Bottle Refusal

Help! My Baby Won’t Take a Bottle.

Most babies take bottles without any difficulty, but it can be very stressful for parents when their baby has a hard time taking a bottle. While on leave from work, it is fine to focus on feeding your baby at the breast exclusively. There is no requirement to offer a bottle if you don’t want to. As it gets closer to the time to return to work, some parents choose to offer a bottle so that it isn’t brand new on the first day back to work. If you want, you can offer it yourself, or you may want to take a break and let a partner or caregiver give the bottle. Below are some tips that may ease the transition.

Try having someone other than the lactating parent offer the bottle.

Breastfed infants typically associate feeding with their mother (or other lactating parent), so they may dislike the option of the bottle when offered by the same parent who normally offers a breast. Try having someone else be the first to offer a bottle. Sometimes the lactating parent needs to be out of the house, not just in another room, for the baby to accept a bottle from anyone.

Try offering the bottle when the baby is not overly hungry or tired.

When babies are having a tough time accepting bottles, it can be helpful to find low-pressure times to offer a bottle so that your own stress level is lower. For instance, try offering a bottle when your baby is not overly hungry or is even in a playful mood. It can also be helpful to practice with a bottle when your baby is not tired. Learning a new skill takes patience and effort, and we all have more of both when we feel well rested and calm.

Try feeding the baby in different positions.

Preferred positions for directly feeding are often different than those preferred for bottle feeding. Try holding the baby facing out to look around the room or sitting propped up on your legs.

Try moving around while feeding the baby.

Feeding the baby while you are walking around the room and gently bouncing or swaying may help some babies take the bottle.

Try letting the baby lead the latch rather than putting the bottle nipple directly into their mouth.

You might tickle the baby’s upper lip and nose with the bottle and wait for them to open wide to latch onto the nipple, like how they would latch onto a breast. Be sure the baby latches onto the wide base of the nipple and not just the tip, with the lips relaxed, as they would when breastfeeding.

Pace-feed the Bottle

Pace the milk flow from the bottle so that the baby has control of the flow and is not at risk for choking or drinking too fast. This method typically slows the flow and prevents overfeeding and bottle preference. See this video to learn more about paced feeding.

Wrap the bottle in a shirt or cloth that mom or the lactating parent has worn so the smell is familiar.

Some parents sleep with a burp cloth or a piece of clothing and then wrap it around the baby’s bottle. Alternatively, the caregiver can hold the cloth or the shirt while feeding the baby.

Try different temperatures of milk in the bottle.

There is no rule that babies need to drink warm milk. Experiment to see if your baby has a preference. If your baby accepts cold milk, you can save yourself some time by not having to warm a bottle before every feeding. You may also try warming the bottle nipple (holding it under warm water) before the feeding, so it is not cold. For a teething baby, chill the bottle nipple in the fridge before the feeding.

Try different bottle nipple sizes, shapes and flows.

The extensive choice of bottle nipples available at stores can be overwhelming, and unfortunately, there is not one “best” nipple. The most expensive bottle/nipple combinations aren’t necessarily better than the less costly options. For most babies, a long, straight nipple rather than a short, flat one is best because it more closely resembles a real breast and nipple. Consider trying a nipple that is “newborn” or “slow flow” so the milk flows more slowly and doesn’t overwhelm the baby. On the other hand, if your milk flows fast from your breast, your baby might prefer a faster flow nipple.

The truth about the taste and smell of expressed milk.

Many parents notice that their expressed breastmilk has an off-odor or tastes soapy. All stored milk has a change in odor and taste over time. This is because the enzyme lipase (found naturally in breast milk) breaks down the fats in the milk after the milk has been expressed and is exposed to the air. You may have heard the term “high lipase,” but this is not accurate. Everyone has lipase in their milk, and the odor is not determined by the amount of lipase, but rather by how long the lipase has had the opportunity to do its job, which is breaking down fats.
The longer the milk is stored in the refrigerator or freezer, the stronger the odor may be. The odor is also partially determined by the fats in the lactating parent’s diet. Your milk is perfectly safe for babies to drink even with this change in taste and odor, and it is unusual for infants to be bothered by it. If you think your baby is refusing milk due to taste or odor, it might be helpful to decrease fish intake or withhold fish oil supplements. Some people find that adding a few drops of alcohol-free vanilla extract can help make the milk more palatable to their baby.

Try feeding the baby with something other than a bottle.

You may try feeding the baby with a spoon, sippy cup, or an open cup (perhaps a small medicine cup or shot glass). Hold the baby in your lap upright. Swaddling your baby may help maintain this position more easily. Bring the spoon or cup to the baby’s mouth and allow the baby to take the milk on their own by just touching the milk in the spoon or cup to the baby’s upper lip. Let the baby set the pace. Be very careful not to pour the milk into the baby’s mouth as this could lead to choking. Check out the IABLE Cup Feeding video to learn more. For infants who are 4 months and older, try offering breastmilk popsicles.

Some babies respond to a slow transition.

• Step 1: Bring the nipple (no bottle attached) to the baby’s mouth and rub it along the baby’s gums and inner cheeks, allowing the baby to get used to the feeling and texture of the nipple. If the baby doesn’t like this, try again later.
• Step 2: Once the baby accepts the nipple in their mouth, encourage them to suck on the nipple. Without the bottle attached, place your finger inside the nipple hole and rub the nipple gently against the baby’s tongue.
• Step 3: When the baby is comfortable with the first two steps, pour some drops of milk into the nipple without attaching the nipple to the bottle. Start by offering small sips of milk, making sure to stop when the baby shows that she has had enough.

Try to stay calm.

It can be stressful having a baby who won’t take a bottle. If a baby senses anxiety from the parent giving the bottle, they may be less likely to accept the bottle. Take care of yourself and try to use tools to help you remain calm, such as meditation, taking breaks, and even talking to a therapist. And remember that most of the time this works itself out by just giving it time and patience.

If your baby still doesn’t take the bottle after you’ve tried these tricks, consider the following.

• Can you shift your schedule so that you can take a break from work to go to your baby and directly feed them?
• Can your caregiver bring the baby to you to directly feed throughout the day?
• Can you telecommute/work from home for a while until your baby becomes more accepting of the bottle?
• Talk to your baby’s doctor if you are concerned that your baby is not eating enough or is not gaining weight.

My baby will finally take a bottle but generally won’t drink much at daycare.

Some babies do something called “reverse cycle nursing” when their parents go back to work. They spend most of the day sleeping/not eating at daycare, and nurse frequently overnight to make up for the calories skipped during the day. Some parents like reverse cycle nursing because directly feeding overnight can be a special time to bond with their baby and helps to support their milk production, especially if they have trouble pumping sufficient volumes at work. However, the interrupted sleep can make it difficult for the parent to meet their own sleep needs. Some families can work out their own system to help the lactating parent get as much sleep as possible while still attending to the baby’s nighttime nursing needs. Here are some tips for getting as much rest as you can:

• Sleep near your baby. Options include a crib in your bedroom or a bedside sleeper that is secured to your bed. If you choose to bedshare or are concerned about falling asleep with your baby, make sure to follow low risk bedsharing guidelines to minimize any risks of bedsharing. (See The Academy of Breastfeeding Medicine Protocol on Bedsharing and Breastfeeding 2019)
• Prioritize the things you need to get done and enlist friends and family to help so you have time to get to bed earlier, nap during the day, and/or sleep later into the morning.