Originally posted on August 6, 2020 @ 1:37 pm

“I imagined that all newborns would gladly accept a bottle…”

When learning about nursing during pregnancy, you will hear phrases like “supply and demand” and how crucial a good latch is for effective milk transfer. Few people, however, discuss the reality that many breastfed newborns refuse to drink bottles of breast milk, something many mothers do not expect. We see baby bottles all everywhere and believe that all infants will drink from them.
Interestingly, because it is a static procedure, the bottle is simpler for a breastfed infant to sip from. Some newborns can consume milk from a bottle considerably quicker than they can from the breast. As a result, many mothers are recommended to wait at least 4-6 weeks, or until nursing is firmly established, before introducing a bottle. Many mothers are surprised to learn that not all newborns will accept a bottle when it is ultimately presented.
While bottle rejection is acceptable in some families, many mothers need to return to work or prefer greater feeding flexibility. It may be incredibly stressful and lonely for a mother who wants or needs to be away from her infant for more than two hours but is unable to do so owing to feeding patterns. Furthermore, bottle rejection can be challenging for caregivers and might discourage loved ones from wanting to help with the baby’s care.
It is a joy to be able to breastfeed effectively, but when the baby is unable to take a bottle, the mother might feel imprisoned. Perhaps she is preoccupied at work because she is concerned about how much milk her kid consumes at daycare. These are absolutely valid and genuine sentiments. Fortunately, this is only a temporary issue.
Megan’s infants, like many of our clients’ newborns, refused bottles, so we understand the emotional toll this can have on a family. We wanted to provide some helpful hints and bottle alternatives to assist you get through this brief period.
Please be aware of the following four facts before proceeding with this article:

There is nothing wrong with you or your child if they refuse to drink from a bottle.
Babies who are effectively nursing do not need to learn to drink from a bottle – they are not deficient in any developmental skills! Many newborns start drinking from a cup as early as 4 months.
Many infants will ultimately take a bottle if they need to, especially if their mother is away at work all day. Most daycare providers have done this before and will work with you to make it a success.
This is just for a short time! Your baby will eventually be eating and drinking from a cup, and they will no longer be nursing. Remind yourself that this will not continue forever!
Oh, and your bottle refuser will one day be a toddler who sees a baby bottle and attempts to drink from it. Little scumbag.
Let’s go through how to deal with bottle rejection.

 

Image via @eechocho

First, a word of caution about safety.

This article assumes that your infant is getting enough milk through nursing to ensure appropriate growth and development. If your infant isn’t transferring milk properly, is refusing to breastfeed, is separated from the nursing mother for an extended length of time and isn’t taking milk, or is refusing formula, please consult with your health care practitioner as soon as possible. Dehydration in newborns is extremely hazardous and must be treated right away. It is also critical to ensure that your child does not have any medical problems that might prohibit them from drinking from a bottle. Premature babies and those with neuromuscular deficits, for example, may be more prone to feeding preferences, and these specific issues should be explored with your child’s physician, lactation and feeding specialists.

Why do newborns refuse to drink from bottles?

Unfortunately, we never know which babies will refuse to drink from a bottle. Many babies have little trouble switching between breast and bottle, but others will battle a bottle and refuse to accept it.

Let’s go through the basics of breast and bottle feeding so we can better grasp what your kid is going through.
Breastfeeding is a dynamic process; as breasts swell and empty, a baby’s mouth adapts to meet these variations. From the start of the feed until the finish, the consistency and nutritional content of breastmilk vary. It begins more watery and richer in protein, which can assist infant quench their thirst and give amino acids for physiologic functions, and gradually increases in fat and creaminess as the feed progresses. The consistency and flavor of breastmilk varies during the day, depending on mom’s nutrition. Breastmilk’s hue might even shift from day to day!
Furthermore, nursing is a dynamic bonding experience for both mother and child. Babies are used to their mother’s voice, scent, body, and the tiny rituals they have formed while nursing. Of course, you don’t have to breastfeed to bond with your kid, but feeding time equals time with mom for a nursing infant.
As a result, when some breastfed babies are bottle fed, they refuse to take the milk. The bottle is not dynamic like a breast, and the nipple is not like mom’s nipple. Babies can tell the difference — they’re perceptive little beings! Furthermore, if mom tries to give infant a bottle, the baby may not comprehend why they can’t have what they’re used to – the breast.
Consider it from your baby’s point of view: all they know is snuggling with mom (warm, comfy, and familiar) and taking milk from her breast. They have only done it this way for a total of 500-2,000 meals, depending on when you start offering a bottle. Suddenly, you’re asking them to do something very different from what they’ve done their entire lives. It’s understandable that many of them decline the bottle.

 

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Image via Cybele Ponton

Stress can have a significant impact on this process.

Before we get into specific techniques (we promise! ), we’d want to underline how much stress may impact how successfully a breastfed infant will take a bottle. When newborns refuse bottles, it may be understandably stressful and anxiety-inducing. Breastfeeding mothers may feel frantic, “stuck” at home, or irritated that their baby isn’t getting it. Similarly, the adult attempting to bottle-feed the infant may be upset or scared since things haven’t gone smoothly. They could be unwilling to try again.
This stress might be picked up on by your baby. They may feel not just their mother’s worry, but also the stress of the person who is giving them the bottle. Breast milk supply may be affected by stress in a nursing mother.
Of course, hearing that you need to “calm down” or “stress less” when confronted with an emotionally charged issue simply adds to your stress. Rather, we (Judy and Megan) want to emphasize the importance of remaining emotionally calm and steady when attempting to provide the bottle. It is equally vital for the person conducting the bottle feeding to be calm, patient, and optimistic throughout the procedure. If your baby is moving their head, spitting out the bottle nipple, or wailing, notice how your body tenses or how the bottle feeder responds to them. Take a pause and try again if the bottle feeder or the baby get obviously agitated. Explain to the bottle feeder that this is a time-consuming operation.

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Image via Tracy Islam

How can I (hopefully) keep my kid from refusing to drink from a bottle?

If you intend to return to work, many lactation specialists advise providing the bottle every few days beginning at 2-4 weeks of age. Of course, if breastfeeding is still proving difficult, speak with a lactation specialist first. Be consistent – it may take some time for your infant to become used to the feel and rhythm of a bottle. Bottle feedings should ideally be performed by someone other than the nursing mother. This may be a fantastic way for you and your partner or another family member to bond.
Start with an ounce or two of expressed breastmilk in a bottle with a slow-flow or preemie nipple if feasible. Judy recommends Dr. Brown’s bottles because of their venting mechanism. This helps to keep air out of the milk, preventing gas and making the feeding process run more smoothly. If we don’t have to burp the baby as frequently, there may be less latching on and off. When newborns are habituated to nursing, they often become irritated and lose the more frequent on/off latching with bottles.

You don’t have to give your infant a complete meal; the aim is to get him or her acclimated to the sucking rhythm and nipple feel of a bottle. If you give a bottle every few days, your baby will be more likely to take it in the future.

 

What should I do if my kid refuses to drink from the bottle?

If your infant refuses to drink from a bottle, here are some specific suggestions and items to rule out. You are not required to attempt all of these things! We are merely providing a variety of approaches that may be beneficial.

Don’t forget to pay attention to your baby’s cues.

We don’t want to force a baby to drink from a bottle by holding it in their mouth if they refuse to swallow or are screaming without suckling. If they have milk in their mouth but are not swallowing it properly, it can constitute a safety issue, and they may establish a bad connection with bottles and feeding time. Above all, don’t rush this procedure.

 

Begin with a cheerful infant who isn’t very hungry and is well rested. You can attempt to offer while a baby is just waking up or about to go asleep, because many babies will be eager to suckle and try a bottle at these times.
Remember that a breastfed infant may not understand what a bottle is until they are required to drink from one. Through play and exposure, children learn about new things. Allow your infant to inspect the bottle before filling it with milk. Allow them to touch or hold it first if they are old enough to reach for it. We want kids to associate bottles with good things. It might sometimes beneficial to view and examine it first.
Find a bottle with a longer nipple – no need to buy breast-shaped bottles. A longer nipple will make it simpler for the average newborn to acquire an anterior-posterior suck pattern and get into a suck swallow rhythm. Judy starts with Dr. Brown’s bottles. If that doesn’t work, try experimenting with other bottles and nipple kinds. Just don’t go out and acquire a large collection of bottles. (Believe us, it will be quite expensive and will just add to their tension if they do not drink from them.) Megan spent hundreds of dollars on several specialized bottles, but her baby never drank from any of them.) Some families discover that one kind works best for their breastfeeding child, but your child may be different. Surprisingly, the only bottle nipple Megan’s infants will drink from were made of latex rather than silicone (Playtex brand).
If at all feasible, have a friend or family member — anybody other than the nursing mother – offer the bottle to baby. This can be quite beneficial in the long run since your kid will learn that milk can come from various individuals in a variety of ways.
Because many newborns can detect the difference between fresh and frozen breastmilk, try providing freshly pumped breastmilk.
Begin with modest amounts – even 14 ounces is plenty! To avoid frustration, limit your time to no more than 10 minutes at a time.
Warm the bottle nipple by immersing it in warm water before commencing to feed to simulate the sensation and warmth of a breast. If this doesn’t work, experiment with the bottle and nipple temperature as well. Your infant may prefer the bottle temperature to be somewhat warmer than the breast warmth.
Allow your baby to touch and feel the bottle while they drink from it – discover more about why it’s important to bring their hands to midline here. Attach a hair tie on the bottle to provide a sensory/tactile focus point for their hands to grasp for during a feeding. Babies can sometimes focus better on feeding if their hands are in a midline position, similar to how they may pat the breast when nursing.
Try to support your baby’s feet using your own body, a breast feeding cushion, or a Boppy to give them stability and the sensation that they are properly supported. This is comparable to when your infant first starts eating solids – foot support is critical.
Maintain brief, pleasant, and regular bottle practice sessions.
Use movement to assist your infant self-regulate while feeding, such as a rocking rocker or swaying motion. Some caregivers have reported success with providing the bottle for the first few times while the infant is in the stroller and moving. It is eventually necessary for the bottle feeder to hold your baby as they take the bottle, although doing so might increase their desire to drink from it at initially. Change things around and observe what makes the baby happy.
Experiment with various holding postures. Try putting your infant in a more upright posture, rather than in a nursing position.
Change the setting and the location where you present the bottle. Consider placing a bottle in the vehicle, a bouncy seat, or another area of the home. If the weather permits, go outside. Try introducing some distraction. Show them a book or sit/stand in front of a window to provide a brief diversion while they become acclimated to the bottle. We don’t want to utilize this as a long-term solution since we want your baby to focus on eating during bottle feeds, but it can help your baby forget that they aren’t eating in the way they like. Change up who offers the bottle; this may be a significant tactic that makes the most effect. Sometimes a baby will only drink from a bottle if the mother is not around, while other times they prefer to be near the mother. Experiment with it in various ways.
Some families discover that if a bottle is offered after the pacifier has been removed, the baby is more likely to accept it.
Make certain that the milk you’re providing tastes excellent. Yes, it might include smelling or tasting it! It might taste metallic, soapy, or rotten, and it’s critical to identify the source of the flavor change. Learn more about what causes milk to alter flavor, including elevated lipase levels in your milk, by clicking here.
Even if your baby isn’t taking a bottle at home, try it at daycare or with another caregiver before concluding that it won’t work. Sometimes the baby will hold out for a few hours, but after they realize mom isn’t coming back, they will finally drink the milk.
Experiment with different nipple sizes and flows. Many breastfed babies have a sluggish flow nipple, however this may not be the case for your kid.
If you have an oversupply or a sudden letdown, your baby may become accustomed to milk flowing from the breast. A bottle needs more effort. (This is really the opposite of what happens with most breastfed babies, who require more labor from the breast.) In the event of an overabundance, consider a softer-textured nipple, such as the Como Tomo bottle. A quicker flow nipple is also possible. Again, experiment with different nipple sizes and flows.
Practice, practice, and more practice. This might take some time.

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Image via @caramielle

Despite doing everything mentioned above, my baby still refuses to drink from the bottle. What should I do now?

To begin, keep in mind that there is nothing wrong with you or your baby if they do not take a bottle. It is not a necessary developmental phase. Breastfeeding improves your child’s oral-motor abilities, so don’t worry about them “losing out” developmentally if they don’t take a bottle.

However, this does not make bottle refusal any easier. Here are some alternatives to bottle refusal:

Breastfeed your child immediately before leaving them at daycare or with another caregiver.
During lunch or pump breaks, have someone bring your infant to you – or go to them – if feasible. This is not an option for many mothers, but depending on your job and closeness to your child, some families may be able to do so.
With a baby as young as 4 months, consider using an open cup. For this to be a constant option, baby must have strong head/neck control. For additional information on introducing an open cup to a baby 4 months and older, see the section below on alternate feeding methods.
Once newborns have mastered an open cup, they can go to a straw cup – some babies can accomplish this as early as 5 months of age. More information about training your infant to use a straw cup may be found here.
Babies can begin eating solid meals at the age of six months. When combined with breast milk in cups, adding solid foods and tiny quantities of water in a cup can help keep baby content until mom returns.
When they are separated from their mother, some infants “reverse cycle.” They consume just enough milk to keep them from becoming hungry throughout the day, but they eat considerably more often at night. This works well for some families, especially if mom is able to go to bed early to accommodate less sleep.

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Image via @ashbcoop

Alternative Feeding Mechanisms

If your baby refuses to take a bottle and you need to give them milk in another way, you may need to use additional equipment. Please see a feeding professional or lactation specialist before adopting any of these approaches, especially if your baby has any respiratory or swallowing difficulties. The main issue with this method of feeding is the danger of aspiration if your infant isn’t actively swallowing the milk.

We are merely providing these ways to assist you utilize these tools responsibly and to be aware that they exist. This is not a substitute for medical advice or care. Discuss with your provider which goods and strategies will work best for your infant.
Syringe or dropper:
Place your infant in an upright position on your lap or the lap of another adult. Assure that their head is safely supported and that your hand is softly supporting their chin. Some parents wrap their infants to help them relax.
Fill a dropper or syringe halfway with warm breast milk. Insert the loaded syringe or dropper into your baby’s gum line towards the cheek of his or her mouth. If they can exhibit lip closure around the dropper, it is also feasible to place it in the middle of their mouth. Allow the dropper’s syringe to sit gently on the tongue in this scenario. If this approach causes you to gag, you’ve gone too far back and should attempt into the cheek area or along the gum line.
Squeeze the dropper or syringe gently to deliver a tiny quantity of breast milk into their mouth. Begin with a few drops at a time, enabling your infant to become accustomed to the sensation. They should be able to shut their lips around the syringe or dropper with repetition and will be able to synchronize their swallowing rhythm. You will eventually be able to supply more fluids.
Remove the lid from the cup, dish, or spoon.
As mentioned in our Ultimate Guide to Cup Drinking, we typically advocate introducing an open cup to babies around 6 months when they begin solids. If your breastfed baby refuses bottles, try an open cup, bowl, or spoon as early as 4 months, or when your baby has adequate head and neck control.

Note that spoon feeding colostrum or breast milk is a technique that is occasionally used much earlier than 4 months – lactation professionals sometimes use it in the hospital before a baby has found out how to nurse. These are broad recommendations to assist families whose newborns routinely refuse bottles and are unable to get milk when mom is away, but each baby and circumstance is unique. Cooperate with your service provider.
Place your infant in a standing position.
Warm breast milk should be placed in a dish or cup.
Capture some breastmilk using a spoon if you’re using one.
Tilt the cup or bowl towards your child’s mouth. If you’re using a spoon, bring it up to the baby’s mouth. Place the cup, bowl, or spoon on the outer edge of their upper lip, softly resting it on their bottom lip with the tongue inside the cup, bowl, or spoon. Keep it in this position for the duration of the stream.
Allow your infant to slowly tongue or lap up the milk. They will be able to swallow more and drink more milk with practice.
Allow lots of time to be with your kid while beginning this approach. Try to relax and limit yourself to no more than 20 minutes of practice time. As long as they have sufficient head support, many infants may become excellent open cup/open bowl drinkers. ​

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Image via @ohhappystatons

Can you nurse your child until toddlerhood if he or she refused bottles as an infant?

Yes! Many mothers choose to nurse their children until they are 12 months old. Breastfeeding a bottle-refusing infant might be less difficult at this time since they don’t need to nurse as frequently as they did in infancy. Many mothers eventually discontinue pumping at work and just breastfeed when they are with their child. While in daycare (or while mom is away), baby sips substitute milk from a cup or receives its nourishment from food and water until mum returns.

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Image via Elaine McDonnell

We understand that bottle rejection may be quite stressful, but we hope that these methods can assist you in finding some answers for your family. Soon, your baby will be sipping from a cup and eating like a pro – this is just a matter of time!

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