Why it’s Time to Stop Teaching Parents Paced Bottle Feeding and Teach Responsive Feeding As Recommended by the AAP

Paced bottle feeding is a wildly popular bottle feeding technique that is promoted as the best way to feed babies who are breastfed. When I did a google search for paced bottle feeding, there were a whopping 572,000,000 results! What’s more, definitions of paced bottle feeding techniques varied significantly, often contradicting each other,  and there were many unproven claims to promoting paced feeding. 

As a 31-year NICU nurse and lactation consultant, I’m mystified why paced feeding for healthy term babies has become the norm. Pace feeding is a therapeutic feeding technique primarily used for medically complex and premature babies whose suck, swallow, and breathe (SSB) reflex is not coordinated or matured, which is essential to bottle-feed without aspirating milk into the lungs.  

The American Academy of Pediatrics (AAP) and global infant feeding guidelines advocate and promote responsive feeding, which is uniquely different from paced feeding.  Full-term, healthy babies are born with their SSB coordination fully developed and can responsive bottle feed safely.

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My Baby Went Through Hell And Suffered Needlessly From Starvation

Jenn T.

My son was born on February 18, 2019. He was 6 lbs 10 oz and had a little trouble regulating his temperature at birth. But after 24 hours, he was okay. I was always told breast was the best way to go. I never breastfed my 9 year old so this was my first experience with it.

My son had latching issues at first and it caused major pain and bleeding. But after latch correction and using nipple shields, the pain dissipated. When we left the hospital, my son weighed 6 lbs (9.3 percent weight loss) and at his checkup the next day, he had gained half an ounce.

At home I was feeding straight from my breasts, every time. My son was content and seemed happy.  He smiled and was great the entire time, so I thought. I didn’t pump to see how much milk I had because the hospital where I delivered told me pumping in the first 6 weeks could cause confusion for the baby with latching.

Now fast forward to when he was 21 days old. He had his three week checkup and he was extra sleepy that morning. When we got to the doctor, and not only did he lose weight, (down to 5.5 lbs), but he also had a temperature of 92 degrees. He was hypothermic! So they sent us urgently to the children’s hospital in Nashville. Continue reading

Accidentally Starving My Baby Broke My Heart, But Made Me Want To Help Other Moms

Para leer en español, por favor vaya aquí.

When our son was born, he weighed 6 pounds 5 oz., and we had issues with him latching from the start. Part of the problem was I had flat nipples, so the nurse gave us a shield and showed me how to use it, and he seemed to do much better. He seemed to be a very content and alert baby.  He lost almost 10 percent of his birth weight during our hospital stay, and we were discharged to see our pediatrician for a follow-up. 

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My Breast Milk Caused My Baby’s Failure to Thrive


Weighing 9.5 pounds at 4 months

My fourth baby ended up hospitalized for failure to thrive and required a nasogastric tube to feed her. Despite constant breastfeeding, excellent milk supply and milk transfer, she never gained enough weight and then began losing weight. She was born weighing 8 pounds and when admitted to the hospital she weighed 9 pounds, 5 ounces.

I worked in labor and delivery and postpartum units as a tech and then a registered nurse for 6 years at a BFHI designated hospital and I was so indoctrinated by “Breast is Best” that I truly believed “a hungry baby wouldn’t starve” and every mother can exclusively breastfeed, including me.

During the hospital stay my baby was subjected to a profusion of invasive tests, and it was determined my breast milk lacked sufficient fat, calories and nutrients to nourish her.  I was in absolute shock and disbelief!

Elena’s doctors ordered her to begin feedings with a 24 calorie formula for the first creecy2months and then she was fed a 22 calorie formula to help her gain enough catch-up weight. We were able to remove her feeding tube after a month when she began to gain weight and thrive and eventually she was transitioned to a regular 20 calorie formula.


With my first 3 babies, I fed them a combination of breast milk and formula.  My twins always received more formula than breast milk because I couldn’t keep up with their demands. My 3rd baby was called “slow to gain” at four months so I increased the amount of formula he got and by 6 months he was solely on formula. In hindsight, my milk was  probably insufficient then too but my other babies always took a bottle so it was easy to supplement them with a bottle.

Thankfully my sweet baby is now almost 2 years old and perfectly healthy but I will never ever spread the “Breast is Best” myth again!


NG tube removed, thriving

I am now a staunch #FedIsBest advocate and will be joining The Fed Is Best Foundation’s Nurse Advocacy Team so that we can educate other health care providers and provide them with current, clinically safe and evidence- based infant feeding practices.

~Karen Creecy, RN

For more information about breast milk composition deficiencies, please read my blog interview with:  Dr. Shannon Kelleher  and Dr. Shannon Kelleher 2

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