Correct Position for Bottle-Feeding
This post was written in partnership with Kabrita Goat Milk-Based Infant Formula. All opinions are my own. If you are a healthcare provider, join Kabrita’s Medical Herd to get access to new research, free continued education to share with your patients and peers, and invites to in-person and virtual events.
Bottle-feeding your baby can be a rewarding and bonding experience, but it’s important to make sure you're doing it correctly for both your baby’s comfort and safety. One of the most significant factors to consider when bottle feeding is position. How you hold your baby and bottle during feedings can impact everything from digestion to ear health.
In this post, I’ll walk you through the correct positions for bottle-feeding, information about paced feeding techniques, how to make a bottle, and tips for preventing and managing the swallowing of excess air. Here we go!
Why Does Bottle Feeding Position Matter?
When you're bottle feeding, especially in the early days after a baby is born, it’s essential to make sure your baby is in a comfortable and safe position. Proper positioning promotes good digestion, reduces the risk of ear infections, and makes the feeding session more pleasant for both you and your baby.
An improper position can lead to discomfort for your baby, such as air swallowing (which can cause gas), an increased risk of choking, and possible ear infections because milk can collect in the eustachian tube, a small tube that connects the throat to the middle ear.
How Many Ounces Should I Put in a Bottle?
A bottle-fed baby, whether taking formula, expressed breast milk, or a combination of both, usually needs to eat about every 2 to 4 hours over a 24-hour period. Babies can regulate their hunger, so they may not want the same amount daily, but we have some general guidelines for how much milk to put in the bottle.
Even though bottle-feeding babies tend to feed on a more regular schedule than babies who are nursing, it’s essential to recognize and respond to your unique baby's hunger cues and fullness cues. Talk to your pediatrician if your baby consistently drinks more or less than the guidelines below:
Newborn (first week): 1-2 oz per feeding
1 month old: Gradually increase formula or breast milk until the baby is taking 3 to 4 oz per feeding with a maximum of 32 ounces of formula per day
2-4 months old: 3 to 4 ounces per feeding with a maximum of 32 oz per day
5-8 months old: As babies get older, they can eat more per feeding and less often; at 6 months of age, bottle-feeding babies can drink about 6 to 8 oz per feeding at 4 to 5 feedings per day
9+ months of age: Once babies are eating 3 meals per day around 9 months, they generally continue to take 6-8 ounces of milk about 4 times per day
**Some bottle-fed babies taking only expressed breast milk may not take more than 3-5 ounces per feeding, which can be normal. The nutrients in breast milk continually change to meet your baby’s exact needs, and babies digest breast milk more fully than formula, so they may not need as much per bottle.
Follow your baby’s hunger cues to determine what amount is best for them! Be sure to follow up with your pediatrician or registered dietitian to make sure your baby is gaining weight, and that growth is appropriate.
Which Formula Should I Offer?
Breast milk is uniquely designed to meet the nutritional needs of infants and is widely recognized as the ideal source of nutrition for infants for at least the first six months of life due to its numerous benefits.
However, there are instances when supplementing breast milk with formula or exclusively formula feeding becomes preferable or necessary. The best types of baby formulas are those that closely mimic breast milk in terms of their nutritional composition, are easily digestible for infants, and meet all safety requirements as outlined by the FDA.
Goat milk-based infant formula is increasingly becoming widely recommended as an excellent alternative or supplement to breast milk. Recent research suggests that goat milk formula is not only safe and suitable for most babies, but it may be better tolerated and provide distinct advantages over cow milk-based formulas.
Notably, the protein composition of goat milk is naturally closer to that of breast milk and has been associated with faster and more efficient digestibility than cow’s milk proteins. Kabrita goat milk-based infant formula is the first and only European-made goat milk-based infant formula that meets all FDA requirements for long-term use.
Kabrita adds evidence-based ingredients to their infant formula, such as iron, folic acid, high sn-2 palmitic acid, DHA, ARA, and prebiotics, to even more closely mimic the composition of breast milk, making it an excellent option for families looking to supplement breastfed babies or for exclusive formula feeding.
Should You Swirl or Shake Bottles of Infant Formula?
When preparing goat milk-based infant formula or heating expressed breast milk, it’s a good idea to swirl the bottle rather than shake it (Kabrita dissolves SO easily with just a gentle swirl). Shaking the formula or breast milk isn’t dangerous, but it can cause bubbles or foam to form, which might make it harder for your baby to drink comfortably and can sometimes cause gas or discomfort. Swirling gently helps mix the bottle more evenly without creating excess air or foam.
**DID YOU KNOW? It is a myth that shaking breast milk can cause the breakdown of proteins and decrease nutritional value - there is no evidence that this occurs. The only harm is the possible addition of bubbles.
How to Bottle-Feed a Baby
Alright, so now that we have discussed how to make a bottle and the importance of bottle-feeding position, let’s dive into the best bottle-feeding positions and the best choices and benefits of specific positioning while bottle feeding.
The Semi-Upright Position
One of the most common positions for bottle feeding is the semi-upright position, typically in a cradle hold. This involves holding your baby at a slight angle, typically at a 45-degree incline. It helps prevent milk from flowing too quickly, which is especially important for babies who are not used to bottle feeding or those who are transitioning from breastfeeding.
The Upright Position
An upright position is particularly beneficial if your baby is prone to reflux or digestive issues. Holding your baby upright during the bottle-feeding session allows gravity to assist in the smooth flow of milk and prevents milk from flowing back into the esophagus, which can cause discomfort.
In this position, hold your baby in a more upright position, closer to a 90-degree incline, while still providing adequate support for your baby’s head and neck. Hold the bottle at a slight angle so that milk completely fills the nipple to avoid air swallowing.
Elevated Side-Lying Position
The elevated side-lying position is another excellent option for bottle-feeding and one of the best bottle-feeding positions for newborns, especially in the early days with premature babies. This position also works well for babies transitioning to bottle feeding who are having a hard time coordinating their sucking, breathing, and swallowing because it gives them more control.
In this position, have your baby rest on their side with their head elevated above their hips. The bottle is tilted gently into your baby's mouth to allow the baby to suckle comfortably, making sure that the nipple is always at least halfway filled with milk.
** KEY POINT: Never lay baby flat to feed! According to the American Academy of Pediatrics, laying down can increase the risk of choking, and it allows milk to run into her eustachian tubes, possibly causing middle ear infections.
How to Use the Paced Bottle-Feeding Technique
If you're bottle-feeding a baby, especially one who is new to bottles or is breastfeeding, it’s a good idea to use the paced bottle-feeding technique. This technique mimics the natural rhythm of breastfeeding by allowing your baby to control the milk flow and take breaks as needed.
With paced bottle-feeding, the bottle is held horizontally, and the neck of the bottle is never completely vertical. Instead, you let the baby suck and pause as needed, giving them more control over the feeding session.
Feeding your baby responsively and monitoring your baby's signs of hunger and fullness can help prevent overfeeding, which can lead to discomfort.
** KEY POINT: Avoid bottle propping with blankets or pillows, as this can increase the risk of choking, tooth decay, and ear infection. It can also contribute to overfeeding and prevent the baby from taking proper breaks during feedings.
Signs of Proper Positioning while Bottle Feeding
Baby's Head: Your baby’s head and neck should be aligned with their body, not tilted backward or forward.
Baby's Mouth: The nipple should be almost entirely inside your baby’s mouth and angled towards the roof of their mouth. The baby's lips should be turned outwards (not tucked under).
**TOP TIP** You can encourage your baby to open their mouth wider before inserting the bottle by brushing the bottle nipple from the bottom lip up to the nose. A sign of a good seal is that you won’t see any milk dribble from the corners of the mouth.
Milk Flow: Baby should control milk flow and can pause to take breaks when needed.
No stress cues: Baby should not have fingers or toes splayed out, turn their head, or push the bottle away during feedings - these are signs that they are either finished with feeding or are uncomfortable during a feeding.
What if my baby seems to be swallowing air?
If your baby’s stomach seems bloated, if your baby seems to be releasing a lot of gas, seems uncomfortable or fussy after feedings, or has more spit up than usual, they may be swallowing too much air.
Swallowing air during a bottle feed typically happens when the bottle is held at the wrong angle, when the flow of milk is too fast, or if the baby is sucking too hard to keep up with the flow of milk. Newborn babies who are new to bottle-feeding or babies who are transitioning from breastfeeding may be more prone to swallowing air as they adjust to the bottle.
Air swallowing can also result from the baby's positioning during the feed, the type of bottle or nipple used, or even the way you’re holding the bottle. But don’t worry—these issues are usually easy to fix with a few adjustments!
As an infant feeding expert and mom of three girls, here are a few of my recommendations:
1. Check baby’s position and bottle angle: Be sure to hold the bottle horizontally or at a slight semi-upright position. This ensures that the nipple is always filled with milk and not air. Make sure the baby’s head is always elevated above the stomach.
2. Check the Nipple Flow Rate: If the nipple flow is too fast, your baby may struggle to keep up with the milk, which can cause too much air intake. On the other hand, if the flow is too slow, your baby might suck harder than necessary, which can also lead to swallowing air. Many bottles come with different flow rates for nipples for newborns and older babies, so be sure to choose the appropriate one for your baby's age and feeding style.
3. Burp Your Baby Regularly: Burping your baby during and after feedings can help release any air they may have swallowed during the feeding session. Try burping after every 2-3 ounces. You can burp your baby by:
Holding your baby upright with their chin resting on your shoulder, and gently pat or rub their back.
Sitting your baby on your lap, supporting their chest and head with one hand while gently patting their back with the other.
Laying your baby tummy down across your lap, supporting their head, and gently patting their back.
4. Use Anti-Colic Bottles: Some bottles are designed to reduce air intake by using special anti-colic vents or valves that prevent air from entering the nipple; a few examples are Phillips Avent Anti-Colic Bottle and Dr. Brown’s Anti-Colic Bottle.
5. Check the Temperature of the Milk: If the milk is too hot or too cold, it may cause your baby to suck more quickly or inefficiently, leading to air swallowing. Always test the milk by dripping a few drops on your wrist to ensure it’s not too hot or cold.
Final Thoughts…
Using the correct position for bottle feeding is crucial for both your baby’s safety and comfort. By paying attention to these details, you can make bottle-feeding a more enjoyable experience for both you and your baby, ensuring that every feeding session is a successful one.
Remember, you’re doing great – it takes practice to learn your baby’s rhythms! With time, you’ll figure out what works best for you and your baby. For more support or if you have questions that haven’t been answered, please leave a comment below or schedule a virtual consult with me in my private practice.
* If you are a parent looking for high-quality feeding options for your baby that more closely resemble breast milk, learn more about Kabrita, the #1 goat milk infant formula brand worldwide.
* If you are a health care provider, join Kabrita’s Medical Herd to receive educational newsletters, research updates, and invitations to events, and stay current on the latest infant nutrition and product information.
Thanks for reading!