The WHO and the main pediatric scientific societies recommend that babies be exclusively breastfed for the first six months of life.
However, that is not always possible. Some babies need to receive supplements, that is, take more milk than they breastfeed directly from their mother. In other cases, mothers need to go back to work before the babies are six months old and someone has to give them milk in their absence.
Dee Kassing, an American lactation consultant, noticed that many babies who were offered the bottle later ended up rejecting the mother’s breast. So she decided to create a method of bottle-feeding that was as close to breastfeeding as possible .
Which babies need to supplement?
Breast milk is the ideal food and exclusive breastfeeding is recommended for the first six months of life. However, sometimes what the baby breastfeeds is not enough and he must receive supplements (which can be expressed breast milk, donated breast milk or formula). Reasons why a baby may need supplements include:
- Babies suffering from hypoglycemia
- Babies who are dehydrated or have lost a lot of weight
- Babies who do not express enough milk (for example, premature babies, hypotonic babies, with ankyloglossia…)
- Mother with primary hypogalactia (rare situation in which the mother cannot produce enough milk)
- Cases in which it is necessary for mother and child to be separated (for example, serious maternal illness)
Supplementation Methods
The bottle is the best known method of giving milk, apart from the breast. However, it is not the only one nor is it the most suitable. There are many other ways to give supplements.
– With finger and syringe (” finger feeding “): the baby sucks our finger and while we give him milk with a syringe that we introduce through the corner of the mouth
– With cup . Incredible as it may seem, babies can suck from a glass. There are some designed specifically for it.
– With a spoon . The baby drinks the milk directly from a spoon.
– With relay . We introduce the milk in a container from which a very fine tube comes out that we stick next to the mother’s nipple. When the baby latches on to the breast, he grabs both the nipple and areola as well as the tube. By sucking, it receives milk from the mother’s breast and from the container.
– With bottle . The best known method. It is useful when we need to supplement large amounts. It is the most used because it is well known, easily acquired and does not require, a priori according to the mothers, as Dee Kassing states, a lot of training. As a disadvantage, it can create teat-nipple confusion in babies, the milk comes out faster than with the breast and these babies can end up rejecting the breast. In fact, early introduction of the bottle is associated with shorter lactations .
What is teat-nipple confusion?
Suckling from the mother’s breast and sucking from a bottle are not the same. When a baby sucks it seals the breast with its lips (we can see the everted lips) making a vacuum; the tongue performs peristaltic movements pumping the milk that comes out through the lactiferous ducts. With the bottle, on the other hand, the movement is totally different and the milk comes out faster.
Although the teat-nipple confusion is controversial, because there are babies who suck perfectly despite pacifiers and bottles, there are other babies who are supplemented with a bottle who may later have more difficulties suckling . They find it harder to find the breast, they suck poorly, they get angry… In these cases, we speak of teat-nipple confusion.
The Cassing method
As we have previously mentioned, the lactation consultant Dee Kassing designed this method with the idea that the bottle would involve the same effort for a baby as sucking on its mother’s breast. Also with the aim that taking a bottle would be the most similar to suckling, using the same muscles and with similar movements.
How should the bottle be?
To do this, Dee Kassing believes that not all bottles are equally appropriate.
The bottle should be straight , not curved. The base of the teat should not be too wide because the baby must introduce the teat completely into the mouth. When nursing, babies stretch the nipple until it reaches the junction between the hard and soft palate (far back). There don’t seem to be any teats that long on the market, but Dee says this isn’t a problem if you put the entire teat in your mouth. In addition, in this way the baby is “forced” to seal the nipple with his lips, as he would with the nipple and areola.
The nipple should be rounded , physiological calls, and not anatomical (which are flattened on one side) because it has been studied that with these nipples the suction is more similar to that of suckling babies.
It is preferable to use a slow flow teat . One of the reasons why bottle-fed babies end up rejecting the breast is because the milk comes out of the bottle much faster and they have to make more effort with the breast. With a slow-flow nipple, the effort required to express the milk is similar. Dee Kassing estimates that it should take babies about 20 minutes to finish a bottle. Some babies, such as premature babies or babies with poor muscle tone, may need a medium flow nipple until they get stronger. Also, the teat should be as soft as possible ( silicone teats seem to be softer than latex).
How to give a bottle following the Kassing method?
– We put the baby incorporated, as vertical as possible, semi-seated. The person giving the bottle can hold your head with one hand. The bottle will be placed horizontally . Thus, we prevent the milk from flowing faster due to the action of gravity and we also avoid choking.
– We stimulate the search reflex in the same way that we do with the chest. We touch the nose and lips, especially the lower lip and, when the mouth is open, we introduce the teat completely . We slightly raise the bottle so that the teat is completely full of milk (and does not swallow air). As the end of the feeding approaches, it may be necessary to lay the baby down a bit to keep the teat full of milk.
– It is convenient to pause during feeding and see if the baby is full or wants to continue sucking.
Advantages of the Kassing method
– Babies who take the bottle by this method do not experience teat-nipple confusion. We know that this does not always happen; there are babies who can perform mixed breastfeeding and pick up the pacifier and continue to attach perfectly to the mother’s breast; but there are others who do, that if they take the bottle or pacifier too soon it seems that they “forget” to breastfeed.
– We don’t overfeed . With this way of giving the bottle, we allow babies to regulate their intake. By having to make an effort to take the bottle, we minimize the risk of overfeeding them.
– Babies regulate coordinate suction-swallowing-breathing .
– Less interference with breastfeeding , since sucking on the bottle with this method is more similar to sucking on the breast.
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