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Finishing at the Breast
There may be many instances when mothers find that breastfeeding babies have become comfortable with the bottle. A common occurrence that happens in younger babies who have been introduced to the bottle early (before 4 weeks old, before breastfeeding has been well-established) is when they experience nipple confusion .
Nipple confusion is characterized by a breastfed baby who originally is well-adapted to latching but subsequently develops a preference for the bottle. This happens because the artificial bottle teat does not need much work — it flows more freely, meaning that baby does less work to get milk (Palmer, 1993).
Why is this a problem? Many times, nipple confusion leads to babies refusing to latch. Babies learn that it requires more effort to directly breastfeed on the breast and suddenly develop difficulties latching or become fussy at the breast when they have to wait for a letdown or the milk ejection reflex to kick in (KellyMom, 2023b).
It’s important to note that it may take some time to reverse bottle preference, so mums should hang in there and not expect an instant resolution. Patience and persistence are key in helping baby relearn how to latch.
When does finishing at the breast become helpful?
For many parents, “finishing at the breast” is a technique that helps babies transition to latching after experiencing nipple confusion. The advantage is that many mothers quickly recognize this issue while their baby is still young and open to learning new feeding techniques (KellyMom, 2023a).
Babies with nipple confusion may become fussy or impatient when they realize it takes time for breastmilk to flow during latching. To address this, parents can begin the feed with a bottle using paced bottle feeding. This method mimics the natural rhythm of breastfeeding by slowing down the flow, helping babies regulate their intake and reducing the risk of overfeeding (Law-Morstatt et al., 2003). Additionally, paced feeding encourages babies to work for the milk as they would at the breast, which can make transitioning between bottle and breast smoother (Thoyre et al., 2012).
Once the baby has had some milk, they may be more inclined to latch onto the breast with ease. The remaining time of the feed is then spent at the breast, hence the name of the method—”finishing at the breast” (KellyMom, 2023a).
Mums can also try breast compressions when the baby first latches. This can help stimulate milk flow and make it easier for the baby to get milk, reducing frustration and encouraging better latching.
How exactly can I help my baby wean from the bottle?
Note: If your baby has been on the bottle or already consuming formula supplements for a while, it is not recommended to stop bottle feeding suddenly. The duration suggested below is meant to be a guideline; use your discretion while monitoring your baby’s diaper outputs to ensure that your baby is always receiving the required milk intake (KellyMom, 2023b).
The following method is a variation technique adapted from KellyMom’s Weaning from formula supplements page (KellyMom, 2020).
- Days 1-3: Consider the total amount of expressed breastmilk or formula that your baby is currently drinking in a day. Reduce this amount by 30ml / 1 oz. Note that this is a reduction from the total amount of milk, not per feed. Monitor your baby’s wet and dirty diapers. If your baby’s diaper output is good, do not exceed this amount of supplementation each day. Once the baby finishes this amount of feed, encourage your baby to latch if they want more milk.
- Days 4-6: Take the new amount of expressed breastmilk or formula (#1) and reduce by another 30ml / 1 oz. Monitor the baby’s wet and dirty diaper output. If the diaper count is good, do not exceed this amount of supplementation each day. Once the baby finishes this amount of feed, encourage the baby to latch onto the breast.
- Days 7-9: Take the new amount of expressed breastmilk (#2) and reduce by 30-60ml / 1-2 oz if things are going well. Monitor the baby’s wet and dirty diapers. If the diaper count is good, do not exceed this amount of supplementation each day and continue latching the baby if they want to eat more.
Continue the above method and slowly reduce the amount of supplement every 2-3 days as long as the baby’s diaper count and weight gain show they are drinking enough milk. Once you reach the point that the baby is able to have more feeds at the breast and the amount of bottle feeds continues to reduce, you can move towards eliminating the bottle feeds entirely, as long as the baby is able to produce a satisfactory number of diapers from just latching alone (KellyMom, 2020).
References
- KellyMom. (2023b, July). Nipple confusion and preference. KellyMom. https://kellymom.com/ages/newborn/nb-challenges/nipple-confusion
- KellyMom. (2020, July). How to decrease formula supplements. KellyMom. https://kellymom.com/ages/newborn/nb-challenges/decrease-formula/
- Law-Morstatt, L., Judd, D. M., Snyder, P., Pinelli, J., McGrath, J. M., & Bowles, B. C. (2003). Pacing as a feeding intervention for preterm infants: A nonrandomized clinical trial. Journal of Perinatal & Neonatal Nursing, 17(2), 114-125.
- Thoyre, S. M., Shaker, C. S., & Pridham, K. F. (2012). Coregulated approach to feeding preterm infants with lung disease: Effects during feeding, clinical outcomes, and maternal experiences. Journal of Perinatal & Neonatal Nursing, 26(2), 123-132.
- Palmer, M. M. (1993). Identification and management of the transitional suck pattern in premature infants. Journal of Perinatal & Neonatal Nursing, 7(1), 66-75.