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Responsive bottle feeding

by Cordelia Uys, NCT Breastfeeding Counsellor

December 2021

Feeding babies responsively preserves their ability to self-regulate and protects them from becoming overweight or obese later on.

Babies need to feed frequently:

Babies have evolved to be in close contact with their mothers, and to be fed frequently, day and night.

A newborn’s stomach capacity:

Day 1:

A baby’s stomach is the size of a cherry and can hold around 5-7 ml per feed.
The total volume needed in 24 hours will be around 37ml.

Day 3:

A baby’s stomach is the size of a walnut and can hold 22ml to 27ml per feed.
The total volume needed in 24 hours will be around 220ml.

One week:

A baby’s stomach is the size of an apricot and can hold 45ml to 60ml per feed.
The total volume needed in 24 hours is about 280-576ml depending on the size of the baby.

One month:

A baby’s stomach is the size of a large egg and can hold 80ml to 150ml per feed.
The total volume needed in 24 hours is between 750ml and 1035ml.

N.B. Because a baby’s rate of growth slows down as they get older, the volumes of breastmilk babies need between one month and 6 months don’t increase very much.

Volumes of formula milk after the first week:

NCT Breastfeeding Counsellor Heather Welford, author of 'Successful Infant Feeding’, says:

"Formula fed babies can’t be expected to take a pre-determined amount of milk at every feed, and the guidance amounts on every formula pack should be used very flexibly. Your baby is your best guide. A rule of thumb is to expect your baby to take something like 150g per kilo of body weight in a 24 hour period. But in practice, healthy babies may have more or less that this.” Of course in the first couple of weeks, a baby will be taking considerably less than this.

The following is from Shel Banks’s book 'Why Formula Feeding Matters’:

“We talk about babies’ needs increasing from nil to about 580ml by the middle of week two of life, and then up to around 750ml by the end of week two. This may then rise very slowly over the next 5-6 months, up to around 900ml - but these are massive generalisations, and will vary from baby to baby. Most babies required roughly 150-200ml of formula per kg of the baby’s weight each day after around two weeks of age, until solid food is introduced at around six months.”

Victorian advice has led to long feeding intervals becoming the norm:

Since the publication in 1894 of a very influential book by the paediatrician Emmett Holt, who advocated long feeding intervals and virtually no night feeding, the majority of parents in Western society have been trying to get their babies to behave in ways which aren’t physiologically appropriate. This is reflected in the advice on feeding frequency commonly given by formula manufacturers, who recommend feeding babies 5 times in 24 hours from the age of 2 weeks. This advice leads to babies being fed larger volumes than they can comfortably fit in their tummy and going long gaps between feeds.

Most adults eat and drink at least 8 times in 24 hours:

For babies, milk is both food and drink. How can it be right to recommend only feeding a baby 5 times in 24 hours when most adults are eating and/or drinking at least 8 times in 24 hours, even though, unlike our babies, we aren’t trying to double our weight in 4 months? Many of us will actually be eating and drinking much more often than 8 times, especially if it’s a warm day, or we’ve been exercising.

Babies are able to self-regulate:

Babies have a natural ability to self-regulate: as long as they’re in control, they will stop feeding as soon as they are full. Breastfed babies can’t be overfed because they are in control – you can’t force a baby to breastfeed if they don’t want to.

Bottle-feeding puts babies at risk of overfeeding:

If you bottle-feed a baby while holding them in a reclined position, a combination of gravity and the baby’s sucking reflex means it’s easy to persuade them to drink more milk than their tummy can comfortably fit. We have all evolved to want to get as much food into our babies as possible, so the temptation to overfeed is strong.

Overfeeding puts babies at risk of becoming overweight later on:

The problem is that when babies are regularly fed large volumes of milk, it stretches their stomach, which can affect their ability to self-regulate and puts them at risk of becoming overweight. At the moment, in the UK, more than 1 in 5 children are overweight or obese when they begin primary school. It has been estimated that in at least 20% of cases, this is due to being overfed via the bottle as babies.

Responsive feeding protects from overfeeding and is kinder:

UNICEF is strongly encouraging parents who bottle-feed their babies to do so responsively, whether the bottle contains breastmilk or formula, because this protects the baby’s ability to self-regulate, and because it’s much kinder. Making a baby wait for a feed is stressful and upsetting and raises their stress hormone levels.

What is responsive feeding?

Feeding your baby as soon as he or she shows any signs of hunger.
Early feeding cues include: mouth opening, head turning, rooting, putting hand to mouth and stretching.
Crying is a late feeding cue: it’s best to feed babies before they’re desperate.
Pacing feeds.
Following your baby’s lead in how much milk they drink. It’s fine for the volumes they drink to vary from feed to feed.
Not trying to get your baby to finish the bottle.

Paced bottle feeding:

Paced bottle feeding makes bottle-feeding responsively much easier. Rather than holding your baby in a reclined position, hold them upright and close to your body, and hold the bottle horizontal with the floor. The teat should only be half full of milk. Pause every 30 seconds or so by pulling the bottle down to vertical. Bring the bottle back up to horizontal once the baby starts to suck again. Stop feeding as soon as your baby no longer sucks/seems interested.

Video explaining paced bottle feeding: https://youtu.be/wumI31Oyc8k

Make sure your baby is taking the whole teat in their mouth

Holding your baby in an upright position that allows them to tilt their head back slightly will enable them to get a deep latch and swallow comfortably.

Limit the number of people who feed your baby

It’s recommended to limit the number of people who feed your baby to no more than 2 or 3. Your baby needs to be familiar with the person feeding them, so they feel safe and relaxed. This is what the NCT says: “Babies build up trust and confidence during feeding, gradually learning what to expect. This is partly how they develop healthy emotional and social attachment. In the early weeks and months, it might help to keep most of your baby’s bottle-feeds for you and your partner, or one other trusted person.

If someone else is bottle-feeding your baby, talk to them about how you feed your baby so there’s some consistency.”

Switch sides

Switching the baby so that you are feeding him or her with your non-dominant hand half-way through the feed will help their physical development. Breastfed babies usually have the experience of feeding on both sides and facing different directions during a feed.

Links:

Books:

Why Formula Feeding Matters by Shel Banks https://www.pinterandmartin.com/why-formula-feeding-matters

Successful Infant Feeding by Heather Welford: https://www.goodreads.com/book/show/14570476-successful-infant-feeding

First Steps Nutrition website for independent information on infant formula:

First Steps Nutrition Trust

https://www.firststepsnutrition.org/parents-carers

https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5d131007a4f6110001954318/1561530383222/Infant_formula_an_overview_June2019.pdf

Making infant milk safely — First Steps Nutrition Trust

https://static1.squarespace.com/static/59f75004f09ca48694070f3b/t/5a5f913c0d92977380f39cbd/1516212541405/Statement_on_formula_preparation_machines_Nov+2016.pdf

NCT leaflet

https://www.nct.org.uk/baby-toddler/feeding/early-days/how-bottle-feed-your-baby