By Amy Spangler

When I return to work I plan to give my baby my expressed breast milk in a bottle. Which bottle or nipple is best?

The “best” feeding bottle and bottle nipple is the one your baby will accept. Expect your baby to refuse everything but the real thing (mom’s breast) at first knowing that over time your baby will be less choosy.

Contrary to product advertisements, there are no bottle nipples that look or feel exactly “like” a mother’s breast; nor are there any that replicate “the shape, feel, and function of a mother’s breast.”

Some companies claim their bottle nipples “make breastfeeding and bottle feeding work better together” while others profess to “support an easy transition from breastfeeding to feeding breast milk.”

Try one of several different kinds of bottle nipples (slow-flow, fast-slow, wide base, narrow base, firm, flexible) until you find one your baby will accept. Ideally, your baby will take to the flow rate (slow, medium, fast) that matches his sucking skills. Slow-flow nipples are designed for certain abilities as opposed to certain ages. If your baby has difficulty coordinating sucking, swallowing, and breathing, you may find that a slow-flow nipple is helpful. While a slow-flow nipple may give a baby more control over the feeding, it may also frustrate a baby who is accustomed to a faster flow. If you opt for a slow-flow nipple, know that there are no industry standards regarding “slow flow.”

While flow that is too slow can be frustrating for some babies, flow that is too fast can make it difficult for your baby to breathe. Signs that milk is flowing too fast include:

• Your baby chokes, coughs, or sputters

• Milk drips out of your baby’s mouth

• Your baby creases his forehead and clenches his fists

Learn to bottle-feed the “right” way

One study suggests that learning to bottle-feed the “right way” may be more important than choosing the “right bottle nipple.” As long as the flow of milk matches your baby’s ability to suck, swallow, and breathe, your baby will eventually learn to accept milk from something other than your breast. The following bottle-feeding tips should make the transition from breast-to-bottle-to-breast easier for mom, baby, and caregiver:

• Start feeding on cue. Make sure your caregiver is aware of your baby’s hunger cues and urge her to feed your baby on cue rather than on a schedule.

• Hold the baby upright. Babies who drink lying down from a bottle are more likely to develop tooth decay and ear infections. When you place a breastfed baby in the cradle position, he expects to breastfeed and will likely refuse a bottle.

• Stimulate the rooting reflex. Using the tip of the nipple, stroke the baby’s nose and lips from top to bottom. Wait for the baby to open his mouth wide and draw the nipple into his mouth.

• Pace the feeding. Mimic breastfeeding by encouraging the baby to pause following a series of sucks (suck-suck-suck-pause).

• Stop feeding on cue. When the baby hints at being full (falling asleep, releasing the bottle nipple, relaxed fingers and hands) stop the feeding. Don’t wake the baby to finish the bottle.

If all else fails, ditch the bottle and get out the cup, teaspoon, medicine dropper, or hollow-handled medicine spoon.

By responding to a baby’s ability to suck, swallow, and breathe in a coordinated way, your caregiver will be able to satisfy your baby’s nutritional needs and support continued breastfeeding.