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.

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