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Step 9 of the 10 Steps to Successful Breastfeeding

July 2019

We will dedicate this month to Step Nine of the Ten Steps to Successful Breastfeeding, which says, "Counsel mothers on the risks of feeding bottles, teats, and pacifiers".  We've delved into pacifiers multiple times this year and you can go back into the blog history to read more about them.


How many of you remember when all the babies were in the centralized nursery right after birth, having one or two nurses taking care of everyone at once? Remember how we used to shove a bottle into an infant's mouth, twist and pump it to make that little one eat faster? All so that we could get everyone fed before whatever task on the care list that needed to be accomplished next.

Now, try to imagine yourself as one of those babies, being force-fed, gulping down 2 ounces and trying to get a breath into the suck/swallow/breathe pattern without drowning! How might that feel? Uncomfortable? Scary? THAT is one of the major reasons we now use paced bottle-feeding for all infants.

Research shows us that the majority of newborns have difficulty going from breast, which requires a wide open mouth, slight tip of the head, tongue down and forward, and deep symmetric latch, to a bottle nipple, which requires a retracted tongue, shallow latch, pursed lips, and biting behaviors to slow the milk flow and allow breathing. As providers, we suggest that the new mother/infant dyad achieve exclusive breastfeeding for the first 3-4 weeks postpartum or until the infant has mastered breastfeeding, staying away from bottles and pacifiers. They are usually unnecessary.

Paced bottle feeding can be accomplished in several ways. There are dozens of YouTube videos on pacing: https://video.search.yahoo.com/yhs/search?fr=yhs-pty-pty_news&hsimp=yhs-pty_news&hspart=pty&p=youtube+paced+bottlefeeding#id=3&vid=b98ebd70c4dc2f0cc89ce8ce52cbcbbe&action=view

Here are just a few of the situations where breastfeeding might need to be replaced or supplemented with expressed breast milk (the ideal supplement), banked human milk, or artificial baby milk:

1. Separation of mother and baby.

a. Neonatal Infant Care Unit or Pediatric Care Unit admission of the baby.

b. Mother is very ill while hospitalized and her pumped milk is being fed to her baby.

c. In many countries around the globe, mothers must return to an employment situation and send her pumped breast milk to her baby in daycare.

2. Although we would be ecstatic if every hospital and birthing location in the world were BFHI certified, that is currently not the case. Many higher-income countries are still working on normalizing breastfeeding and getting their hospitals and birthing centers in line with the Ten Steps to Successful Breastfeeding. There are still centralized nurseries with separation of mother and baby. There are still situations where supplementation by bottle is given, either for maternal choice or medical need. And there are still mothers who choose not to breastfeed; we always hope that decision is a truly educated, informed decision.

3. Although there are many ways to supplement (if medically indicated) a baby, such as spoon, finger-feeding, cup-feeding, tube feeding device at the breast, etc., there are many Healthcare Providers who automatically reach for the bottle, especially as that device has been normalized in their city/state/province/country. If that bottle is going to be used, we want ALL providers, parents, and caregivers to use a kinder, gentler and more respectful way to feed the baby.


Kathy Parkes, MSN-Ed, RN, IBCLC, FILCA CHC

Professional Development Educator


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Last Updated: September 2018