Busting the BS of Breast-like Bottles
Replacing direct breastfeeding with “products” is a global multi-million dollar marketplace. Most of the focus on this has been the marketing tactics used by formula companies. However, new opportunities have crept in over the past decade or two.
Bottles and teats promoted as replicas of the human breast have a dual target market: parents who are keen to reproduce the breastfeeding experience because they regret the transition to formula, and breastfeeding parents introducing bottles of expressed breastmilk, donor breastmilk or formula alongside direct breastfeeding.
Baby bottles have a long history but their simple design hasn't allowed for much innovation. Teats have a little more scope but the basic design is largely unchanged. The greatest evolution has been in the materials used: glass bottles and rubber teats have been superseded by plastic bottles and silicone teats. However a resurgence in glass and rubber has followed concerns about chemicals like BPA in plastic products. Generally though, bottle feeding parents use fairly standard products.
Wider-bodied bottles were a clever design introduced by one brand. By bundling these with products like breastpumps and sterilising units, they locked buyers in to their non-standard bottles and teats which came with a premium price point.
The traditional bottles and the wide-bodied bottles both do the job intended. Yet manufacturers needed to expand their market by creating a new “must-have” item to entice parents.
Enter the breastfeeding bottles and teats.
Your breasts and nipples are uniquely shaped, not even an identical pair. Breasts come in a multitude of shapes and sizes, as do nipples. Babies mould the tissue of both to fit their own unique mouth shape, creating a one-off, personalised method of transferring milk from the mother's body into the baby's body.
Which is why there is no such thing as a bottle or teat which is “just like the breast”. There is nothing about a hard plastic container which replicates a squishy breast, regardless of the shape. And a rigid silicone teats is nothing like the human nipple which stretches with its connected areola to the back of the infants mouth.
It's time for honesty around the design of these products. The issue is not new: back in the 50s, a well-known brand of teat was marketed as being the same shape as a mother’s nipple.
“Already at the end of the 1940s, the dental experts, Prof. Dr. Dr.Wilhelm Balters and Dr. med. dent. Adolf Müller, discovered that babies who had been breastfed developed significantly fewer crooked teeth, and so they researched sucking, drinking and breastfeeding further. As a result, they invented the first asymmetric teat shape, which was modelled on the physiology of a mother’s breast during breastfeeding. “Natural and suited to the jaw” was the name given to this shape, which is still used in the production of NUK Teats and Soothers even today.”
https://www.nuk.com.au/en_au/about-nuk/brand-biography
Maureen Minchin is a medical historian whose 1970s experience of motherhood resulted in her second book, Food for Thought: a parent’s guide to food intolerance, recognized as ground breaking in its treatment of infant allergy. Her third book, Breastfeeding Matters, was declared a “milestone in the history of breastfeeding” by Prof JD Baum. Minchin’s book addresses the claims made about “orthodontic teats” by brands like NUK and applied the known evidence of how breastfeeding works in great detail. Since the book was first published, this evidence base has continued to grow and illustrates even more clearly how difficult it would be to replicate the breastfeeding experience.
In 1997, Robyn Noble IBCLC identified the rising problem of eat design:
“Current teat designs have evolved with no reference to Woolridge's landmark research published over ten years ago which clearly demonstrated how normal breastfeeding works. Rather, manufacturers offer consumers an array of teats which have been shortened in length and distorted in conformation when compared with teats available thirty years ago which coincidentally were a closer physiological match with the positioning of the nipple and breast tissues in the mouth of a breastfeeding baby than teats designed and produced since then.” https://pubmed.ncbi.nlm.nih.gov/9699472/
Research into how babies latch and remove milk from the breast has greatly benefited from modern technology allowing us to see what is happening inside the infant’s mouth during a breastfeed. Ultrasound imaging has been used for 40 years to study breastfeeding infants' sucking dynamics. Advancements in image resolution now enable a more detailed analysis of tongue movements, identification of oral structures, and measurement of nipple position and tongue motion. We can now see exactly what a baby is doing, in real time.
In New Zealand, another form of imaging technology has used MRI to observe the mother and baby as they breastfeed. Again we can see exactly how the infant draws the nipple back in their mouth to remove milk and clearly see how the suck/swallow action works. Real-time MRI imaging was successful in capturing dynamic images of the breastfeeding swallow!
“This imaging modality confirms the dorsal surface of the infant's tongue elevates the maternal nipple to the hard palate, closing the space around the nipple with no air visible in the oral cavity during sucking and swallowing. Breastmilk was easily visualized, being high intensity on T2 sequences.
Simply incredible Ph.D. research by Dr. Nikki Mills, of University of Aukland, New Zealand. These images were published in her paper titled, ‘Imaging the breastfeeding swallow: Pilot study utilizing real-time MRI’ in Laryngoscope Investigative Otolaryngology”
Source: MEDspiration 2020
Yet here we are with social media and advertising filled with reassuring-sounding claims that products are so close to nature that “bottle refusal” can be avoided. None of these teats or bottles function in any way like the breast inside the infant mouth. What they do achieve is to look vaguely similar on the outside. Looking like a breast does not mean functioning like a breast.
Babies are not stupid.
Beyond the early weeks, it is challenging to introduce a teat. A hard, silicone protrusion from a plastic container of milk won't fool a hungry baby who is expecting the soft, warm body of its mother at feed time. It is the experience which is so different that confuses the breastfed baby. A different face smiling down on them, smelling and feeling different. Their father, grandparent or carer holding an unfamiliar thing which confusingly smells of familar breastmilk or another unfamiliar liquid. Pressure on their body from a position different to being held to breastfeed. Hunger cues not being met with the soft, familiar nipple and breast but a hard object being pushed into their mouth and over their tongue.
Its not about right or wrong, good or bad - its just different.
There are two stages when issues around offering teats to breastfed babies tend to arise.
Firstly, in the early days when learning to latch depends on repeatedly experiencing the same series of actions trigger the reflexes involved in attaching. “Nipple confusion” is used to describe babies who don’t easily switch techniques when needed between the breast and a teat or dummy. They take the shallow latch used to suck from a bottle and apply it to the nipple and areola. Causing painful nipples and reduced milk removal.
Secondly, beyond this learning period, when parents decide to introduce a teat and bottle to allow separation of mother and feeding on an occasional basis. While there are babies who accept the new method of feeding without protest, many babies baulk at the idea.
The general advice is to wait until breastfeeding is well-established before introducing bottles but not to wait to long, in case the “window of opportunity” is missed. Very roughly, this is between 6 weeks and 12 week, however the recommendation lacks evidence.
Product marketing aims to convince parents to try the latest design, the new solution, the most expensive brand. As teat after teat is rejected by a confused baby, the cupboard fills with unused products and more money wasted . Parents begin to feel their must be something wrong with their baby - surely taking a bottle is a natural, instinctive action?
By four months, most babies have enough brain development to spot the bottle coming and protest. Swapping teats and bottles for those vaguely breast shaped is not going to do the trick. Instead, using a completely different tool - like a cup - is much more likely to be effective. While it is very important for babies to have opportunities to suck, there is nothing to suggest that occasional feeds without sucking are a concern if unlimited breastfeeding is available at other times. We don’t need to trick babies with fake breasts: a bottle is a bottle and a breast is a breast. If they won’t take a bottle, choose a different tool.
