Directly nursing from the mother’s breast isn't always the first option for some families in special circumstances.  If baby is not able to be fed via cup, syringe, or spoon, bottle feeding use is the next best option. 

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Paced bottle feeding is a method that mimics breastfeeding by helping baby eat more slowly from the bottle in a series rest periods that would naturally occur at the breast.  This helps baby not overeat from a bottle due to the ease of milk ejection and flow, distending (stretching) baby's stomach.  Slowing baby down can help them realize the feeling of fullness so they may stop eating on their own, just as they would at the breast.  This method can also help avoid bottle preference due to the instant gratification vs. working harder for the milk at the breast.

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How to pace feed:

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1. Offer the bottle when baby's cues indicate hunger rather than on a schedule.  You want to use the slowest flow nipple, regardless of baby's age.  NEVER enlarge or add nipple holes yourself as pieces can become dislodged while sucking and lead to choking.
    

2. Hold baby in an upright position as opposed to cradle hold.  The more upright the better, given baby's head is supported well.
    

3. Touch nipple to baby's upper lip in order for baby to gape open their mouth.  Allow baby to draw the bottle nipple into their mouth on their own.  Never push or force nipple in!
    

4. Bottle should be held horizontally (parallel to the ground) to help slow the flow. Don’t be worried about air intake, burping will remedy this.
    

5. Allow baby to suck for 4-6 sucks, take the bottle out of baby’s mouth, pause for several seconds, then slowly offer on lips and allow baby to draw the bottle back in their mouth. Repeat.  Switch from one side to the other midway through feed to provide eye stimulation and development as well as helping avoid side preference.
    

6. Feeding should take at least 20 minutes.  Look for cues that baby is full such as:
    

• Not drawing the nipple back in

• Falling asleep

• Eyes wandering

• Hands open and relaxed

• No longer sucking

• Turning their head to the side. 
   

Don’t force baby to finish a bottle by twisting or moving the nipple around in baby’s mouth.  Immediately stop feeding when baby starts showing signs of fullness.  Let them decide when they are done.​

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Be sure to portion bottles out appropriately depending on how long mother and baby will be apart.  Breastfed babies average about one ounce per hour apart from their mother.  Offering more than average and not pace feeding can lead to stretching baby's stomach out as well as making the pumping mother feel like they're unable to keep up with baby's demand.

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Signs of a poor bottle-feed include:

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• Gulping or swallowing quickly

• Catch-up breaths

• Fast feeds

• Leaking milk from the sides of the mouth or down the chin

• Flaring nostrils or wide eyes

• Stiffening of arms and legs

• Lips turning blue. 

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Things to avoid:

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1. Never prop a bottle. It’s a dangerous practice that can cause choking and overfeeding.  If the flow is too strong baby isn't able to stop for air!
    

2. Don’t bottle feed your baby while swaddled.  Baby needs to have their hands free to participate in feeding as well as allow you to watch for signs of distress.
    

3. Don’t feed baby facing away from you as this is an important time for the development of social interaction.  Make eye contact and talk with your baby. 
    

4. Don’t force your baby to finish a bottle by twisting it or moving it around in baby’s mouth. Let your baby decide when he’s done. Overfeeding can lead to an uncomfortable and unhappy baby!

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Once baby is 4-5 months you may introduce a cup, sippy cup, or straw cup instead of a bottle.  Babies can then pace themselves, however keep a close eye on how much they consume as we don't want babies to become dehydrated or underfed.

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Here is a good visual video on how to pace feed:

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https://www.youtube.com/watch?v=UH4T70OSzGs