Bottle refusal
Lately it seems that I’ve had a bunch of moms contact me because their babies won’t take a bottle.While I am delighted that their babies are happily breastfeeding, I understand how stressful this can be when mom has to go back to work. It is stressful for the parents, for the caregiver, and most of all, for the baby. Their tiny tummies are designed to fill with milk every few hours (or less!) and to go all day, often over 8 hours when moms are working full-time, is unnatural and uncomfortable. It isn’t necessarily unhealthy, even though it feels that way for a baby to wait that long to eat. Babies being the resourceful little people that they are, will usually make up for it by nursing non-stop once mom and her breasts are back in the neighborhood. For the most stubborn of babies, I try to reassure moms that this length of time would be no different than if the baby were sleeping through the night and not nursing at all for that span of time (although it’s a rare breastfed baby that sleeps that long!) Putting it in that context seems to relieve moms of some of the worry that they feel when their babies aren’t eating the whole time she is at work. Keeping baby close at night so they can partake of the all-night diner can help moms allow their baby to make up for lost time and still get their rest.
Usually when a mom calls me to look for solutions to her baby’s bottle refusal, they have already tried every trick in the book and every nipple on the market. In that case, I don’t have a magical suggestion that will suddenly convince the baby that bottles aren’t so bad. Usually patience and persistence pays off, and most kids will eventually give in and accept the bottle, even if a bit grudgingly.
So what are some of the tricks you can try if your baby is bottle resistant?
* experiment with different nipples- for every nipple out there, there is a baby who loves it and a baby who hates it. Experiment with different shapes, different lengths, different flows….Generally, it is recommended that breastfed babies should always stick to the slowest flow nipple so that they don’t drink too much too fast. But if mom has a strong letdown and a fast and furious milk flow, her baby might be frustrated with a slow flow nipple. Also, babies have a suck/swallow reflexive cycle, which means if they swallow, they’ll suck again. So if the nipple starts to flow once you put it in baby’s mouth and they swallow, you might be able to get them in the suck/swallow mode. Wide base nipples are marketed to breastfeeding moms because they look more like a breast, but many babies know very well that it is NOT the breast, and do better with a more narrow nipple. Your baby’s oral anatomy can impact how well they can suck on certain nipples, so it is definitely not a once size fits all proposition. Certainly don’t buy a whole set of any bottles and nipples until you find one that works for your baby. Buying an expensive starter set of a whole bunch of the same bottle is almost a guarantee that your baby will hate it!
*experiment with different people trying to feed baby- Moms are often told that they should be nowhere around when daddy or grandma are trying to give the baby a bottle because the baby will sense that the breast is nearby and be more likely to refuse. While this can be true for some kids, there are many babies who take the bottle better for mom. She is the one that baby associates with feeding, and she might be more able to finesse the baby to take it. She also can do the “bait and switch” that sometimes convinces some babies to give in and take the bottle. To do this, put baby in nursing position with their cheek right next to your bare breast. Let them nurse for a couple of minutes to take the edge off their hunger, get them in the suck/swallow mode, and let them know they are being fed. Then quickly (really quickly!!) take your breast out and put the bottle nipple in. I’ve seen many resistant babies eventually accept the bottle with this technique.
*experiment with different times of day- Often parents try the bottle in the evening, because that’s when partners are home from work, and that’s when it will give mom a much needed break. The trouble with this though, is that evening is most babies’ fussy time. They are crabby and overstimulated at the end of the day, and this is when most kids want to cluster feed to help them settle. A bottle is the last thing they want when they really need mama to comfort them with the magic boob. Try mid-day on the weekends, or a morning feeding before partners have to leave for work.
*try different positions/places to give the bottle- Maybe your baby doesn’t want to be held in their nursing position to take a bottle. Try with them facing out, try walking around while feeding them, or sitting on an exercise ball. You can go outside (if weather permits) and the change in scenery might distract your baby enough to accept the bottle. You could even try getting in the tub with them! Let them relax in the warm water with you, enjoying that skin to skin contact…they will be nice and calm and you might be able to convince them that the bottle is not so bad after all. Obviously, this is not a technique that you could use for all feedings (daycares might have an issue with it!), but if it will initially convince a resistant baby, it could be a start in gaining bottle acceptance.
*Use small amounts of milk and experiment with different temperatures- If your baby rejects the bottle after they’ve had it in their mouth, you can’t save the milk for another day. Once baby’s saliva mixes with the milk, it will introduce bacteria, so the milk would need to be used within an hour or two of trying it. (don’t re-refrigerate it; just keep it at room temperature if you’re going to try again within a short period of time). You don’t want to waste your precious milk and all the time and effort it took to pump it. Just start with an ounce in the bottle until you know that baby is going to take it. Some breastfed babies want their milk warmed, like it is when it comes from the original tap, while others will take it room temperature or even cold from the refrigerator. (teething babies sometimes appreciate this and will chew on the nipple which can lead them to eventually start sucking from it)
*try a cup- if you’ve tried all the tricks and your baby still refuses, you can easily feed a baby with a cup- not a sippy cup, just a small, flexible, open-top cup. Some parents find that using the little cups that come with cough syrup work well for this. Hold your baby sideways on your lap supporting their head and neck with your hand; with your other hand, put the edge of the cup to the baby’s lower lip and gently tilt it so the milk reaches the baby’s upper lip (don’t pour, you don’t want the baby to choke). As the milk touches the baby’s upper lip, they will sip. It’s the cutest thing and they can drink a good amount of milk relatively quickly with this method. For a baby that doesn’t want to suck on anything but mom, this can work really well. You can watch You Tube videos of how to do it. If you have an active, exuberant baby, you might need to swaddle them so their flailing arms don’t send the milk flying.
*most of all, don’t make it a battle- if you push a resistant baby to take a bottle, it is a battle that you will lose. You want to be very low-key about it and stop if the baby starts to get upset. A little frustration might be expected, but if they are really getting agitated, you want to stop and try again another time. You don’t want to the baby to have a negative association with the bottle or they will see it on the counter and start to plant their feet! It’s hard not to do when you are terrified about going back to work with a baby who won’t eat, but that anxiety can just add to the negativity of the experience for the baby.
I have certainly come across a few kids through the years that never gave in…just waited for mom to come home to eat. Most of the time, however, with patience and persistence, even the most stubborn babies will eventually give in. The best way to avoid this problem is not to wait too long before introducing a bottle to your baby. You want to wait about a month after birth until breastfeeding is well established before giving it, but after about 6 weeks, many babies start to balk at it. Once you’ve introduced it, you don’t go too long in between bottle feedings, or baby may start to change his/her mind. Just because they took it early on doesn’t mean they will continue to do so if you don’t keep them familiar with it. It doesn’t have to be every day, and it doesn’t have to be a full feeding. Just an ounce or two in the bottle a couple of times of week will suffice. You nurse your baby afterwards so they still get their mommy fix, which will further reinforce that the bottle is not unpleasant.
If you need further help and encouragement, contact your Lactation Consultant. Though we are primarily breastfeeding advocates and advice-givers, we are baby feeding experts and can help in many ways, even if it’s just to reassure mom that it will be alright…
