Bottle feeding in the neonatal unit

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INTRODUCTION

Baby to be >34⁺⁰weeks’ gestation/CGA before bottle feed introduced
- greater maturity required in comparison to breastfeeding due to difference in suck/swallow/breathe co-ordination

AIM

Responsive and safe bottle feeding
Cue based feeding approach by parents and staff
Prevent longer term sensory based feeding difficulties

INDICATIONS

Breastfeeding is the preferred feeding method for the majority of babies except if:
- mother unable to breastfeed for medical reasons (e.g. maternal HIV, HTLV) or on treatment making breast milk unsafe
- parental choice – discuss merits of breastfeeding, including bottle feeding expressed breast milk
- baby’s medical condition makes full breastfeeding unsafe or unfeasible

CONTRAINDICATIONS

Mother has chosen to breastfeed
Baby has a medical condition and specialist assessment identifies that bottle feeding is contraindicated

Special precautions/cautions

Medical condition indicates oral motor and pharyngeal skills may be compromised or delayed, impacting baby’s feeding co-ordination (e.g. extreme prematurity, chronic lung disease, cleft palate, certain syndromes and neurological impairment); take special care introducing bottle feeds. Refer to speech and language therapy service

PROCEDURE

Action	Reason
Parents/carers to be supported to give majority of bottle feeding opportunities to their baby	Consistency Bonding and attachment Build secure and responsive relationships
Plan care activities in relation to feeding	Baby has optimum energy to practice and establish bottle feeding skills
Ensure quiet environment with soft lighting	Supports baby to maintain a regulated state
Observe for baby’s feeding readiness cues (stirring, stretching, mouth opening, seeking, rooting, hands to mouth) Baby should also: be able to maintain their awake and alert state have a stable respiratory system be tolerating tube feeds be able to sustain rhythmic non-nutritive sucking on a finger or dummy	Supports a safe, co-ordinated and positive bottle feeding experience Reduces negative bottle feeding experiences e.g. aspiration and food refusal leading to sensory based feeding difficulties
Slow-flow teat Teat placed still on baby’s bottom lip and baby opens mouth to take the teat into their mouth	Supports a safe, co-ordinated and positive bottle feeding experience Reduces negative bottle feeding experiences e.g. reduced co-ordination resulting in aspiration
Use elevated side-lying feeding position Refer to Elevated side-lying feeding position leaflet https://networks.pcc-cic.org.uk/nhs-networks/west-midlands-neonatal-operational-delivery/neonatal-guidelines-2022-2024-1/supporting-links-for-guidelines-2022-2024	Safe and comfortable Stable midline position and tone Supports co-ordination and pacing Improves oxygen saturations Enables safe clearance of excess milk
Pacing: baby observed for signs of needing a break and paced by removing the teat or lowering the teat to stop the flow	Supports suck/swallow/breathe co-ordination Supports baby to maintain a regulated state Builds secure and responsive relationships
Offer bottle feeding opportunities for up to 10–20 min Monitor baby’s response to the bottle feed and stop sooner than the above time if changes in physiological stability (loss of colour, rapid breathing, fast heart rate), tone or behavioural state (finger splay, sudden onset of sleepiness, hyper-alert) are observed Assess and score using WMNODN bottle feeding assessment chart https://networks.pcc-cic.org.uk/nhs-networks/west-midlands-neonatal-operational-delivery/neonatal-guidelines-2022-2024-1/supporting-links-for-guidelines-2022-2024	Prolonged bottle feeding can: reduce bottle feeding opportunities because baby fatigues impact growth and nutrition through excess energy expenditure increase negative bottle feeding experiences e.g. reduced co-ordination resulting in aspiration and food refusal leading to sensory based feeding difficulties
Follow a cue based feeding approach See Progression to oral feeding in preterm babies guideline and the Feeding journey leaflet 2020 https://networks.pcc-cic.org.uk/nhs-networks/west-midlands-neonatal-operational-delivery/neonatal-guidelines-2022-2024-1/supporting-links-for-guidelines-2022-2024	Bottle feeding skills establish at baby’s pace and emerging development NGT as a safety net for nutrition allowing bottle feeding skills to emerge and mature Support modified responsive feeding before moving to full responsive feeding
Parents to room in with baby before discharge	Builds secure and responsive relationships Allows neonatal team to support families transition to home with baby
Teach parents to prepare baby formula feeds following infection prevention guidelines Equipment washed and sterilised appropriately	Supports prevention of infection and illness

See Guideline Supporting Information

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Date updated: 2024-01-15