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Your Quick Guide to Paced Bottle-Feeding

Black couple holding baby that is bottle feeding.

Have you ever found that a baby has trouble “keeping up” with a feeding? Ever wondered if you could make it easier for both of you? You can. Try using paced bottle-feeding.

What is paced bottle-feeding?

Introduced by speech pathologist and pediatric feeding specialist Marjorie Meyer Palmer, paced bottle-feeding is one type of a systematic pacing technique. It’s also called “externally-paced bottle-feeding.”

Systematic pacing techniques can be used for any feeding method. However, these techniques are most often discussed in the context of bottle-feeding since that’s currently the most common means of infant feeding. 

Which babies can benefit from paced bottle-feeding?

This technique could be helpful for any or all babies. But some babies benefit more than others.

Preterm babies or those who are experiencing medical complications will likely have difficulty:

  • swallowing,
  • breathing,
  • coordinating suck-swallow-breathe.

Paced bottle-feeding helps to overcome the above-listed feeding-related problems.

What does this technique accomplish?

Using this technique helps babies to experience:

  • a slower flow of milk,
  • reduced force of gravity that propels the milk into the mouth,
  • better ability to coordinate a rhythmic suck-swallow-breathe pattern.

This last point is especially important. Coordinating a rhythmic suck-swallow-breathe pattern means there’s a lower likelihood of:

  • becoming overwhelmed with fluid, 
  • experiencing frustration with feedings,
  • gagging, choking, and aspirating fluid.

In short, paced bottle-feeding helps babies accept milk in the amount and at the speed that works best for them. Caregivers can give as much control to the baby as possible, and babies can “keep up” when consuming the offered fluids.

Are there any “rules” when using paced bottle-feeding?

There probably aren’t any real “rules,” but there are certainly some best practices.

In The Breastfeeding Atlas, authors Wilson-Clay and Hoover highlight a guiding principle of paced feeding: The caregiver’s goal should be to reduce stress cues that occur during bottle-feeding. To achieve this, the caregiver should attempt to partner with the baby, rather than take complete control of the feeding.

How does the caregiver accomplish paced feeding?

As with any feeding, the baby’s vital signs should be stable and within normal limits. The caregiver should always perform proper hand hygiene. Both should be comfortably positioned.

You can accomplish paced bottle-feeding by following these simple steps.  

  1. Select a teat that you think might work. (You may need to try more than one.)
  2. Try to get the baby into a more upright position. (Ideally, hold the baby in a position that’s similar to breastfeeding.) This reduces the likelihood that gravity will pull the milk towards the baby.
  3. Hold the bottle so that the fluid within the teat is horizontal with the infant’s lips. DO NOT tilt the bottle so that it’s “aimed” at the baby. Tilting increases the gravitational pull of milk towards the baby and defeats the purpose and benefit of paced feedings. 
  4. Use the number of suck-swallows to guide your own movements. If the baby doesn’t take a breath spontaneously after 3-5 sucks, stop the flow of fluid, rest the teat lightly on the upper lip, and WAIT for a few seconds. This enables the baby to swallow and take a breath. 
  5. Always watch for stress cues. Finger-splaying, stiffening the back, grimacing, pulling away from the bottle, irregular breathing, milk leaking around the side of the mouth, gagging, or coughing are common signs of stress.
  6. Avoid the temptation to pull the bottle completely out of the mouth. Babies who have experienced that several times will respond by exerting more negative pressure on the teat. The feeding interaction becomes a tug-of-war between baby and caregiver. That’s not a “return of control” to the baby! Instead, move the bottom of the bottle towards the chest.
  7. Remember, there’s no need to have the teat completely filled with milk. Yes, a little air may be in the top of the teat, but the milk will find its way into that tiny space. All babies take in some air while feeding; that’s why they burp later! If gassiness is a problem, you could try these tips to reduce air bubbles in the bottle.

For more details about this technique, be sure to read Dee Kassing’s excellent article in a peer-reviewed journal.

Paced bottle-feeding is simple a technique. Whether they are healthy or compromised, this paced bottle-feeding respects their capabilities and helps to overcome possible limitations. For one reason or another, if a baby isn’t being fed at the breast, paced bottle-feeding is a technique that can accomplished by practicing a few simple steps.

Have you tried paced bottle-feeding? Share your experiences in the comments below.

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1 Comment

  1. Kim Cook

    I recommend paced bottle feeding to all babies that breast and bottle feed. This helps them to come back to the breast as it mimics the brestfeeding more accurately and doesn’t make it too easy. I also usually show or send them the video from Stanford on paced bottle feeding.

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