"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!
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!