Bottle Holding is Not Bottle Propping (and neither is the end of the world)

I won’t lie to you guys – there were many, many times in FC’s babyhood when I would have killed for a device like this. Judge all you want, but when stuck in Los Angeles traffic on the 405 and your kid is screaming in hunger and you know all he needs is a little formula…

Anyway. I never did bottle prop, but I can’t say I wasn’t tempted. And I rejoiced when he started holding his own bottle around 5 months of age; it made those long car rides exceedingly easier.

(This is one of the rare cases where I didn’t envy my breastfeeding friends, by the way. At least if Fearless Husband was driving, I could sit in the back and hold a bottle for FC. Considering you can’t take the baby out of the carseat while driving, I’m not sure there would be any way to breastfeed on the road without pulling over. In LA, this isn’t always the easiest thing to do… there are long stretches of my commute where pulling over would mean putting myself at major risk, what with being a woman alone with a baby and the violent crime statistics of the neighborhoods. Obviously not a huge problem as you can always just feed your baby before you begin your journey, but if you get stuck on the 10 freeway for two hours – a daily occurrence here – and you have a newborn in the car…. you can imagine why I felt a bit less bitter about bottle-feeding during those times.)

Now, when FC started holding his own bottle, it was pure awesomeness, because he would still let me hold him and snuggle him while he ate. It was the best of both worlds – since I didn’t need to hold his bottle, I had both hands free to play with his feet, hug him tight, or even read him a story while we cuddled.

My fearless, feisty little Fearlette is a whole other can of tomatoes, though. She started holding her own bottle around five or six months as well. Fearlette loves to be held, but only on her terms; she has to look out into the world, has to be in control. And when it comes to her bottle time, that is hers and hers alone. She can’t really be bothered to drink a whole bottle anyway (which has made the whole weaning onto sippy cup thing disgustingly easy this time around), so she’ll grab it from me, crawl or cruise away into a corner, take a few sips and throw the bottle on the floor, usually face-down (I have Stanley Steamer on speed-dial). I’ve tried in vain to make her let me hold her – waiting until she’s ravenously hungry to offer her a bottle, as if I could lure her into my arms via her gurgling stomach…. but she just wiggles her way out.

I miss those warm, snugly feeding sessions. Oh god, do I miss them. And yeah, I suppose if I were breastfeeding, I’d still have them, because she’d be forced to have physical contact with me while feeding.

But on the other hand, I get sort of a kick out of her independence. Forcing her to be close to me isn’t going to make her bond with me; if anything, it’s going to smother her. We have plenty of snuggle time, just not while she’s eating. Food and comfort do not need to be one and the same, at least after you get through the newborn stage.

Bottle holding is not bottle propping, at least in the psychological sense. You are not depriving your child of bonding time or physical proximity just because his hands are holding the food-dispensing apparatus. If he still lets you hold him while he eats, then there is no difference at all between feeding a child who does not hold the bottle and one who does. If he doesn’t want you to hold him, and has the ability to a) hold the bottle and feed himself and b) physically move away from you so that he is eating somewhere other than your arms, it’s okay to allow him this freedom. Considering no newborn on earth can feed herself, we are talking about older babies, here; ones who are learning to crawl, figuring out their own place in the world, and at least in the Fearless Chidrens’ cases, becoming their own little hard-to-please individuals. Fostering autonomy is just as important as cementing bonds that are most likely already set in stone, by the time a baby is capable of holding his own bottle.

Physiologically, however… it’s a bit of a trickier distinction. Fearlette only wants to drink her bottle lying down, flat on her back. I have no freaking clue why this is; I always held her with picture-perfect bottle-feeding posture, fancying myself a formula feeding “expert” and all: close to my chest, slightly elevated, right at boob level… the whole shebang. And yet the minute she was able, she grabbed the bottle from me, sprawled out on her back, and went to town. For months, I tried to amend this behavior, even attempting another kind of “propping” – baby propping, where I’d prop her up on some pillow so her upper body was appropriately elevated. She’d have nothing of it. It was either eat flat on her back, or not eat at all.

I was – and still am – less than thrilled about this situation. According to one anti-bottle-propping brochure from Intermountain Primary Children’s Medical Center:

If you bottlefeed your baby while she is lying flat, she will be more prone to ear infections. Your baby has little openings from the back of her throat to her ears called a Eustachian tube (pronounced you-stay-shun tube). Adults have these tubes, too, but your baby’s Eustachian tubes are shorter, wider, and flatter. When you feed your baby with a propped bottle, the liquid pools in the back of her mouth. The liquid can then back up into her ears through the Eustachian tube. This is bad because bacteria can then enter through the tube into the ear, and cause an ear infection.

This sounds plausible. I’ve said before that I believe the correlation between ear infections and formula feeding is due to the mechanics of formula feeding, not the lack of breastfeeding. I would like to have research done on babies fed breastmilk in bottles versus babies fed formula in bottles, to see if there is a significant difference in the number of ear infections between the groups. My own purely anecdotal evidence, the Fearless Family Sibling Study, found that the baby who did not insist on drinking all bottle flat on his back has had no ear infections in all three of his years on this planet, while the baby who prefers drinking while supine has had three in her not-quite-one.

And then, there’s this, from a guide for WIC professionals dealing with infant feeding:

It is not advisable to give infants a bottle (whether propped or not) while the infant is lying down at nap or bedtime or while the infant is lying or sitting in an infant car seat, carrier, stroller, infant swing, or walker. In addition to possibly causing choking and ear infections, these practices can lead to dental problems if there is milk, fruit juice, or a sweetened beverage in the bottle.

Aw, crap. Really? The highlighted part pretty much outlines the only places my daughter will drink a bottle.

But a closer look at this passage – one used to inform “professionals” about counseling bottle feeders – finds some incongruities. First of all, why does a baby holding her own bottle and drinking in a swing, carseat, etc, have more of a risk of dental problems than that of a baby whose mother is holding her during a feeding? Only one citation is used for this passage, and it is a manual from the American Dietetic Association. No studies of note.

In fact, I couldn’t find any studies specifically looking at the dangers of bottle propping or bottle holding, except for one from 1968 (oh and if anyone can get the full text of the study without paying exorbitant fees, let me know… I’d be curious to read it).

So I’m a little confused. Where is the evidence that bottle propping actually causes choking, dental disease, or ear infections? I’m not saying it doesn’t, because some of the theories and hypotheses out there sound perfectly reasonable, but until we have research, that is all they are: theories and hypothesis.

Look. The only people I actually know who bottle prop are a) daycare providers and b) moms with multiples. If I had to take care of more than two infants at one time, I’d be wanting more than just a bottle propper. (Like a bottle of Jack Daniels and some Valium.) These women are using actual bottle proppers, designed to keep the bottle at the proper angle. I would assume that this would help with the choking and ear infection risk, as long as the baby was being properly observed – not just left unattended with a propped bottle. That would be child endangerment, not poor feeding technique. I can’t see why using an apparatus that allows for hands-free feeding would be physically dangerous in the hands of a responsible adult, so the only thing left to worry about is that elusive “bonding” aspect. Considering we can’t really do a study which measures the effect of occasional bottle propping on the emotional state of infants, I’m not sure there is empirical evidence to back up these warnings.

As is the case with most infant-feeding-related stuff, these recommendations are so mucked up by the moralistic tone of parenting advice, that it’s hard to discuss them without people getting defensive or judgmental. Bottle-propping needs to be discussed and studied on a purely logistical level, as does bottle holding. Framing these recommendations as “good parents do this” and “bad parents do this” helps no one; neither do vague admonishments about ear infections, choking, and obesity; and it certainly isn’t helpful to use the two terms interchangeably.

Until I see some good, clinical research about why bottle propping is dangerous, I’d approach these recommendations a little more realistically. Yes, it’s better to hold younger babies while you feed them, if and when it is possible. If you’re a mom of six kids, or a babysitter of triplets, or in some situation where this might not be possible all the time, go ahead and prop a bottle when necessary – just do it safely. Make sure the baby is old enough and strong enough to turn away from the bottle when he’s finished, and keep a close eye on him to make sure he’s not choking (or use a slow-flow nipple – it takes like seven minutes for a drop of formula to come out of the newborn Avent nipples, for example. It’s not like buckets of formula are going to be pouring out of one of those bad boys).

As for those with older, independent bottle holders, if they let you hold them once in awhile, more power to you. Otherwise, hug, love and cuddle your kiddo in every other way possible. It’ll be okay.

Seriously, though, it will.

Suzanne Barston is a blogger and author of BOTTLED UP. Fearless Formula Feeder is a blog – and community – dedicated to infant feeding choice, and committed to providing non-judgmental support for all new parents. It exists to protect women from misleading or misrepresented “facts”; essentialist ideals about what mothers should think, feel, or do; government and health authorities who form policy statements based on ambivalent research; and the insidious beast known as Internetus Trolliamus, Mommy Blog Varietal.

Suzanne Barston – who has written posts on Fearless Formula Feeder.

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19 thoughts on “Bottle Holding is Not Bottle Propping (and neither is the end of the world)

  1. This made me laugh: And yeah, I suppose if I were breastfeeding, I'd still have them, because she'd be forced to have physical contact with me while feeding.

    Miles hit a phase where he wanted to nurse, but wanted to be as far from me as possible, so he would get just barely close enough to eat, and then sprawl the complete opposite direction. I deeply and entirely envied bottle feeders, because that is not easy on the nipples.

  2. I was reamed a few weeks ago by somebody suggesting that I was a bad parent with a poor attachment to my son for 'allowing' him to hold his own bottle. The brutal truth of it is that unless he's laying on the floor, head on a cushion drinking his bottle and holding it himself he is.not.interested. And our relationship is just fine. I also tend to think that if I WAS breastfeeding, at this point in our relationship together he would probably be trying to self wean – his newly found independence would demand it (no way I'd be exclusively breastfeeding – there WOULD be bottles of EBM).

  3. Omg, ashley, that made me cry I laughed so hard! What an image! That is one problem-solving little guy you've got there…

  4. I used to let DD give herself a bottle in the night time, this was when she was insistent that she still needed a bottle in the middle of the night at 2 1/2, I don't think it did her any harm. She always loved having cuddles both bottles and breasts and just generally, she's one of the cuddly-est babies I've ever met. I don't think feeding was anything above a usual cuddle.

    I also remember an occasion where my Mother, the most nervous driver in the world, was stuck in a traffic jam and DD started crying with hunger in the back. My Mother was completely horrified that she would become so distracted that the car would spontaneously combust or something (we literally weren't moving so it was beyond irrational), she started shouting “Do something, get something in there, for God's Sake, just DO SOMETHING!!!!” I didn't know what to do so I started trying to squeeze my torso around the back of the baby car seat and make my chest to co-operate somehow, THAT is not a latch you'll find in “The Womanly Art of Breastfeeding”! It didn't work and I dread to think what the people in the car next to us thought!

  5. Relative to the post….i've never seen one of those bf devices before, tbh, I think if you've got more than one baby/are v. busy working from home, I could see that it'd be handy.

  6. It seems to me that the risks are more from leaving the child unsupervised than bottle-propping. But bottle-propping doesn't (and shouldn't) equal leaving the child unattended while feeding…

  7. This is interesting to me, and I'm breastfeeding. My daughter gets bottles (of breastmilk) when we're separated. My husband reports she's like your daughter and will only accept the bottle when lying flat on her back, not being held. He's tried everything he can think of. Hopefully this won't lead to ear infections because what else are we supposed to do with her if she won't take the bottle in any other position?

  8. Ashley – I had one of those too – it was that second nursing strike/only eating while watching videos on YouTube twisted away from mama that did me in. On the point of baby-held bottles in car seats and swings, I always thought the assumption was that babies will not be able to move their heads and hands well enough to push away a too-fast flow from the bottle, but surely these days bottles are slower-flowing and won't pool milk/formula/bm in the back of the mouth? And if baby can pick up his or her own bottle, surely can also take it out of his or her mouth if it's too much? Mine insisted on holding his own bottle in daycare at about 9 months but at home still insists on being fed by mama so I don't have much empirical evidence to go on, but that's my vague impression.

  9. I think the dental problems thing is only if they fall asleep while drinking. Some liquid gets left in the mouth causing a bacteria frenzy. I can't see how a baby drinking in a chair but staying awake would have any trouble. And the dental decay isn't just bottles. Nursing a baby to sleep can have a similar effect.

  10. Yes, I second what Liz Busby said about the dental stuff…that's what our pediatrician said.

    Anyway, I have twins, and we figured out a way to feed them both at the same time fairly early on: the feeder would sit on the couch with a boppy pillow around the waist, and put a baby on each side. With a bottle in each hand, both babies could eat simultaneously and have contact with the feeder. When they got too big for that, we put them in bouncy seats, and sat between them holding the bottles. They were around 7mos when they figured out how to hold their own bottles, which they did in their bouncy seats. But they always were held (even if they held their own bottles) at the bedtime feeding, so plenty of bonding there. They are pretty independent children at this point (I do by SELF!!) and quite affectionate as well so I think husband, childcare provider and I have done a decent job in finding the balance between fostering attachment and fostering independence.

  11. My daughter is fiercely independent also! I think that may have played a part in our bf difficulties. On top of never learning to latch properly, she didn't like being held facing in where she couldn't see anything! She doesn't like to cuddle and never has, even as a infant. Now she's a spitfire 2 year old and I love that independent streak. I think it will take her far in life. 🙂 So much for the “you won't bond if you don't breastfeed theory” -we have a great relationship on top of being bottle fed and not even wanting to be snuggled! But oh, I do miss sweet baby cuddles!

  12. My little guy is five and a half months and has NO desire to hold his own bottle. I know he's able to, but every time I try to show him he just looks at me like “I don't think so!” He likes to be sprawled out on my lap…and hates being at an angle too. He likes to be laying down.

    Also, I've fed him in his carseat while we've been on long trips. It's made things easier. And in his five months of life he hasn't had any signs of ear infection.

  13. Our youngest little one has been holding her own bottle since 5 months old (she's 10 months now), which was crazy to me because her older siblings insisted on me holding, rocking and feeding them until nearly their first birthday if not later. I do miss cuddly feedings, but at the same time, her independence has proven to be a blessing in many instances. She's still cuddly and wants me to hold her throughout the day, just usually not when she's eating. The responses we get from people are mixed. Some are like “oh, I wish my baby did that!”, while others just kind of go “Oh, that's… interesting” while they try and hide some “you're terrible parents for forcing her to do this” sneer. This isn't something you can just teach or force on a baby, in my experience. It has to be something the baby wants to do.

  14. You're certainly entitled to your opinion, Courage. I disagree, but that's partly because I believe in making parenting choices based on instinct and what works for yourself and your baby versus what studies say. I fully understand the effect of sugar on teeth- but whether someone is sucking on a bottle while holding it himself or whilst someone is holding it for him is irrelevant, IMO.

  15. I don't know of any research to back this up, but when my son figured out how to hold his own bottle, I was glad because I felt like it gave him more control of how much he was drinking and when he was done. I didn't have to rely on my own reading of his hunger and fullness cues. I tried unbelievably hard not to over- or underfeed him and to make bottle feeding as close to breastfeeding as possible. This was just one more way that it seemed like it could make that possible. Now, I still usually made him stay on my lap for the cuddles, but if he didn't want to sit on my lap, or if he wanted to sit facing away from me and not cuddle, I didn't force it. Usually he didn't want to get too far away.

    There were times when we gave him a bottle in the car while driving someplace or while he was sitting in his stroller. These were the exception rather than the rule, and it's not like we handed him a bottle and then went to do something else. If we were in the car, I was in the backseat with him. If he was in his stroller, it was probably because there was nowhere we would sit comfortably to hold him while he had his bottle. We were with him and could take the bottle away if he wasn't drinking or fell asleep.

    Once he got to the point where he was more interested in exploring the world than sitting still for a bottle, he made his choice clear, and it was a very quick and painless transition to exclusive use of sippy cups.

    We didn't give him a bottle in his crib at night. We didn't give him a bottle and then not supervise him with it. If he fell asleep while having a bottle, we took it away. Those were all to avoid him having dental issues or simply choking. But I don't see how letting him hold his own bottle was, by itself, anything but a positive step developmentally.

  16. Hmmm, bottle proppers…I have to admit, there have been times, like when I was home on maternity leave and everyone else was at school and work, where I put my daughter in her carseat with a blanket and propped her bottle so I could eat a peanut butter and jelly sandwich. I would put her carseat right next to me, eat my sandwich, watch her, and get that moment where I could regroup for the rest of the day. I didn’t leave her, I didn’t have it propped so tight to her head that she couldn’t spit it out, she was able to turn her head away from it-and did. Otherwise, I fed her in my arms, semi-upright and played with her little toes with my free hand. There have been times in the car where we have had to feed her-and we try to only give an ounce or two so she doesn’t spit up all over herself. Someone is always in the backseat with her if we give her a bottle. I find nothing wrong with it-it’s the irresponsible parents who go off and ignore their kids that ruined it for everyone. There was a pic of the bottle propper you linked to and the caption read :My parents are too busy to feed me”. Wow.

  17. There is a huge study to reference about human touch and development. Look at the Romanian orphans. While that is an EXTREME example, it is definitely something to think about. Their brains didn’t grow and they have physical malformations from being left in cribs all day. Occasionally propping a bottle is obviously not going to cause this, but there is something to be said about human touch and needing it for proper development. I don’t think that bonding or the physical closeness have to be done in unison with eating, but I think that breastfeeding is natures way of insuring that physical connection happens.

  18. There is a study in Seminars in Pediatric Neurology 17:7-12 2010 on Infant Acute Life threatening Event – Dysphagic Choking Versus Nonaccidental Injury. A 4.5 month old infant with no previous health problems was being fed in bed with a formula bottle propped on his chest. The father did not intend the infant to choke and die – I am an advocate for safety for the infant and protection of families. I believe that the father was devastated. Hence, education and advocacy for not propping a bottle is a good intention so that a parent will not be subjected to a situation a sad and terrible as having their infant die. Yes, the attachment advocates can be overbearing; yet research indicates that touch and holding is very important to releasing the hormones necessary for emotionally growth (growth of neurons in the brain that are involved in emotional health in the first months of life) for the infant.

  19. I am a grandmother who came across your blog after talking with my daughter about my 4 month old gand daughter who is beginning to try to hold her own bottle. Your blog was towards the top of my results searching for what age they usually will hold their own bottle. I found your thoughts on bottle feeding and propping interesting and wanted to comment on a few things.

    First your thoughts about the connection of bottle feeding and ear infections. Obviously my two children are not enough to make a study. My daughter was breastfed until about 4 months, then I had to give up due to difficulties I had. I don’t think she had a single ear infection her entire first year and I don’t think she had more than 1 or 2 as a toddler. My son on the other hand was only breastfed and never had a bottle. However he had constant ear infections to the point of being deaf until he got tubes at the age of two. I personally believe a bottle or drinking anything could possibly play a role if laying incorrectly. However I think genetics and the way a child’s ear is formed plays a bigger role. My children have different father’s. My son’s father had the same problem with ear infections as a child.

    As to the issues with bottles causing tooth decay. Yes I am a trained dental assistant. I worked for a pediatric dentist and had to assist in very small children who had severe tooth decay. However this can also happen with breastfed babies. But I don’t think the position while being fed will make a big difference. Anytime there is juice or milk left sitting in the mouth there is risk. The best way to avoid that isn’t changing a position but to use a clean soft damp cloth to wipe out a babies mouth after each bottle. Also to start using a baby tooth brush at the proper age.

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