Question:

I am seeking out any clinical information (research articles, case studies, hospital/center practices or pathways) for treating infants who are struggling to transition from breast feeding to bottle feeding. My center sees many patients, who are often typically-developing and without a significant medical history,  who are excellent breast feeders but are refusing or having difficulty with bottle feeding. Often,  these mothers are under a lot of pressure,  as they are returning to work and worry that their child will be unable to feed while they are apart. Thanks!

Answer:

In this group of breastfeeding infants who don’t transition to bottle-feeding readily, we may see a wide variety of etiologies even in the subset of otherwise apparently normally developing infants.

I always try to keep my clinical radar open to the less obvious and go from there. Because of the protective controllable flow from the breast (compared to that received from a rubber manmade nipple), the faster (and therefore less controllable) flow rate when offered a bottle may reveal or create true incoordination. Caregivers may select a faster flowing nipple for bottle-feeding without knowing that it often makes bottle feeding harder for  a breastfeeding infant. Perhaps subtle airway differences that may be “manageable” for the infant at breast then make bottle feeding stressful. Perhaps not using the rooting response with the bottle (like mother does at breast) may make organization of the motor maps that underlie the root-to-latch sequence to initiate bottle-feeding difficult. Well-intentioned but ill-advised use of prodding with bottle-feeding  or “spinning the bottle” with bottle-feeding doesn’t happen at the breast; that can override and confuse motor sequencing that creates stop-start patterns and disorganization with the bottle. Caregivers during bottle-feeding may steer the infant back to sucking when he stops to breathe (to accommodate the less manageable flow); this can create physiologic stress when the swallow-breathe interface is then not synchronous.

Taking the infant’s perspective always helps me figure out the “whys” as a starting point. Each infant has his own  “story”, history and parent-infant relationship that makes his clinical presentation unique.  While breastfeeding infants who don’t transition to bottle-feeding readily can be often grouped as a “population”, our thoughtful reflective peeling apart of the layers for each infant is essential. This usually leads me to ask, “what else” (as my friend and mentor Joan Arvedson always says) and keeps my thinking in the “grey zone” where there are more questions than answers and that is a good thing.

I hope this is helpful