Using a pump can help with supply.
National Breastfeeding Month is a time we talk about breastfeeding and milk supply, but we wanted to share a few milk supply tips from the lovely Stephanie Nguyen, RN, MSN, WHNP-C, IBCLC, owner of Modern Milk and amazing Nurse Practitioner/IBCLC.
First off, a word on milk supply: many moms think their supply is low, but in actuality it’s just fine! True low supply is when you are not making enough milk to meet baby’s needs or baby isn’t gaining weight. Ask yourself these questions.
Perhaps you’re pumping and need a boost or you’re working on improving milk supply per your pediatrician. Here are Steph’s top 3 things you can do NOW to boost your supply!
Does my baby need to be able to hold their own bottle?
Foodie Judy here - welcome! Megan and I have the privilege of interacting with thousands of families on Instagram and our private Feeding Littles Clients Only Facebook Group for those who have taken our online or in-person courses. One question we have heard often is, "Should my baby be able to hold their own bottle?"
The short answer: yes. We want babies to be able to hold their own bottle, as doing so is an important skill and strength-building exercise that develops their hands at a midline position. However, for a variety of reasons we always want to hold/supervise baby as they bottle feed - more on this later.
Note: taking milk from a bottle is a skill that many exclusively breastfed babies never need to do. Some babies never accept a bottle and go straight to a cup. If your baby doesn't need to or won't take a bottle, they're not missing a key developmental skill as long as they're also practicing "hands to midline" in other capacities. More on this below.
First, let's discuss midline position, why it's critical in your child's development, and how to help promote bringing hands to midline or crossing midline.
What is "midline" and why does it matter?"
The midline is an invisible line from the top of our head to bottoms of our feet, separating the two sides of the body. We cross that imagery line any time we move a foot, hand or eye into the space of the other foot, hand or eye. We also cross the midline with our tongues when we use the tongue to laterally move food from one side of our mouths to the other.
The ability to freely cross the midline allows us to do almost every daily life activity, including bathing, brushing our teeth and hair, driving a car, using a keyboard or playing sports. Midline is necessary for visual tracking. We rely on visual tracking for reading, as our eyes must continually cross the midline as they scan the page. Watch a young reader as they learn to read a simple book: at first, they may have to turn their head slightly as they read the book, then they progress to pointing to the works as their heads stay mostly still. Eventually they no longer need to point to the words as their eyes do all of the work - crossing midline has become automatic.
Not only is crossing the midline essential, but it's also important for your baby to be able to hold objects at midline. When toddlers can't hold their own cup, they struggle to stay hydrated. Babies who can't successfully hold food at midline may have trouble learning how to self-feed. Check out baby Bryson (7 months), below, holding his own water cup at mealtime. (For more on water and hydration needs in babies, toddlers and kids, click here.)
Thus, the reason why we want baby to eventually hold a bottle is because it leads to holding other objects like water cups, food, toys and eventually books, crayons and pencils in their hands. It's part of a progression that eventually supports independence and learning.
OK, so midline is important...but how do we develop it during bottle feeding?
Around 3 months of age, babies begin to notice touch inputs in their hands as they take shape of an object like a rattle, toy, bottle or breast. By 4-6 months, babies begin to transfer objects from hand to hand. This is a very exciting fine motor milestone - you may notice that your baby practices this repeatedly. It's essential in their development of a sense of midline.
Since we know hands at midline are important, here are some techniques I use to help babies work toward holding their bottle - and eventually other objects - at midline when you are holding them for a feeding. We always want to hold/supervise babies with bottles.
I'm breastfeeding. Does my baby need to hold a bottle? How can I develop their hands at midline?
Some breastfeeding moms choose to not give a bottle of expressed milk to baby and go straight to a cup when offering water (6+ months). Perhaps mom doesn't respond well to a pump or baby refuses a bottle. If your baby doesn't ever take a bottle, they're not missing out on a developmental skill. They don't need to learn how to drink from a bottle to be a successful self-feeder and cup drinker.
It's still important for breastfed babies to bring their hands to midline while feeding. Below are some techniques I use with my breastfeeding clients to help promote hands to midline:
My baby can hold their own bottle? Can I just let them do their own bottle feeds?
Once your baby has the ability to hold their own bottle, many parents want to let them bottle feed independently without holding baby. You may see babies drinking bottles independently and wonder if your baby is "too old" to be held for bottle feeds.
I'm a realist. I bottle fed my children and work with parents every day in my private practice. I completely understand that sometimes it's just easier to hand baby their bottle in the stroller at the zoo and let them do their thing once they're able to hold it themselves. We always come from a place of gentle education without judgment. Take this information and do what works best for your family.
The concerns I have regarding independent bottle feeding are two-fold:
The flow of a bottle can be fast, and sometimes babies can't keep up with it or can't pull the bottle away while drinking. This is why it's especially important to avoid propping a bottle for baby to drink. When a baby is unsupervised while drinking a bottle, their risk of overeating or choking on the liquid is increased. Furthermore, a baby drinking on a completely flat surface like in a crib has an increased risk of ear infections, as milk can pool in their mouth and flow back into their Eustachian tubes.
Note: if you are breastfeeding, laying a baby flat during breastfeeds (for example, while side lying) does not carry the same ear infection risk because milk doesn't pool in their mouth the same say.
When babies drink from a bottle while sitting straight up (e.g. in a high chair) they have to tilt their head back to drink, which leads to poor sucking skills. If your baby needs milk while seated, we recommend working on a cup instead of a bottle. Start with an assisted open cup and work to a straw or other cups as described in this post.
Bonding and Interaction
Bottle feeding, like breastfeeding, is meant to be an interactive experience. Similarly to family meals with solid foods, bottle feeding time is an opportunity to bond. Holding your baby while they bottle feed - even if they hold their own bottle - promotes communication, language, social interaction, eye contact, rhythm (if you rock or sway), trust in their caregivers, and a sense of security. Encourage them to hold their own bottle when they're ready, but I encourage you to hold them at a 45 degree angle and interact with them while they bottle feed.
I hand my toddler a bottle in the middle of the night to drink in their crib and go back to sleep. How do I get them to stop?
Check out Taking Cara Babies, our dear friend and internationally-renown sleep expert, who has plenty of resources that will help you and your child get a good night's sleep.
What if my baby won't sit still for bottle feeds?
Older babies (7-12 months) start to get mobile and may not want to sit still for a bottle feed. If they have been crawling, cruising or walking with their bottle it can be hard to get them interested in cuddling during bottle feeds. Sometimes their refusal to sit still may tell us more about their development than we realize.
Top left (clockwise) via Instagram: @n_and_cs_mom, @livvy_k.a, @rachelpolish, @jackie_bosco
Confused about cups?
You're not alone! One of the most common questions on our Facebook group and Instagram is "How do I introduce a cup?" We know you have questions about cups given your child's specific age and stage, so we want to break it down step-by-step so you know exactly how to introduce various cups and what cups are appropriate for your child's age.
Note: the images in this post were used with permission from parents in Feeding Littles Group. Thank you to everyone who contributed images - we wish we could use them all!
The big questions.
Before we get to teaching specific cups and how to progress to more advanced skills, we wanted to answer some important questions.
Q: When should I introduce a cup?
A: Around 6 months, when your baby starts food (Baby-led Weaning or Traditional Weaning/spoon feeding).
Q: What type of cup should I use first?
A: An open cup (see schematic and videos below).
Q: What are your favorite straw cups and water bottles?
A: In each section below after the video, look for the links to individual sections of our Amazon Store for specific cup buying recommendations.
Q: What should I put in the cup?
A: Water or breast milk/formula.
Q: What about juice?
A: We only recommend juice for constipation (prune, pear, peach juice diluted with water). Otherwise, juice isn't necessary for babies and young children - fruit is a much better option!
Q: How much water can a 6 month old have?
A: No more than 1-2 oz - we don't want it to displace baby's milk feeds.
Q: Why should I offer some water at 6 months? Aren't breast milk and formula perfectly hydrating?
A: Yes, they are! However, water in a cup has a few important functions:
Q: How much water can my baby drink?
A: In general, we recommend no more than 1-2 oz around 6 months and 3-4 oz max around 9 months. Around 12+ months baby can have as much water as they want but will likely still be drinking breast milk, milk and/or formula along with it (see last question about milk needs, below). Many pediatricians consider a water maximum (after 6 months) as number of ounces equaling baby's age in months; thus, no more than 7 oz of water for 7 months. For most babies this would be far too much water for them to also drink enough of their milk, but it's a nice maximum guideline if baby is sick or for some reason isn't drinking their milk.
Q: When should I ditch the bottle?
A: Start working on transitioning off the bottle around 11-12 months. It may take many months for your toddler to stop using the bottle entirely and transition to cups, but the biggest issue with prolonged bottle use is the potential effects on your toddler's teeth. If using a bottle before nap or bedtime, try to brush your toddler's teeth before they go to sleep.
Q: How much fluid do toddlers and older kid need?
A: Toddlers and kids need more fluid than you think! Below are averages recommendations of total fluid per day. Read more specifics about your child's needs - and how to calculate them if you'd like - here.
Q: How much breast milk or formula should my baby (under 12 months) drink?
A: Babies will vary wildly in how much their bodies need for adequate growth and development. Some babies drink 26 oz a day, while others need over 40 oz. Most babies need at least 24 ounces of breast milk or formula until they're closer to one. This equates to 6-12+ breast feeds depending on baby's milk transfer. Talk to your doctor, dietitian or IBCLC if you're concerned about how much milk your baby is drinking.
Q: How much milk should my toddler or child drink?
A: This is a tricky question and depends on your child's overall diet. If you have our Toddler Course, head to Step 16: Calcium, Milk and Beverages. We plan to write a post about milk in the future and won't go into many details here, but if your child is drinking cow's milk or an alternative milk, general guidance recommends no more than 16-24 ounces per day to allow your toddler or child to also eat enough food and not fill up too much on milk. Drinking too much cow's milk can increase a child's risk for iron deficiency anemia as well. Many moms continue to breastfeed far into toddlerhood, and some families choose not to use any milk after infancy. Feeding Littles firmly believes that there's no one right solution for every child - some kids thrive on cow's milk while others breastfeed far into toddlerhood. Some kids eat high-calcium, high-fat foods and get all of their calories from solid foods and no milk. Every child is different and will vary. If you have any questions about how to meet your child's needs, please talk with your pediatrician.
Q: What about smoothies?
A: Smoothies are OK as of 6 months in small amounts, as long as they don't contain artificial sweeteners or herbs (found in protein powders). Most straw cups made for thin liquids are too narrow for smoothies and the thicker smoothie consistency gets stuck. Check out our smoothie cup video and product recommendations at the end of this list!
How do I introduce cups to my baby?
We recommend a specific order of cup introduction to help your baby progress through specific oral-motor skills. Above all else, make sure to start with an open cup first. It really helps your baby learn how to take a small bolus of liquid in her mouth and swallow. We recommend avoiding hard spout sippy cups - the rationale is described in the final video.
Step 1: Open cup
First, let's talk about how to teach your baby to drink from an open cup:
Why does Judy recommend open cups first?
We see so much more success in straw and other cup drinking when babies master an open cup first! To see our list of favorite open cups, click HERE in our Amazon Store.
Step 2: Straw cup
While open cups are wonderful for drinking at home, straw cups are preferred by parents for water drinking while on the go because they're oftentimes leak-proof (or at least leak-resistant). Some people are moving away from disposable straws for environmental reasons, but it's still important to teach straw usage because most kids' cups utilize a reusable straw, and as you'll learn later that we don't want to use hard spout sippy cups for oral development and speech reasons. Straws also strengthen muscles in the mouth that are important for eating and talking.
Some babies learn how to use a straw simply by placing one to their lips or by capturing some liquid in a straw with your finger and placing the other end in baby's mouth. Many babies, however, need a little help figuring out the straw. Below Judy will go through how she teaches straw usage with her clients. If your baby figures out a straw cup without issue, you can skip the Mr. Juice Bear/Honey Bear step, but it's very helpful for babies who don't figure out straws right away.
Straw cup video 1: Mr. Juice Bear / Honey Bear
Find Mr. Juice Bear and the Honey Bear in our Straw Cup HERE in our Amazon Store.
Straw cup video 2: Take N Toss and assisted straw skills
Check out the Take N Toss cup HERE in our Amazon Store!
Straw cup video 3: Handled straw cups and independent straw cup drinking
Check out our favorite handled straw cups in our Amazon Shop HERE! Look for cups with handles first; eventually your child will be able to manage cups without handles.
A note about the Zoli Bot cup: some clients have recently noticed that the Bot straw was hard to suck out of. We contacted Zoli and after doing some research, they realized that in switching to a thicker silicone so that babies don't bite through the straw, the flow of the straw is slower. Watch this video to modify the Bot cup straw until a more permanent solution is found.
Step 3: Munchkin 360 cup
After your tot has mastered the open and straw cup, try a Munchkin 360 cup! The 360 cup mimics an open cup but is leak proof and portable (it can be put in a diaper bag).
Take a look at the wide selection of Munchkin 360 cups in our Amazon store HERE!
We just love this photo from follower @skipsrunsplays - sometimes learning to drink from a cup can be exhausting!
Step 4: Bigger kid cups - water bottles, Contigo, etc.
As your child progresses, he may be ready for a "real" water bottle or "big kid" cup! Learn how to navigate this next phase.
Find the Contigo cup and other "bigger kid" (non-handled, larger) straw cups HERE. Larger Munchkin 360 cups without handles can be found HERE.
What about smoothie cups?
Parents in our Facebook Group always ask about smoothie cups. Check out what Judy recommends, below.
Check out our favorite smoothie cups HERE.
Why do we avoid sippy cups?
Learn why Judy doesn't recommend hard spout sippy cups. With all the cup options available there's no need for traditional sippies!
As you can imagine, this post took us a bit of time to create, so we decided to have a little fun with it. Feeding Littles presents: "The Most Important Cups for Your Kitchen."
For the record, this was a joke...we do NOT recommend teaching your kiddo to drink from a flask. Or a wine glass. Joke. Seriously.
We hope this has helped you decide what cup to use for your kiddo! Cheers!
Megan and Judy, co-owners of Feeding Littles, bring you helpful info on food, nutrition, picky eating, and feeding young children. Megan McNamee MPH, RDN is a Registered Dietitian Nutritionist based in Scottsdale, Arizona. Judy Delaware, OTR/L is an Occupational Therapist specializing in feeding therapy with children 3 and under in Boulder, Colorado. Megan and Judy are both moms of two and love helping families develop a healthy appetite for all foods!