For newborns and up to two months, I strongly recommend the out-in-front hold. When you picture someone feeding a baby a bottle you likely envision the cradle hold because it’s the most common. You cradle the baby you would if you were holding or snuggling him and feed in that position. For newborns, as well as reflux babies or lazy feeders, this is the worst way to feed.
All newborns I work with I feed swaddled and at a significant incline using the out-in-front hold. I do this for a few reasons:
- The swaddled feedings help the baby stay relaxed and focused on eating. Newborns have significant startle reflexes where they involuntarily jump, thrash, and even hit themselves when their arms are exposed. These movements often startle the baby himself and make him more unsettled during the feed, or cause him to lose focus on the task at hand. Swaddling, even loosely and only the upper part of the body (mostly arms), gives a close secure feeling while limiting the distractions of the innate startle reflex. A burp cloth can still easily be tucked under the chin to catch any leakage, drool, or spit up that might occur during the feed.
- I use the out-in-front hold because newborns have the hardest time learning to latch, suck, swallow, and breathe. Holding out-in-front allows me to put them a very steep angle by laying them along my one arm. This angle helps with any reflux or digestion issues, no matter how minor, which are common in the newly developing system of the newborn. It also allows me to control the baby’s neck. When a baby’s head is slumped forward, sucking and swallowing are more difficult. When the neck is arched back ever so slightly, it opens everything up and allows for better feeding efficiency. With my free hand (for me my right hand because I am right-handed) I can simultaneously manipulate the bottle to feed on a nice upward angle. Baby is upright, neck is leaned back, and bottle is upright.
I transition into the standard cradle hold as baby gets a bit older, less “scrunched up” and the startle reflex has lessened.
My favorite, the out-in-front and swaddled feeding position
Standard cradle feeding position
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A baby must be properly latched to a bottle in order to feed comfortably and efficiently. Some babies have small mouths, some can’t extend their jaws far, some have high-arched mouth pallets, and so on. As such, babies prefer different bottles.
Poor latch can result in spitting up, crying, gas, refusal to eat, small feedings, a lot of squirming and fussing while eating, need to frequently burp, and/or leaking milk. A frequent “clicking” noise while feeding is also a tell-tale sign of a poor latch.
In general, almost any baby can latch well to a standard bottle. That’s because they’re narrow and simply easier. They require less mouth and jaw work. If you’re using a wide-mouth bottle, you need to pay careful attention to your baby’s latch.
Correct standard bottle latch
Incorrect wide-mouth bottle latch. Baby is just sucking on the tip of the nipple. She can take in a lot of air from each side of the bottle due to this poor latch. She can also leak milk out of her mouth while eating. Her feeds may also be very slow.
Correct wide-mouth bottle latch. Baby’s mouth is wide open and approaching the base of the nipple. Her jaw is pressed down. There is no gapping on the side of her mouth and she will be much less likely to take in air or leak. This is how this bottle is intended to work and be fed from.
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Over the shoulder: this is the most common burping position, but not all-that-effective, in my opinion. This is where you put baby upright, over your shoulder and pat them mid-back with your dominant hand while firmly rubbing your hand up and down his back in between patting sessions.
Propped on the knee: this is my favorite position! You sit baby on his bum on your lap/knee. If he’s a newborn he will scrunch all up, but you support him by the chin area, encouraging uprightness, but keeping him slightly leaned forward. You use your dominant hand to pat him mid-back while firmly rubbing your hand up and down his back in between patting sessions.
On the tummy over your lap – for this position you put your knees together, creating a makeshift “table,” and place baby face down on your lap. Baby’s head stays exposed and off of your lap as not to obstruct breathing. You rub, do not pat, her back while keeping her on her belly. The counter pressure of your lap pressing on his belly, coupled with the back pressure from your rubbing, can produce a burp.
Out in front bounce – this is a technique I use least frequently, though for some babies it produces a burp in seconds. Caution must be taken to gently bounce baby up and down. We are not shaking baby in any way. You hold baby facing him away from you. One hand cradles baby’s bum and the other wraps around the front of him. You hold him tightly and gently bounce him up and down (much like how people will cradle and bounce a crying baby, while “shhhhh-ing” them to get them to settle).
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How Much & How Often?
Ahhhh, the greatest question of all time. And the crappiest advice is often given in response to this question.
Answer: there is no answer. It varies wildly and is extremely open-ended. Do not listen to anyone, ever, who tells you that you are overfeeding your baby or that your baby shouldn’t be eating that much. Aside of unique circumstances, like reflux where a baby will eat insatiably to ease the burning sensation that is caused by the condition, a baby will not overeat. Did you get that? A baby will not overeat! A baby will not overeat!
Forgive my obnoxious passion here, but I see parents deprive their babies from the amount of formula that they want and need, because someone, somewhere, throws a number at them that they feel they are bound to. An underfed baby will be a very fussy and unsettled baby, struggling to rest and sleep, and an entire household can spiral out of control due to really dumb advice. I have seen it more times that I can count!
An “overfed” baby will either refuse to eat more, pursing his lips and literally barring you from reoffering the bottle, refuse to suck, or he will spit-up. That’s it. That is the “tragic” result of “overfeeding.”
I cannot encourage you enough to use your instinct and feed your baby what your baby needs, because there is not a clear regimen to follow here. However, I will offer some very general guidelines.
Birth to two weeks – 1.5 to 3 ounces, six to ten times per day
Two to four weeks – 2 to 4 ounces, six to eight times per day
Two months – 5 to 6 ounces, five to six times per day
Three to five months – 6 to 8 ounces, four to five times per day
Six to nine months – 6 to 8 ounces, three to four times per day
Nine to twelve months – 6 to 8 ounces three to four times per day
Another common guideline is to feed 2.5 times baby’s weight per day in ounces of milk. So, an eight-pound baby will require at least 20 ounces of formula per 24 hours. A 12-pound baby will require at least 30 ounces of formula per 24 hours.
Formula fed babies will eat roughly every three to four hours and increase feeding amount while simultaneously decreasing feeding frequency as they get older (eat more but less frequently). As daily intake increases, the need for overnight feedings decreases.
Once your baby consistently (three or more times in a row) and efficiently (within 20 minutes) finishes her current feeding size, offer her 1/2 to 1 ounce more at the next feeding. This is baby’s way of signaling that she wants more, and the human breast would be stimulated to produce more milk in this instance, so you are simply mimicking that process but with a bottle.
Every time that your baby consistently and efficiently finishes “X amount” increase the amount – over and over and over. Typically, you will need to increase quickly in the beginning (the first 24-96 hours) and really follow baby’s cues. From there it’s very specific baby-to-baby. Some will gradually and predictably increase feeds by one ounce every 1-2 weeks. For others, it’s more of a roller coaster and they may seem content at a certain amount and then demand a massive increase. I can’t stress how variable it is.
Once a baby is consuming around 32 ounces in a 24-hour period and does not seem satisfied, it is time to discuss the introduction of solids with your baby’s pediatrician. Babies will require solids at different ages, but the 32-ounce threshold is a helpful indicator.
Questions about things like on-demand feeding, how to schedule baby’s feedings, do I have to wake baby to feed, how to get rid of overnight feedings, what to do when baby falls asleep during feeds, cluster feeding, what should baby be doing in between feedings, how to formula feed once baby starts eating solids, or how and when to increase feedings? Contact us now