Introducing the bottle….and when it gets refused!

I hear there are babies that seamlessly transition from boob to bottle and back without the bat of an eye. I know nothing of these alleged babies. I dealt with bottle refusal with both of my kids!  As a working mom, or just a mom that needs/wants to be able to be away from her baby at times, this can be both problematic and very stressful!

Pretty much any lactation consultant that you talk to will tell you to hold off on introducing a bottle (or pacifier) until breastfeeding is “well established”.  This is both important to establish a good milk supply, but also to not create nipple confusion. In general, it is recommended to wait about a month.

My son probably had every breastfeeding struggle in the book. Bad latch. Weak sucking. Reflux. Hindmilk/foremilk imbalance. You name it. It sucked (no pun intended). I met with our local lactation consultant weekly for the first few weeks. The best advice that I was ever given regarding breastfeeding struggles was to not quit on a bad day and to give it 6 weeks. Ironically, we struggled early on over everything and ultimately he became a boob loving bottle snob.


Once we had the breastfeeding thing down my husband and I decided it was time to introduce the bottle. Here are some basic tips for that first bottle for a breastfed baby:

-Use a bottle that best mimics breastfeeding. I personally tried Tommee Tippee, Dr. Browns, and Latch by Munchkin. Some babies have no preference and some will be very particular. This could be a trial and error situation.

– Use the slowest flow, or stage 1 nipple. Baby can easily choke on a faster flow nipple which can also lead to bottle aversion. This also gives baby control over how fast they eat.

-Only offer a small amount. Remember, babies tummies are very small and most will not be taking more than 2-4 oz at around a month old. Plus, nobody wants to waste perfectly good liquid gold!!

-Let dad or another family member offer the bottle. Babies can actually smell their mother’s from up to 20 feet away! Don’t underestimate the baby that knows the food source is just as close as this artificial bottle you’re trying to offer! Leave the house if you can!

-Avoid “nursing positions”. Create a different association with the bottle. Have the person offering the bottle prop them up in front of them or in a bouncer seat, bumbo, or high chair.  Many babies associate the cradle nursing positions to be only for nursing and may protest a bottle in this position.

-Avoid normal nursing locations. If you always nurse your baby in a certain chair or room, offer the bottle in a completely different location.

-Offer the bottle when baby is demonstrating hunger cues, not when they are screaming in hunger. Do NOT force them to take the bottle!

-Don’t offer the first bottle in the evening. This is naturally a fussier time of day for babies and when nursing is often more for comfort than for food. Offer a bottle in the morning or during the day when baby is happiest and more likely to accept the bottle.

Hopefully you have a rock star baby, you follow all these tips, baby takes the bottle like a champ and that’s it!

OR you could be like my son, take a bottle perfectly for about 2 months and then all of a sudden adamantly refuse it!

OR you could be like my daughter, take a bottle perfectly for about 2 months and then adamantly refuse it for about 2 months then go back to taking one!

So what’s a mom to do??

First, lets look at possible reasons why babies refuse to take a bottle…

Around 2 months old babies become more self-aware. In turn, they gain the ability to choose how they want to be fed. Changes in routine affect babies as well. Nursing is just as much about feeding as it is comfort.  Both my children refused the bottle when my husband had to be away for work for an extended period of time.  Sometimes bottle refusal is short-lived and is just a passing phase. This was the case for my daughter. Once my husband was around again, she went back to taking  a bottle. I was not so lucky with my son.

Here are some trouble shooting tips for when you have tried the already mentioned ones and baby still refuses to take a bottle:

-Try different bottles and nipples.  Borrow different bottles from friends if you need to so that you’re not buying a bunch of different ones. Try different nipple flows. When you introduce a bottle you always start with the slowest flow but as baby gets older they may only take a bottle if it has a faster flow.

-Try different temperatures of breast milk. It’s obviously extremely hard to get that perfect 98.6 degree straight from the boob temperature in a bottle warmer so offer bottles warmed, room temperature or even cold. My son ultimately only drank cold breast milk while I was at work.

-Try a cup. Some babies just do not want another type of nipple. My son started drinking from a straw cup at around 4 months old and drank from a cup while I was at work instead of a bottle. This is perfectly fine! Babies don’t have to take a bottle as long as they’re getting the nutrition they need! This is a good straw cup trainer:

These work by squeezing the cup while baby sucks on the straw. With consistent practice the magical moment occurs when baby sucks simultaneously as you squeeze and the light bulb goes off how to drink from a straw. Straws, pacifiers, bottles, and sippy cups all require different sucking patterns/muscles which is good for oral motor development but also why some babies have preference to what they take.

Sippy cups are also an option but require both a different sucking pattern and head tilt so can actually be a little more difficult to learn from.  I recently found this training sippy cup that my daughter has been using and I like it because it mimics the bottle she uses which mimics breastfeeding.

-Offer something different in the bottle or cup! At 4 months it is ok to offer baby a small amount of diluted juice. Just make sure it’s 100% juice and mix it with equal parts of water. Something different can spark interest in the bottle or cup and can help get them used to it before you offer breast milk in it.  If you try this option do it in between feedings during play time. Make it a fun “treat” to get a cup or bottle.

-Try combinations of fresh breast milk, frozen breast milk, or a combination. Freezing, defrosting, and reheating breast milk can all alter the taste of it. Experiment with how you offer fresh versus frozen.

-If your baby successfully takes an ounce or two of breast milk from a cup or bottle don’t automatically offer the breast. Try to just continue with your normal routine. If they’re still hungry, they’ll make up for it at their next feeding. Again, don’t underestimate how smart babies are! Once they have that self-awareness they will learn quickly that if they refuse the bottle or cup and you offer the breast they’re getting what they want! Yes, this is a controversial point to make as many would argue to feed the baby if they are hungry.  Others would also argue that it could backfire and cause baby to refuse the breast! This is definitely a suggestion to take with a grain of salt! My point being, baby has to learn to take something other than the breast. Most moms have also heard at some point or another that when a baby is hungry, they will eat.

Unfortunately, this process can be a long one. It can also change as your baby grows. Patience, as with every other aspect of parenting, is the key to success.  For my son, he ended up only taking cold breast milk from a straw cup and only about 4 oz while I worked or had to be away. Less than ideal for sure but it worked for us. Trial and error, and the help of other family members, friends, or daycare providers will help you find the solution that everyone is happy with.

Good luck!!

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