8 Ways to Help a Breastfed Baby Overcome Bottle Refusal with Kristen Manchester, MS, CCC-SLP, CLC
Kristen Manchester, MS, CCC-SLP, CLC of Growing Little Eaters is a licensed pediatric speech-language pathologist and certified lactation counselor specializing in infant and toddler feeding. She has years of experience working both inpatient and outpatient at a children’s hospital.
Bottle refusal in breastfed babies can be very common, but that doesn’t make it any less stressful or frustrating for both you and your baby!
So, why does this happen?
We know that bottle feeding and breast feeding are two very different skills. They differ in:
· Milk flow initiation, control, and speed
· Nipple placement in your baby’s mouth
· Your baby’s lip placement
· Your baby’s tongue movement
We also know that babies are born with a sucking reflex – they reflexively suck on the breast or bottle, which allows them to grow and survive after birth. However, this sucking reflex disappears around 2-4 months of age, at which time sucking becomes something your baby must now do on their own. This means that if your baby has really only learned the skill of breastfeeding in the first few months of their life, it can be challenging for them to learn the new skill of bottle feeding when they no longer have a sucking reflex to help them learn.
So how can we help?
1. Offer a wide base bottle: The wide base bottle will feel more familiar to a breastfed baby who is used to producing a wide latch with breastfeeding. This will also help your baby remember to produce a wide lip opening when they go back to breastfeeding if this is a goal of yours.
2. Offer a (truly!) slow flow nipple: We know that, in general, breastfeeding is slower than bottle feeding. Faster flowing nipples can feel very overwhelming to a breastfed baby and cause refusal. However, use caution! Many bottle systems that are marketed as “slow flow” or “like the breast” actually have VERY fast flow rates. In general, most breastfed mothers’ milk flow rates are similar to a Dr. Brown’s bottle with a preemie nipple or Avent Naturals with a level 0 nipple.
3. Try to offer the bottle EMPTY during non-feeding times: This allows your baby to become more familiar with the bottle and help with acceptance once we fill it with milk.
4. Offer the bottle (with milk) before your baby is due for a feed: Offering a bottle about 1 hour before your baby is due to eat can help ensure they aren’t over hungry while practicing this new skill.
5. Offer to a calm, happy baby: If your baby becomes upset, stop and soothe them. Forcing the bottle or offering when your baby is crying typically makes bottle rejection worse.
6. Offer just the tip of the nipple to your baby’s mouth: Allow your baby to suck on just the tip of the nipple for a few seconds before slowly introducing the rest of the nipple to your baby’s mouth. This helps reduce gagging and overall refusal.
7. If there is another caregiver available, have them try to offer the bottle.
8. Be consistent, calm, and keep trying! While this can be a very frustrating time for both you and your baby, know that consistency is key! Stay calm and keep trying.
9. BONUS TIP: If your baby continues to struggle with bottle acceptance and is 6+ months old, we can also introduce an open cup or a straw cup (if baby about 8 months old).
For additional tips, information, and one-on-one support, visit GrowingLittleEaters.com and follow @growing.little.eaters on Instagram.