Help! My baby is refusing the bottle!
Oh, the dreaded bottle refusal. You never know who, why or when it will strike. It’s every working parent’s nightmare.
For many years, lactation consultants assumed that babies were choosing to “refuse the bottle” and would therefore advise parents to “trick” babies by letting them a) get hungry (the “starve it out” approach), and b) have someone other than the breastfeeding parent give the bottle (the old “it’s mom’s fault for being so loving” approach). One of the biggest problems with this advice is that it sets up a combative relationship between parent and child.
Your bottle refusing baby is not pushing the bottle away to make your life more difficult or to manipulate you into breastfeeding them. Babies under 12 months old just don’t have the cognitive function to do that, and when we assume that they do, we enter into an “us vs. them” mentality.
I get it. We adults live in a world with complex relationships, where people can say one thing and mean another, be overly dramatic to make a point, or use tactics like silence and defensiveness. These skills are not yet available to our under 12 month olds.
So if your baby is not refusing the bottle to be difficult or to just get what they really want from you, why are they pushing that bottle nipple out of their mouth and turning their head away and crying?
Your baby is actually telling you that it’s hard for them.
Babies lack the communication skills to say “Hey mom/dad, I know you want me to drink from this thing, but I am not sure how to not gag on that firm nipple, then get my tongue and lips around it to create vacuum pressure inside my mouth, then adjust to the flow while coordinating sucking, swallowing and breathing.” Instead they cry and push it away. It certainly looks like bottle refusal, but it’s actually bottle difficulty.
If your baby is having a good ole time with breastfeeding, it means that they have figured out the mechanics of that really well. There is a good chance that it took them a minute to become a breastfeeding expert, so it may take them time to become a pro at bottle feeding.
Some of you are probably thinking, how different could bottle feeding and breastfeeding be? It’s all just sucking, right? Nope.
While it’s true that the mechanics of sucking, swallowing and breathing are pretty similar regardless of whether we are using a breast or a bottle, babies actually rely on very different muscles of the jaw to get milk out of a bottle or breast and into their mouth.
Not to mention that our nipples are not the same as bottle nipples (despite some really clever marketing by bottle companies, there still is no “just like breast” bottle nipple) and how one feels in a baby’s mouth affects how they feed from it.
If you are a parent of a baby, you are well aware of the vast array of bottle and nipple shapes, sizes, materials and flow rates. It’s beyond confusing. Did you know that there is almost no regulation on what bottle companies have to say on their packaging? All they’re required to say is what the material is. So claims like “soft, breast-like shape”, “anti-colic”, and “like breastfeeding” are all just marketing.
Did you know that flow rates aren’t regulated either? One bottle’s “slow flow” is completely different from another. Heck, one batch of “slow flow” nipples coming off the assembly line can be different from the next batch. No wonder parents (and babies!) are so confused. No one is minding the store. (If you would like to learn more about actual flow rates, check out the work of Infant Feeding Labs.)
Speaking of confusing, parents will often say, “But she took a bottle with no problem at 3 days old when we were giving a bit of formula supplementation. Why is it a problem now?”
The answer is that newborns are hard wired to suck. It’s a strong reflex that is built into every healthy, full term infant. Sucking is not a choice that they make - it’s reflexive and automatic.
However, this suck reflex goes away at around 3 months of age, so after that, sucking does become a choice. Sucking doesn’t just happen; a baby has to decide to do it. This is why we see bottle difficulties crop up later, after that reflex is gone.
Another reason it can become difficult later is that the baby gets bigger. When we put a bottle nipple into a newborn’s mouth, it pretty much fits like a glove in there. The oral cavity is small, allowing the nipple to stabilize and the tongue to easily cup around the nipple.
As the baby grows, not only is the suck reflex disappearing, but the oral cavity is larger, making it more difficult for some babies to stabilize the nipple and get a good grip on it with their tongue.
By this point, you’re probably saying to yourself, “OK, Sharon, interesting info, but I’m going back to work and my baby won’t take a bottle. How do I fix this???” Fair.
The first step is to re-frame this problem as a mechanical issue, not a problem that your baby is creating to get what they want. You and your baby are on the same team.
The same way that you will one day work with your baby on skills involved with riding a bike or writing a letter to their congress member, you need to help your baby figure out how to drink from a bottle.
To work on building bottle skills, start with a content, not-hungry baby. Never force your baby to take a bottle or keep it in their mouth if they don’t want to. You want to keep this light and fun. When we create stress and pressure on our kids, they become unregulated and learning new things is even harder for them.
Here are the steps to take when you are working on improving skills:
Let your baby play with and suck on an empty bottle nipple, just like a pacifier. If your baby can’t reliably bring something to their mouth yet, you can hold it for them. The most important thing here is to keep it very casual and low stress. Treat this as play. If your baby isn’t into it, take it away and try again later.
Start dipping the nipple in a bit of milk or formula and letting them suck on it. Once your baby has gotten good at letting the nipple into their mouth and sucking on it, it’s time to start connecting this thing with feeding, but without the flow of milk.
Give your baby the same nipple that they have been happily sucking on, but now connect it to an EMPTY bottle. You can dip the nipple in milk or formula to give them tastes and keep it interesting.
Now it’s time to try this with milk in the bottle! Start with a small amount such as 1 ounce. Occasionally babies have a strong milk temperature preference, but many babies do not care. The most important thing is to start with stability. Babies get confused when their food is moving from side to side. Imagine if your sandwich was moving around while you were trying to take bites from it! Get your baby into a comfortable, stable position with their chin away from their chest and hold the bottle in place. It helps to gently anchor your hand on the baby so that you both feel like the bottle is not moving around.
This parent is stabilizing their hand on the baby’s chest to anchor the bottle. The baby’s head is tipped back a bit to allow for good swallowing. Also, check out that wide latch around the nipple!
Go really slowly here so the pace doesn’t overwhelm your baby. Keep that bottle tipped down, so it’s pretty much parallel with the floor. It’s perfectly fine for your baby to start by sucking on the empty nipple; they won’t end up with a belly full of air since they will breathe it back out. This technique makes bottles more like breastfeeding, since milk doesn’t usually start flowing immediately from our breasts.
Side lying is another good bottle feeding position. Parent and baby are stable.
If your baby is still having trouble, they may have a more complex problem such as a strong gag reflex or an oral restriction. Consider working with a feeding specialist or IBCLC who can help you choose the best nipple for your baby and give you specific exercises to work on at home. If that isn’t easily available to you, here are a few things you can try for the following problems:
Gagging: Make sure you are aiming the bottle nipple towards the roof of your baby’s mouth, not towards the back of their throat. If touching the roof of the mouth frequently elicits a gag reflex, you may need to work on slowly desensitizing your baby by starting with a clean, upside down pinky finger. Begin by placing the tip of your pinky right behind the upper gum ridge and as your baby allows, start “windshield wipers” back and forth, eventually making your way along the hard palate. The point is NOT to cause gagging, but to build up your baby’s tolerance to something touching their palate by gradually moving towards it. Do this about 5x per day for about 1 minute. Only do this when your baby is ok with it. If your baby really wants you to stop, you should stop.
Tongue not cupping around the nipple: If your baby accepts the nipple into their mouth without gagging, but looks like they don’t know where to put their tongue, first make sure the bottle is stabilized. You may want to start with your baby laying on the floor or on a changing table. If this isn’t helping, consider doing some suck training with a clean, upside down pinky finger. Once your baby creates a strong vacuum around your finger, start playing “tug of war” with them by pulling your finger out slightly. Practice this until your baby is reliably able to hold your finger in their mouth without losing suction. Then try with the bottle nipple again.
Baby gets upset just seeing the bottle: This is more of a bottle aversion and you will need to work on making friends with the bottle before your baby will even consider drinking from it! Try keeping the empty bottle around so it becomes just another object in their environment. Once your baby accepts that, start using the empty bottle as a toy, maybe using it as part of a game like peekaboo. Then, when your baby makes friends with it, you can start the steps listed above.
Bottle difficulty is really stressful for parents, but when you understand what your baby is trying to tell you and figure out how to help them, you feel empowered as a parent. Your child’s life will be full of challenges, and you are there as a guide to help them navigate these difficulties. Bottle feeding is one of the first times you will do this, and certainly not the last.
