Paced bottle feeding: how to do it, step by step

What paced bottle feeding is

Paced bottle feeding is a way of giving your baby more control over a bottle feed (NHS). Babies usually drink a little, stop for a rest, and then drink more. Pacing helps them do that from a bottle, so the feed is closer to the way they’d breastfeed.

Milk can flow quickly and steadily from a bottle, even when a baby wants a break. Pacing slows things down, so your baby has time to notice when they’re full. The NHS says this helps avoid overfeeding.

It works the same whether the bottle holds expressed breast milk or formula.

Who it helps

• Breastfed babies who also take a bottle. The USDA describes paced feeding as a method sometimes used with breastfed babies, because it gives them control over the feed in a way that’s similar to breastfeeding. The NHS says it mimics the way a baby would breastfeed.
• Any bottle-fed baby. The NHS presents paced feeding as part of responsive bottle feeding for all babies: following your baby’s cues rather than the clock or the markings on the bottle.
• Babies who spit up a lot. The USDA lists paced bottle feeding, burping at natural breaks and stopping when your baby is full as ways to help a baby spit up less.
• Anyone who feeds your baby. Partners, grandparents and childcare staff can all learn it, so every feed follows the same pattern.

How to do it, step by step

1. Start when your baby shows early hunger cues (see below), before they’re crying (NHS, CDC).
2. Choose a slow-flow teat (nipple). The USDA says a slow-flow nipple helps a baby control how much they drink and can reduce spit-ups.
3. Hold your baby close and semi-upright, with their head supported so they can breathe and swallow comfortably (NHS). Look at them and talk to them during the feed.
4. Invite, don’t push. Touch the teat to your baby’s top lip and wait for them to open wide and draw it into their mouth (NHS, USDA). East Lancashire Hospitals NHS Trust says to rub the teat softly across the top lip and put it in gently as your baby opens and searches for it.
5. Keep the bottle almost horizontal, tipped just enough to fill the teat with milk rather than air (NHS, USDA). This stops the milk flowing too fast.
6. Let your baby take breaks. When they pause, let them rest. If taking the teat out upsets them, tip the bottle down with the teat still in their mouth: the flow slows, but the teat still feels comforting (NHS).
7. Burp them at natural breaks in the feed, or at the end (USDA). Switching the arm you hold them in partway through gives them a new view and mirrors switching sides at the breast (USDA).
8. Stop when they’re full, even if there’s milk left in the bottle (CDC). Never force your baby to finish a feed: the NHS says this is distressing and can mean they’re overfed.

There’s no set time, but the USDA says a typical bottle feed takes about 15 to 20 minutes and should follow your baby’s fullness signs.

Hunger and fullness cues

Signs your baby may be hungry (CDC, NHS):

• hands to mouth, or sucking on fists or fingers
• turning their head toward the bottle, or rooting around for the teat
• puckering, smacking or licking their lips
• clenched hands, wriggling, getting restless, or opening and closing their mouth

Crying is a late sign of hunger (CDC). If your baby is very upset, a cuddle first may help them settle enough to feed (NHS).

Signs your baby needs a break, or has had enough (CDC, NHS, East Lancashire Hospitals NHS Trust):

• slowing down or stopping sucking
• spilling milk out of their mouth
• closing their mouth, turning their head away, or pushing the bottle away
• splaying their fingers and toes, or relaxing their hands
• falling asleep

When you see a break cue, pause and burp them, then offer the bottle again if they show they want more.

How much milk?

Paced feeding doesn’t change how much your baby needs: it lets them show you. Babies feed little and often and may not finish the bottle (NHS), and some feeds are bigger than others. For rough amounts by age, see how much breast milk or formula.

If you’re worried about wasting breast milk or formula, offer a smaller amount and add more if your baby still shows hunger cues. The CDC suggests starting with small amounts when you first introduce a bottle.

Introducing a bottle to a breastfed baby

• Pick a time when your baby is calm and not too hungry or too full (CDC).
• Start small. The USDA suggests about half an ounce (15 ml) of breast milk at first, increasing once your baby is willing.
• Your baby may take a bottle more easily from someone other than you (CDC).
• Give it time: it can take a while for a baby to learn to drink from a bottle (CDC).

If you have questions about your milk supply or about combining breast and bottle, talk to your midwife, health visitor, pediatrician or a lactation consultant. See breastfeeding and starting solids and pumping schedule.

Safety basics

• Never prop a bottle or leave your baby alone with one. They may choke on the milk (NHS), and the CDC adds that propping raises the risk of ear infections and tooth decay, and of drinking more than they need.
• Don’t put your baby to bed with a bottle. Milk can pool around the teeth and cause decay (CDC).
• Only breast milk or formula goes in the bottle. Never add cereal or other food: it won’t help your baby sleep longer and could make them choke (CDC).
• Leftover milk. Throw away any formula left in the bottle after a feed (NHS). The NHS says to throw away unused breast milk too; the CDC says breast milk left in the bottle can be used within 2 hours after your baby finishes feeding, then thrown away. For making up and storing formula, see choosing and preparing formula; for storing breast milk, see pumping schedule.

When to call the doctor

It’s normal for babies to bring up a little milk during or after a feed (NHS). Talk to your pediatrician, GP or health visitor if your baby:

• is sick a lot, is sick forcefully, or seems to be in pain during or after feeds (NHS)
• often coughs, splutters or gags during feeds, even with a slow-flow teat (see tongue tie and feeding for other signs worth mentioning)
• isn’t gaining weight, or isn’t having plenty of wet and dirty diapers (NHS)

In the UK, the NHS says to call 111 if you’re worried about a baby under 12 months, or if your baby stops breast or bottle feeding while they’re ill.

Call 911 or go to the emergency room if your baby:Call 999 or go to A&E if your baby:Call your local emergency number (such as 112 in Europe or 000 in Australia) or go to the emergency department if your baby:

• is struggling to breathe, or taking lots of quick, short breaths
• has blue, gray, pale or blotchy skin, lips or tongue
• vomits green or yellow-green fluid, blood, or something that looks like coffee grounds
• is floppy or not responding as usual

These signs come from the NHS.

If your baby can’t breathe, cough or cry, they may be choking: start choking first aid straight away. Shout for help and have someone call 911 straight away. If you’re alone and your phone is with you, put it on speaker, call, and start back blows at once. Don’t leave your child to find a phone.Shout for help and start back blows and thrusts straight away. If someone is with you, ask them to call 999 now. If you’re alone, call 999 (on speaker) if the blockage hasn’t cleared after one round of back blows and thrusts, and keep going until help arrives.Shout for help and have someone call your local emergency number (such as 112 in Europe or 000 in Australia) straight away. If you’re alone and your phone is with you, put it on speaker, call, and start back blows at once.

Even if the object comes out, get medical help (NHS).

Where US and UK advice differs

US and UK advice on pacing agrees: hold your baby close and fairly upright, keep the bottle near horizontal, let them take breaks, stop when they’re full, and never prop the bottle. The words differ: US guidance says “nipple” where the NHS says “teat”. The bigger US and UK differences are about making up formula, such as water temperature and sterilizing: see choosing and preparing formula. Leftover breast milk differs too: the CDC says it can be used within 2 hours after the feed ends, while the NHS says to throw unused milk away.