"I assumed all babies would willingly take a bottle..."
When you learn about breastfeeding during pregnancy, you hear terms like “supply and demand” and are taught how important a good latch is for successful milk transfer. However, very few people talk about the fact that many breastfed babies refuse to take bottles of breast milk, something many moms don’t expect. We see images of baby bottles everywhere and assume that all babies will drink from them.
Interestingly, the bottle is easier for a breastfed baby to drink out of since it’s a static process. Some babies can drink milk much faster from a bottle than a breast. For this reason, many moms are advised to not introduce a bottle until at least 4-6 weeks, or when breastfeeding is well established. What many moms don’t expect is that not all babies will take a bottle when it’s eventually introduced.
While bottle refusal is OK for some families, many moms need to go back to work or would like more flexibility in feeding. It can be extremely frustrating and isolating for a mom who wants or needs to be away from their baby longer than two hours but cannot due to feeding schedules. Furthermore, bottle refusal can be difficult for care providers and can discourage loved ones from wanting to care for the baby.
It is a blessing to successfully breastfeed, but when baby can’t take a bottle, sometimes mom feels trapped. Perhaps she’s distracted at work because she worries about how much milk her baby is drinking at daycare. These are very valid, real feelings. Fortunately, this situation is temporary.
Both of Megan’s babies refused bottles, as have many of our clients’ babies, so we are fully aware of the emotional toll this can take on a family. We wanted to share some practical tips and alternatives to bottles that can help you survive this temporary phase.
Before you read this article, please know these four things:
Oh, and one day your bottle refuser will be a toddler who sees a baby bottle and tries to drink from it. Little stinker.
Let’s talk about how to navigate bottle refusal.
All images used in this blog post were submitted by members of our Feeding Littles Clients Only Facebook Group and are used with permission.
First, an important safety caveat.
This article assumes that your baby is getting enough milk to support adequate growth and development via breastfeeding. If your baby isn’t transferring milk well, is refusing to breastfeed, is away from breastfeeding mom for a prolonged period and isn’t taking milk, or is refusing their formula please work with your health care provider ASAP. Dehydration in infants can be very dangerous and must be addressed immediately. Additionally, it’s important to make sure that your child does not have any medical issues that would prevent them from taking a bottle. For example, babies born prematurely and those with neuromuscular impairments maybe more susceptible to feeding preferences, and these specific concerns should be discussed with your child’s pediatrician, lactation and feeding specialists.
Why do babies refuse bottles?
Unfortunately, we never know which babies will refuse bottles. Many babies have no difficulty transitioning back and forth between breast and bottle, while other babies will fight a bottle and refuse to accept it.
Let’s briefly discuss the mechanics of breast and bottle feeding so we can better understand what your baby is experiencing.
Breastfeeding is dynamic – as breasts fill and empty, a baby’s mouth constantly adjusts to accommodate these changes. Breastmilk changes in consistency and nutrient quality from the beginning of the feed to the end. It starts off more watery and higher in protein, which can help baby quench their thirst and provides amino acids for physiologic processes, and becomes higher in fat and creamier in texture as the feed proceeds. The milk consistency and changes throughout the day, as does the taste of breastmilk depending on mom's diet. Even the color of breastmilk can change from day to day!
What’s more, breastfeeding is a dynamic bonding experience between mom and baby. Babies are used to mom’s voice, her smell, her body and the little routines they have established together while feeding. Of course, you don’t have to breastfeed to bond with your baby, but from a nursing baby’s perspective, feeding time equals time with mom.
That’s why when you try to bottle feed some breastfed babies, they refuse to drink the milk. The bottle is not dynamic like a breast, and the nipple itself is very different than mom’s nipple. Babies know the difference – they’re smart little creatures! What’s more, when mom tries to give baby a bottle, baby might not understand why they can’t have what they’re used to – the breast.
Think about it from your baby’s perspective: all they know is cuddling with mom (warm, comfortable, familiar) and getting their milk from her breast. They have done it only this way for potentially 500-2,000 feeds, depending on when you start to offer a bottle. Suddenly you are asking them to do something extraordinarily different than what they’ve practiced their entire life. It makes sense that many of them refuse the bottle.
Stress can affect this process, big time.
Before we talk about specific strategies (we promise to get there!), we want to emphasize how much stress can affect how well a breastfed baby will take a bottle. When babies refuse bottles, it can understandably be extremely stressful and anxiety-driven. Breastfeeding moms may feel desperate, “trapped” at home or angry that their baby isn’t figuring it out. Similarly, the adult attempting to feed the baby with a bottle may be frustrated or fearful because it hasn’t been going well. They might not be willing to continue to try.
Your baby can pick up on this stress. They sense not only their mom’s anxiety, but also the stress of the person giving them the bottle. Stress in a breastfeeding mom may affect their breast milk production.
Of course…hearing that you need to stress less or “calm down” when faced with an emotionally-charged topic only stresses you out even more. Rather, we (Judy and Megan) just want to highlight how important it is to be emotionally calm and steady when trying to offer the bottle. It’s equally as important for the person doing the bottle feeding to try to remain calm, patient and positive during this process. Notice how your body tenses or how the bottle feeder responds to the baby if your baby is turning their head, spitting out the bottle nipple or crying. If the bottle feeder or the baby begin to get noticeably stressed, take a break and try again. Explain to the bottle feeder that this is a process that might take time.
How can I (hopefully) prevent my baby from refusing bottles?
If you are planning to return to work, many lactation professionals recommend offering the bottle every few days starting at 2-4 weeks of age. Of course, if breastfeeding is still a major struggle, work with your lactation consultant first. Be consistent – it can take time for your baby to become accustomed to the feel and the rhythm of a bottle. Ideally, have someone other than the breastfeeding mom do the bottle feeds. This can be a great bonding experience for your partner or another family member.
If possible, start by putting an ounce or two of expressed breastmilk in a bottle with a slow-flow or preemie nipple. Judy recommends Dr. Brown’s bottles because they are known for their venting system. This helps keep air out of the milk, which prevents gas and makes the feeding go more smoothly. If we don’t need to burp the baby as often, then less latching on and off may occur. Many babies get frustrated and somewhat lost the more frequent on/off latching with the bottles when they're used to breastfeeding.
You don’t need to offer a full feed; the goal is to get your baby used to the sucking pattern and nipple feel of a bottle. If you’re consistent with offering a bottle every few days, your baby will be more likely to continue to accept it.
My baby won't take the bottle - what do I do?
Below are some specific tips and multiple things to rule out if your baby refuses a bottle. You don't have to try all of these things! We are simply offering multiple techniques that may help.
Don't forget to read your baby’s cues. We don’t want to force a baby to drink from the bottle by holding it in their mouth when they’re refusing to swallow or if they’re crying without suckling. It can become a safety hazard if milk is in their mouth but they’re not swallowing effectively, and they can develop a negative association with bottles and feeding time. Above all else, don’t force this process.
My baby still won't drink from the bottle despite trying everything above. Now what do I do?
First off, it’s important to remember that there’s nothing wrong with you or your baby if they don’t take a bottle. It’s not a required developmental step. Breastfeeding does great things to develop your child's oral-motor skills, so don’t worry that they are “missing out” developmentally if they don’t take a bottle.
However, that doesn’t make bottle refusal easy. Here are some ways to work around bottle refusal:
Alternative Feeding Devices
NIf your baby will not take a bottle and you need to give them milk in another manner, sometimes additional tools may help. Before using any of these techniques, please consult a feeding specialist or lactation specialist, especially if your baby has any breathing or swallowing issues. The biggest concern with this type of feeding is a risk for aspiration if your baby isn’t actively drinking the milk.
We are simply offering these techniques to help you safely use these tools and be aware that they exist. This does not replace medical advice or care. Talk with your provider about which specific products and techniques will work best for your baby.
Dropper or syringe:
Open cup, bowl or spoon
We generally recommend introducing an open cup to babies around 6 months when they start solids as discussed in our Ultimate Guide to Cup Drinking. However, if your breastfed baby is refusing bottles, you can try an open cup, bowl or spoon as early as 4 months, or when your baby has good head and neck control.
Note: sometimes spoon feeding colostrum or breast milk is a technique used much earlier than 4 months - lactation specialists often utilize it in the hospital before a baby has figured out how to breastfeed. These are general guidelines to help families whose babies consistently refuse bottles and can't receive milk when mom is away, but every baby and situation will be different. Work with your provider.
Can you continue to breastfeed into toddlerhood if your baby refuses bottles as an infant?
Yes! Many moms decide to breastfeed into toddlerhood (12+ months). At this point, breastfeeding a bottle-refusing baby can be less stressful since they don’t need to breastfeed as much as they did in infancy. Many moms gradually stop pumping at work and only breastfeed when they’re with their toddler. While at daycare (or while mom travels), baby drinks an alternative milk from a cup or gets their nutrition through food and water until mom comes home.
We know that bottle refusal can be really stressful, but we hope these strategies help you discover some solutions for your family. Soon your baby will be drinking from a cup and eating food like a pro – this is so temporary!
When serving veggies and fruits to babies, toddlers and young eaters - think color!
We recently featured various veggies and fruits of all the colors of the rainbow on our Instagram account. Our followers asked us to compile the charts into one printable document...so here it is!
A few things to keep in mind:
Scroll through to see the chart, and click the link below to download the PDF file.
Do you get stuck at lunch time? Need a little easy inspiration? Our philosophy on lunch is simple - "What do you have in the fridge or the cupboards?" That, friends, makes up lunch. No complicated recipes, no super complicated meals. Just lots of nourishing, satisfying, tasty foods that give them energy to get back to learning, playing or taking a nap! Click on the link below to access our Lunch Toolkit. We hope it helps inspire you!
Top left (clockwise) via Instagram: @n_and_cs_mom, @livvy_k.a, @tpaigemcintosh, @jackie_bosco
Updated May 2020
Confused about cups?
You're not alone! One of the most common questions on our Facebook group and Instagram is "How do I introduce a cup?" We know you have questions about cups given your child's specific age and stage, so we want to break it down step-by-step so you know exactly how to introduce various cups and what cups are appropriate for your child's age.
Note: the images in this post were used with permission from parents in Feeding Littles Group. Thank you to everyone who contributed images - we wish we could use them all!
The big questions.
Before we get to teaching specific cups and how to progress to more advanced skills, we wanted to answer some important questions.
Q: When should I introduce a cup?
A: Around 6 months, when your baby starts food (Baby-led Weaning or Traditional Weaning/spoon feeding).
Q: What type of cup should I use first?
A: An open cup, then a straw cup (see schematic and videos below).
Q: How do I know when to move on from an open cup to a straw cup?
A: When your baby can successfully swallow a small amount of water from an open cup that you assist in holding. (They don't need to be able to do it independently to learn a straw cup.)
Q: What are your favorite straw cups and water bottles?
A: In each section below after the video, look for the links to individual sections of our Amazon Store for specific cup buying recommendations.
Q: What should I put in the cup?
A: Water or breast milk/formula.
Q: What about juice?
A: We only recommend juice for constipation (prune, pear, peach juice diluted with water). Otherwise, juice isn't necessary for babies and young children - fruit is a better option!
Q: How much water can a 6 month old have?
A: No more than 1-2 oz - we don't want it to displace baby's milk feeds.
Q: Why should I offer some water at 6 months? Aren't breast milk and formula perfectly hydrating?
A: Yes, they are! However, water in a cup has a few important functions:
Q: How much water can my baby drink?
A: In general, we recommend no more than 1-2 oz around 6 months and 3-4 oz max around 9 months. Around 12+ months baby can have as much water as they want but will likely still be drinking breast milk, milk and/or formula along with it (see last question about milk needs, below). Many pediatricians consider a water maximum (after 6 months) as number of ounces equaling baby's age in months; thus, no more than 7 oz of water for 7 months. For most babies this would be far too much water for them to also drink enough of their milk, but it's a nice maximum guideline if baby is sick or for some reason isn't drinking their milk.
Q: When should I ditch the bottle?
A: Start working on transitioning off the bottle around 11-12 months. It may take many months for your toddler to stop using the bottle entirely and transition to cups, but the biggest issue with prolonged bottle use is the potential effects on your toddler's teeth. If using a bottle before nap or bedtime, try to brush your toddler's teeth before they go to sleep. We have a detailed Milk and Weaning eBook included in our Infant and Toddler online courses that addresses all of this. It can also be purchased separately here.
Q: How much fluid do toddlers and older kid need?
A: Toddlers and kids need more fluid than you think! Below are averages recommendations of total fluid per day. Read more specifics about your child's needs - and how to calculate them if you'd like - here.
Q: How much breast milk or formula should my baby (under 12 months) drink?
A: Babies will vary wildly in how much their bodies need for adequate growth and development. Some babies drink 26 oz a day, while others need over 40 oz. Most babies need at least 24 ounces of breast milk or formula until they're closer to one. This equates to 6-12+ breast feeds depending on baby's milk transfer. Talk to your doctor, dietitian or lactation specialist if you're concerned about how much milk your baby is drinking.
Q: How much milk should my toddler or child drink?
A: This is a tricky question and depends on your child's overall diet. If you have our Toddler Course, head to Step 16: Calcium, Milk and Beverages. If your child is drinking cow's milk or an alternative milk, general guidance recommends no more than 16-24 ounces per day to allow your toddler or child to also eat enough food and not fill up too much on milk. Drinking too much cow's milk can increase a child's risk for iron deficiency anemia as well. Many moms continue to breastfeed far into toddlerhood, and some families choose not to use any milk after infancy. Feeding Littles firmly believes that there's no one right solution for every child - some kids thrive on cow's milk while others breastfeed far into toddlerhood. Some kids eat high-calcium, high-fat foods and get all of their calories from solid foods and no milk. Every child is different and will vary. Please refer to our Milk and Weaning eBook in both courses or here for more details about choosing a milk for your child.
Q: What about smoothies?
A: Smoothies are OK as of 6 months in small amounts, as long as they don't contain artificial sweeteners or herbs (found in protein powders). Most straw cups made for thin liquids are too narrow for smoothies and the thicker smoothie consistency gets stuck. Check out our smoothie cup video and product recommendations at the end of this list!
How do I introduce cups to my baby?
We recommend an order of cup introduction to help your baby progress through specific oral-motor skills.
Your baby only needs to learn to drink from two types of cups:
Above all else, make sure to start with an open cup first. It really helps your baby learn how to take a small bolus of liquid in their mouth and swallow. We recommend avoiding hard spout sippy cups - the rationale is described in the final video.
What about Miracle 360 cups? Parents like the 360 cup, which is similar to an open cup with a silicone membrane lid, because it is less likely to spill. In the past we recommended it as the third cup type to teach your baby. However, recently many feeding specialists have expressed concern about how some kids use this type of cup. Please head to the 360 Cup section in this post for more details.
Step 1: Open cup with adult assistance
First, let's talk about how to teach your baby to drink from an open cup:
Why does Judy recommend open cups first?
When can my baby drink from an open cup without my assistance?
As your baby gets older and more experienced with an open cup, they will begin to hold it independently and drink on their own. Many of Judy's private feeding therapy clients are able to independently drink from an open cup by 10 months of age, but every baby is different.
To help your baby drink from an open cup on their own after they've practiced with you holding the cup:
To see our list of favorite open cups, click HERE in our Amazon Store.
When can we move onto a straw cup?
As soon as your baby successfully swallows from an open cup using your assistance, try a straw cup! We want your baby to be able to use both types of cups.
Step 2: Straw cup
While open cups are wonderful for drinking at home, reusable straw cups are preferred by parents for water drinking while on the go because they're oftentimes leak-proof (or at least leak-resistant). Some people are moving away from disposable straws for environmental reasons, but it's still important to teach straw usage because most kids' cups utilize a reusable straw, and as you'll learn later that we don't want to use hard spout sippy cups for oral development and speech reasons. Straws also strengthen muscles in the mouth that are important for eating and talking.
Some babies learn how to use a straw simply by placing one to their lips or by capturing some liquid in a straw with your finger and placing the other end in baby's mouth. Many babies, however, need a little help figuring out the straw. Below Judy will go through how she teaches straw usage with her clients. If your baby figures out a straw cup without issue, you can skip the Mr. Juice Bear/Honey Bear step, but it's very helpful for babies who don't figure out straws right away.
Straw cup video 1: Mr. Juice Bear / Honey Bear
Find Mr. Juice Bear and the Honey Bear in our Straw Cup HERE in our Amazon Store.
Straw cup video 2: Take N Toss and assisted straw skills
Check out the Take N Toss cup HERE in our Amazon Store!
Straw cup video 3: Independent straw cup drinking
Handles can be easier for baby to use, but they're not required. Check out our favorite straw cups in our Amazon Shop HERE!
Step 3: Bigger kid cups - water bottles, heavier cups, etc.
As your child progresses, they may be ready for a "real" water bottle or "big kid" cup! These larger cups and water bottles are great for daycare, preschool or the diaper bag because they're less likely to leak and hold more liquid.
Some things to consider with heavier or larger water bottles:
If you've answered "yes" to these questions, it may be time for a "big kid" cup!
Our Straw Cup Amazon list has lots of water bottles for kids 16-18+ months, including our favorite brands Contigo, Hydroflask and Yeti. If you're looking for even bigger water bottles for kids 4+ years, head here.
Note: a hard or wider straw as found in the Contigo, Hydroflask and Yeti cups do not pose the same oral-motor concerns as a hard spout sippy cup. They are still straws and promote a normal suck pattern.
What about smoothie cups?
Parents in our Facebook Group always ask about smoothie cups. Check out what Judy recommends, below.
Check out our favorite smoothie cups HERE.
What about the Munchkin 360 cup?
As we explained above, we used to recommend the Miracle 360 cup for parents who wanted a more spill-proof option that mimicked an open cup. However, recently some feeding therapists have noticed that the 360 cup can contribute to problematic drinking patterns in some kids:
But we love the 360 cup! Should we stop using it?
If your child cannot or will not drink from anything but a 360 cup, here are some tips:
Why do we avoid sippy cups?
Learn why Judy doesn't recommend hard spout sippy cups. With all the cup options available there's no need for traditional sippies!
As you can imagine, this post took us a bit of time to create, so we decided to have a little fun with it. Feeding Littles presents: "The Most Important Cups for Your Kitchen."
For the record, this was a joke...we do NOT recommend teaching your kiddo to drink from a flask. Or a wine glass. Joke. Seriously.
We hope this has helped you decide what cup to use for your kiddo! Cheers!
Breakfast is sometimes the most difficult meal of the day. Kids are hungry, time is short and it's easy to get stuck in a rut. We created this free Family Meal Toolkit - Breakfast Edition to help you navigate the first meal of the day with a little less stress. Head to the link below to download it for yourself!
In this toolkit you'll find:
Judy here! I’m an Occupational Therapist specializing in feeding therapy. It seems like there are so many ideas on the internet for how to keep toddlers and kids occupied while we shelter in place. But…how do you play with a baby?
Guess what? As an OT I work with play in each of my sessions! How does this relate to feeding? Well, infant development and play skills are essential in setting the foundation for gross and fine motor development. They also develop vision and cognitive skills. Eventually all of these things piece together to promote successful feeding! (And learning!)
In short, play helps promote feeding. It's all connected.
We've created a free printable for you to reference if you're in need of some ideas that I recommend to my private practice clients. You might be doing a lot of these things already, but we just wanted to offer some inspiration for easy ways to play with your baby that can help promote development, bonding and fun for both of you.
How are we doing, friends? We know this can be a really challenging time for everyone, and we wanted to help in our own small way. Click on the link below to download our free Family Meal Toolkit - Dinner Edition! In it you'll find:
Click on the link or image below to download the Toolkit now!
Whenever we post about favorite salad toppings we get questions about how/when kids can eat salads, too - this post is very long overdue!
The biggest issue with salad is the safety of the greens. If we give a toddler soft leafy greens before they have a good rotary chew pattern established and a lot of teeth they may just swallow it whole. Lettuce leaves may be soft, but they do require lots of great chewing with teeth to break down (unlike many other foods that can be chewed successfully with gums).
Here are some simple guidelines:
A few additional tips:
One big question we always get is, “How do you keep lunches cold?” (Shown here are Bentgo boxes that we love! You can find them in our Amazon shop under Lunch.)
Here are some tips from USDA:
Don't forget that these safety guidelines apply to any food out of the fridge, even snacks you send with your preschooler or diaper bag snacks.
When life changes, so does eating. Having a new baby definitely changes everything in your house. If you also have a toddler or older kid at home, don't be surprised if the addition of a sibling causes disruption at mealtime. You may find yourself serving crackers and milk for lunch. We want to be the first to tell you this: it's ok.
How can you make mealtime a little better with a newborn and an older kid - or multiple kids?
Megan and Judy, co-owners of Feeding Littles, bring you helpful info on food, nutrition, picky eating, and feeding young children. Megan McNamee MPH, RDN is a Registered Dietitian Nutritionist based in Scottsdale, Arizona. Judy Delaware, OTR/L is an Occupational Therapist specializing in feeding therapy with children 3 and under in Boulder, Colorado. Megan and Judy are both moms of two and love helping families develop a healthy appetite for all foods!