Firstly, my personal opinion is that any baby who resolutely refuses a
bottle is a very smart baby indeed. Secondly, in situations where babies
cannot breastfeed, my Ministry of Health promotes cup-feeding, not
bottle-feeding, because of the dangers associated with bottles and teats.
Nevertheless, many mothers prefer to use bottles and there are advantages of
a closed container, less waste, probably more satisfaction for the baby from
sucking as opposed to lapping/drinking, and ease of delivery for the person
feeding the baby.  My suggestions for teaching a baby to take a bottle in
the least stressful way would include:

1. Insurance.  Concentrate on establishing a really good *breastfeeding*
relationship first so that there is an excellent breastmilk supply, and the
baby finds latching and feeding really *easy*.  This could take about 4 - 6
weeks and would reduce the possibility of "nipple confusion".  So start
offering the bottle some time after 4 - 6 weeks.

2.  The milk. Use expressed breastmilk in the bottle.  This reduces the
number of new things the baby has to cope with - only a change in the method
of delivery, not the substance!  Naturally you only use a little milk at
first, so as to avoid waste.

3.  The teacher. The *mother* is probably the best person to teach the baby
how to bottle-feed.  Why?  Because the baby will trust the mother the most,
and the mother knows her baby best - how to read all those little signals
and cues.

4.  The container. Choose a bottle with a rounded teat - not one of those
"orthodontic" teats. This is to keep the baby's tongue *down* during
breastfeeding so as to preserve the baby's breastfeeding skills.  Test the
rate of flow of the teat - it should drip, pause, drip, pause, not go
drip-drip-drip - you don't want to drown the baby, but you do want the milk
to flow fast enough to easily feed the baby and not provide too much
sucking-satisfaction.

5. The timing.  Choose a time when the baby would like a little something to
eat, but is not so starving that his fuse is very short.  The baby should be
awake, alert and *happy*.  Mother needs to have the attitude that she is
teaching her baby a new skill, like she first taught him to breastfeed, and
may one day teach him to ride a bike or swim, etc.  It takes patience,
humour and spaced repetition.

6.  Method. The baby should be sitting up a little, not flat. Elicit the
rootng reflex by lightly dabbing the teat on the baby's lips.  When he
gapes, the tip of the teat should go *up* into the baby's palate to the 'S'
spot, to stimulate the sucking response - unless this happens he wont know
what to do with it and if it presses down on the back of his tongue he may
gag.  So it must go *up*.  Many babies look absolutely mystified when you
first put a bottle in their mouths, but mom should be ready with biiig
smiles and bright encouragement for even 1 - 2 sucks. The baby may pause,
play around with the tongue and try again. Biiiig smiles from mom are in
order and so on. Practice sessions can go from 1 - 2 "sucks" (mouthings!
and/or swallows) to 3 - 4, to 15 ml consumed, and so on.  Expect success to
come with small steps. If the baby gags or fights or shows other signs of
stress mom should stop *immediately*, withdraw the teat, calm him down, tell
him he's wonderful, and try again later, either in a few minutes or at
another time.

7. The after-sale sale. Once the baby is starting to "feed" from the bottle
and has accepted it then mom can teach the carer how to bottle-feed.  Once
this last step has been accomplished, it might be good for the baby to learn
one more thing, that mother usually *breastfeeds* and milk in the bottle
comes from someone *else*.

8. Maintaining breastfeeding. To avoid nipple confusion and nursing strikes
in the future, mom needs to always make sure that breastfeeding is
*delicious* for the baby - she shouldn't try and stretch out the intervals
between breastfeeds, nor should she ever cut them short.  She should allow
the baby to use the breast not only for "feeding", but also for comfort,
falling asleep, re-charging batteries - to encourage the baby to think of
her as one large lovely any-time comfort-object.

Sorry, no references, just observation of trial-and-error with
acknowledgement to the moms who have allowed me to practice introducing
bottles to their babies.

Pamela Morrison IBCLC, Zimbabwe
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