Side-lying bottle supplementation for breastfeeding babies

The terms 'mother' and 'breastfeeding' are used throughout our documents; we recognize and respect that individuals and families may use other preferred terminology.

Why do I need to supplement my baby's feeds?

There are a variety of reasons for supplementing your baby's feeds both while they are in the hospital and once they go home. A few reasons might include:

• Your milk supply is low, or you are not able to breastfeed.
• Your baby needs extra calories or liquids to gain weight.
• Your baby gets tired easily during feedings, and this is impacting your baby's weight gain.

What is supplementation?

Supplementation is a way to give your infant extra nutrition and calories while breastfeeding. The extra liquid food that you provide to your baby is called a feeding supplement.

If your baby requires supplemental feeding, speak to a lactation consultant (LC) or health-care provider for support with using and assessing feeding techniques and supplies. This page covers the side-lying bottle-feeding technique.

Supplies you will need to supplement your baby's feeds using a bottle

• A bottle
• A slow-flow nipple
• A feeding supplement such as expressed breast milk or formula
• A pillow or support to lie baby on

Side-lying bottle feeding

Side-lying bottle feeding works best in a 'football hold' (see illustration). It is important to keep the bottle parallel with the floor and to keep the nipple half full so that gravity is not driving the feed. Using a slow-flow nipple also helps to make sure the milk flow is not too fast for your baby. To bottle feed your baby, follow these steps:

1. Wash your hands thoroughly.
2. Prepare the feeding supplement of expressed breast milk or formula. If you are using a fortified feed, follow the recipe written by your baby’s dietitian.
3. Pour the supplement into the bottle. Lie your baby on their side and support their neck and head with your hand. The bottle is held in the opposite hand.

   

4. Touch baby’s lips with the bottle nipple and let the baby pull it into their mouth. Keep the nipple touching the roof of the baby’s mouth during the feed. A typical feed lasts 20 to 30 minutes. Encourage the baby to drive the feed, allowing them to pace themselves.

How long should it take to feed your baby?

Supplemental feeding should not take longer than any other method of feeding. A feeding session usually lasts between 20 and 30 minutes.

Knowing how long to supplement your baby

It is important that you understand why you are supplementing your baby's feeds and how weight and growth will be monitored. See your baby's health-care provider one to two days after leaving the hospital. Talk to them about your baby's weight and growth. Your baby should be weighed naked on a baby scale to measure an accurate weight. Your birth hospital may also have a breastfeeding clinic to help with feeds and monitor weight gain. Make sure that you take your baby to their health-care provider for regular check-ups to see how well your baby is gaining weight and growing.

As soon as your baby is at a good weight for their age, your baby's health-care provider will tell you how to slowly decrease the strength or amount of feeding supplement you give your baby. When your baby is getting enough milk from the breast alone, you will be able to stop the feeding supplement.

These are important signs that your baby is feeding well:

• Your baby is gaining weight.
• Your baby has at least six to eight soaking wet diapers every 24 hours by the time they are 5 days old.
• Your baby has two or more bowel movements every 24 hours in the first month of life.
• After a month, your baby may have fewer bowel movements each day but should still have six to eight soaking wet diapers every 24 hours.

When to see a health-care provider

If you have any concerns about your baby at any time, call your baby's health-care provider. If you have concerns about the supplement you are feeding your baby, call your baby's health-care provider.

At SickKids

If you have any questions about supplemental feeding or breastfeeding in general, please call the Breastfeeding Program at 416-813-5757 ext. 2.