Bottle feeding positions

There is more than one way to hold a baby for a bottle feed.

The traditional semi-upright, cradle-like position is familiar to many families and is often the position shown in general bottle-feeding guidance. However, it is not the only option. Some babies seem more comfortable in a different position, particularly if they are finding the flow of milk difficult to manage, are still developing their suck-swallow-breathe coordination, or are moving between breast and bottle.

The position you choose can affect how your baby is supported, how easily you can see their face and respond to their feeding cues, and how the milk reaches their mouth. There is no single bottle-feeding position that is right for every baby, and exploring different positions can sometimes make feeding more comfortable for both of you.

What can be in a bottle?

A bottle may contain expressed breast milk, infant formula, or a combination of both.

For babies under 6 months, milk feeds provide both nutrition and hydration. Correctly prepared formula already contains water as part of the feed, so water should not be added to or used to dilute formula.

Expressed breast milk is still breast milk, but feeding expressed milk from a bottle is not necessarily identical to feeding directly at the breast. Human milk naturally varies in composition, including its fat content. Research has also found that the way milk is expressed can affect the composition of the milk obtained. A systematic review found that expression technique affected fat content, although the available studies were limited and did not demonstrate the same effect on protein or lactose content (Çınar and Karakaya Suzan, 2021).

This means expressed breast milk should not simply be assumed to have exactly the same composition as the milk an infant receives during direct breastfeeding. There is no single fixed composition of "breast milk", because human milk naturally varies and the milk obtained can also be influenced by how and when it is expressed.

What makes a comfortable bottle-feeding position?

A useful bottle-feeding position is one in which your baby is well supported but still has enough freedom to move their head, mouth and body. Being able to see your baby's face is particularly important because their facial expression, breathing, movements and feeding cues can all tell you something about how the feed is going.

The NHS recommends holding a baby in a semi-upright position for bottle feeds, with their head supported so they can breathe and swallow comfortably (NHS, 2023). The NHS also recommends watching the baby and responding to cues that they need a break rather than expecting them to continue until the bottle is empty (NHS, 2023).

Beyond these general principles, there are several positions that can be explored.

The traditional semi-upright position

The traditional semi-upright position is probably the one most people picture when they think about bottle feeding. Your baby is held close to your body, supported along your arm, with their head higher than their bottom and their head and neck comfortably supported.

For some babies, this is a very comfortable and familiar way to feed. It can also make it easy for the caregiver to maintain eye contact, notice feeding cues and enjoy the closeness of the feed.

However, the position itself does not determine how quickly milk reaches your baby. If milk is flowing continuously or too quickly, a baby may have fewer opportunities to pause and regulate the feed themselves. This is one reason that positioning needs to be considered alongside the bottle, teat, milk flow and the way the feed is offered.

The NHS advises against forcing a baby to finish a bottle because this can result in overfeeding (NHS, 2023).

Upright on your lap, facing outwards

Some babies seem to prefer being held more upright, particularly when they are alert and interested in their surroundings. One option is to sit your baby supported on your lap, facing outwards, while keeping them close and providing whatever support they need around their body, head and neck.

This can provide a very different experience from being cradled across the caregiver's body. It may give a baby who dislikes feeling enclosed a little more freedom to look around, while still allowing the caregiver to remain close and responsive.

The important consideration is whether you can still see your baby's face and observe how they are managing the feed. If the position means that the caregiver cannot see the baby's face, another responsible adult should be able to observe the baby throughout the feed.

Elevated side-lying

Elevated side-lying is another position that has received particular attention in research involving premature babies and infants with developing feeding skills.

In this position, the baby is supported on their side with their body well aligned and their head slightly elevated. The caregiver remains close and can see the baby's face throughout the feed.

Research in preterm infants has explored semi-elevated and elevated side-lying positions in relation to feeding performance and physiological stability (Clark et al., 2007; Park et al., 2014; Girgin, Gözen and Karatekin, 2018; Raczyńska and Gulczyńska, 2019).

Feed Eat Speak has also described elevated side-lying as an option that may be explored with newborns and babies experiencing feeding difficulties (Zimmels, 2018).

Although much of the research relates specifically to premature infants, the position can also be considered as one of several options for a term baby who is finding a conventional bottle-feeding position difficult.

A familiar breastfeeding-style position

For a baby who normally breastfeeds, the transition to a bottle can involve more than simply introducing a different container. The position of the baby's body and the closeness of the caregiver may also feel different.

Some families therefore find it helpful to experiment with a position that has elements of the baby's familiar breastfeeding position. This might be a cross-cradle-style position, with the baby's body supported across the caregiver, or a side-by-side or under-arm position in which the baby is supported alongside the caregiver's body.

The purpose of the latter is not literally to put the baby "in the armpit". Rather, it is a way of using a familiar body position that may feel more recognisable to a baby who is accustomed to feeding at the breast.

There is no guarantee that a familiar position will make a baby accept a bottle, but it can be one of several things worth trying when the change from breast to bottle is proving difficult.

Positions for premature or smaller babies

Premature and smaller babies may need more individualised support because their ability to coordinate sucking, swallowing and breathing can still be developing.

The research into elevated and semi-elevated side-lying has particularly focused on preterm infants, with studies examining how different positions affect feeding performance and physiological responses (Clark et al., 2007; Park et al., 2014).

For a premature baby, a baby with complex medical needs or an infant experiencing significant feeding difficulties, positioning may need to be tailored with support from the neonatal or infant-feeding team. A position that is useful for one baby is not automatically appropriate for another.

What about the bottle and teat?

Position is only one part of bottle feeding. The bottle itself, the shape and flexibility of the teat and the rate at which milk flows can all influence how a baby experiences a feed.

It is very common for families to recommend products to one another, but a bottle or teat that works beautifully for one baby may be much less suitable for another. Babies have different oral dimensions, palate shapes and suck-swallow-breathe coordination, so there is no reason to expect one particular teat shape or bottle system to suit every baby.

Marketing can also make particular products sound as though they have universal advantages. It is worth being cautious about this, particularly when a product is presented as the answer to a feeding problem without considering the individual baby.

If you want to explore the different features of bottle teats in more detail, see Bottle Teat Shapes.

Position is not the same as paced bottle feeding

Positioning and pacing are closely related, but they describe different things.

Positioning is about how your baby's body is supported while they feed. Pacing is about how the flow of milk is offered and how your baby is given opportunities to pause.

A baby can therefore be held in a comfortable position and still find the milk flow too fast. Equally, changing the position alone will not necessarily resolve a feeding difficulty.

For a more detailed explanation of pacing, see How to Pace Bottle Feeds: A Calm Practical Guide.

When a baby refuses a bottle: movement and sensory changes

For some babies, changing the whole environment around the feed can be worth exploring. Rather than sitting still and offering the bottle in the same position repeatedly, some families find that their baby is more willing to accept a bottle while being held upright and gently walked or swayed. This is sometimes described as motion feeding.

The movement may provide a familiar sensory experience and can be particularly worth considering when a baby becomes upset as soon as they are settled into a conventional bottle-feeding position. Gentle movement, rather than vigorous bouncing or rocking, can sometimes help a baby settle enough to explore the bottle.

A change in the sensory environment may also be helpful. Some babies respond to a calm voice, singing, a familiar lullaby or gentle background sound such as white noise while they are being offered a bottle. These approaches are quite different from using a screen to distract an infant, and screens are not necessary for this purpose.

The aim should not be to distract a baby so thoroughly that they take the bottle without noticing what they are doing. Instead, a calm change in movement, sound or surroundings may help some babies feel more settled and receptive to trying something unfamiliar.

If a baby consistently refuses a bottle, it is worth considering why rather than repeatedly trying to persuade them to drink. The feeding position, teat shape and flow, temperature of the milk, the person offering the bottle and whether the baby is accustomed to breastfeeding can all be relevant.

Bottle propping: this is dangerous

Bottle propping is sometimes presented as a convenient way to allow a baby to feed without the caregiver having to hold the bottle. It may involve balancing the bottle against a blanket, cushion or toy, using a specially designed holder, or buying a product intended to keep the bottle in the baby's mouth.

This is not a safe way to bottle feed.

A baby who is feeding from a propped bottle cannot reliably control what happens if the flow becomes too much for them. They may cough, choke, aspirate milk or become unable to breathe properly, while the adult may not recognise what is happening quickly enough to intervene.

The danger is serious enough that the UK Office for Product Safety and Standards has issued safety alerts about baby self-feeding products and prop feeders. These products are designed to allow a baby to bottle feed with little or no assistance from a caregiver and have been identified as presenting a risk of serious harm or death from choking or aspiration pneumonia (OPSS, 2022; OPSS, 2025).

Some of these products have been removed from the UK market, yet similar products and "hands-free" feeding gimmicks can still appear online. The fact that something is being sold or marketed specifically for babies does not mean that it has been shown to be safe.

The NHS is equally clear that babies should never be left alone with a propped-up bottle because of the risk of choking (NHS, 2023).

This is therefore much more than a question of whether bottle propping is "good practice". A baby should never be left to feed from a propped bottle or a self-feeding device. The potential consequences can be fatal.

Is there a best bottle-feeding position?

There is no single position that every baby needs to use.

The traditional semi-upright position may work very well for one baby, while another may settle more comfortably in an elevated side-lying, upright or breastfeeding-style position. A baby's preferred position may also change as they grow and their feeding skills develop.

Rather than looking for one "best" position, it can be more helpful to consider how your individual baby is managing the feed. Are they comfortable? Can you see their face? Are they able to breathe and swallow comfortably? Can you recognise when they need a pause? Does the position allow you to respond to their cues?

If a baby is regularly coughing, choking, spluttering, losing milk from their mouth, becoming distressed, taking a very long time to feed or struggling to coordinate feeding and breathing, changing position may be worth exploring, but persistent feeding difficulties deserve individual assessment rather than simply trying different positions indefinitely.

References

Clark, L., Kennedy, G., Pring, T. and Hird, M. (2007) ‘Improving bottle feeding in preterm infants: investigating the elevated side-lying position’, Infant, 3(4), pp. 154–158.

Çınar, N. and Karakaya Suzan, Ö. (2021) ‘Investigation of the effect of human milk expression techniques on milk content: a systematic review’, Journal of Tropical Pediatrics, 67(6), fmab108.

Girgin, B.A., Gözen, D. and Karatekin, G. (2018) ‘Effects of two different feeding positions on physiological characteristics and feeding performance of preterm infants: a randomized controlled trial’, Journal for Specialists in Pediatric Nursing, 23(2), e12214.

NHS (2023) ‘Bottle feeding advice’. NHS.

NHS (2023) ‘Bottle feeding your baby’. NHS Best Start in Life.

Office for Product Safety and Standards (OPSS) (2022) ‘Product Safety Alert: Baby Self-Feeding Pillows / Prop Feeders (PSA3)’. GOV.UK.

Office for Product Safety and Standards (OPSS) (2022) ‘Product Safety Alert: Baby Self-Feeding Products (PSA4)’. GOV.UK.

Office for Product Safety and Standards (OPSS) (2025) ‘Warning of new variant of dangerous baby self-feeding products’. GOV.UK.

Park, J., Thoyre, S., Knafl, G.J., Hodges, E.A. and Nix, W.B. (2014) ‘Efficacy of semielevated side-lying positioning during bottle-feeding of very preterm infants’, Journal of Perinatal & Neonatal Nursing, 28(1), pp. 69–79.

Raczyńska, A. and Gulczyńska, E. (2019) ‘The impact of positioning on bottle-feeding in preterm infants (≤34 GA): a comparative study of the semi-elevated and the side-lying position – a pilot study’, Developmental Period Medicine, 23(2), pp. 117–124.

Zimmels, S. (2018) ‘Elevated side lying bottle feeding’, Feed Eat Speak, 14 August.