Answer:  Here’s the truth: if your baby practices with a bottle that has a poor shape or flow that doesn’t mimic his breastfeeding latch, breastfeeding will suffer.  But if your baby practices with a bottle nipple that provides a good latch and flow, and you are pumping to maintain your supply, practicing safeguards that your baby will eat when you return to work.  BB&B gives you the tools you need to choose the best bottle for your baby.
Many breastfeeding mothers hesitate to practice with a bottle anyway.  We wonder if perhaps our current culture is a bit brain-washed.  😉
A dad called us just today.  He and his wife read the book, and his wife was not comfortable practicing with the bottle (even though he wanted her to since he’d be the one caring for the baby).  Today, mom’s first day back to work, baby absolutely won’t take the bottle.  Not a big surprise.  Now they’ve moved on to the chapter of overcoming a bottle nipple strike.  Too bad, because this most likely could have been avoided.

Slowest/Fastest Flow?
Question:  Which brand of bottle has the fastest or slowest flow?

Answer:  There is an answer to this question!  Appendix B of BB&B ranks slow-flow, name brand nipples (53 different nipples tested) from slowest to fastest flow.  In our professional opinion, some slow-flow nipples flow too slowly for the average baby, while some slow-flow nipples flow too quickly for the average breastfed baby.  Buy the book, or see if your library has a copy!  (Ask them to carry it!)
Why won’t we post this information online?  Because flow is only one small aspect of making bottle-feeding more like breastfeeding.  Mothers (and professionals) need to understand all of the components that help a baby successfully breast and bottle-feed, and giving information on flow alone will end in early weaning for many babies.

Which Bottle is Most Like Breastfeeding? 
Question: I want to breastfeed for a long time, so I want to be sure the bottle I choose is most like breastfeeding.  Lots of the bottles claim to be the best choice.  So which is it?

Answer: That is the million dollar question.  Literally.  The baby bottle market is a billion dollar industry, and of course every brand wants your money.  Every baby has a slightly different suck, just as every mother’s breast has a slightly different shape and texture.  One specific brand can’t possibly cover all these dynamics.  In fact, it happens very often that the best choice of nipple for one baby is different than the best shape for his brother or sister before him!

Won’t Take Bottle? 
Question:  I return to work in two weeks and my baby won’t take a bottle.  He is six weeks old. What do I do?

Answer:  Panic moment!  Did you use the SIMPLE Method to find the best bottle nipple shape when he was younger?  If so, stick with that shape, and keep trying.  You can try when he is sleepy, or just as he is waking from a nap.  You can try before you breastfeed, or perhaps in the middle of a breastfeeding when he’s not too hungry.  Reread Chapter 16 Refusing the Breast or Bottle to find a myriad of ideas to help your baby take a bottle.  Some moms offer the bottle multiple times a day until they are sure the baby will accept the bottle.  Keep in mind the bottle need not replace a full feed.  If he is willing to take 1/2 ounce from the bottle, consider it “fixed” and breastfeed (but keep practicing!).