Bottle refusal – advice – what does science have to say?

Bottle refusal in breastfed babies – what to do?

We all know that breastfeeding is considered the best way to feed our babies and the messaging we receive from the hospital staff, most lactation consultants and midwives is to delay the introduction of a bottle for as long as possible to avoid creating nipple confusion and causing problems with breastfeeding.

Interestingly research has looked at breast and bottle feeding and seen there are big differences in the mechanisms behind these feeding methods. Breastfed babies need a wide-open mouth, and bottle fed babies a pursed mouth. There is also the difference of a vacuum being created with breastfeeding vs compression action in bottle feeding.

These differences in feeding are essentially what lactation consultants mean when they say nipple confusion. The worry is the babies will be confused with how to feed at the breast after experiencing the bottle.

Yet Moral et all found in 2010 that babies easily adapt between different sucking mechanisms. Perhaps bottle preference in breastfed babies when offered both is more to do with how easily available the milk is from a bottle, and the perceived ease of bottle feeding by a mother struggling with breastfeeding. Hence the advice to wait until breastfeeding is well established before trying a bottle.

But what about those people who know from the beginning they want their baby to take a bottle and breastfeed.

Maybe you want to mix feed, or maybe you just want your baby to take a bottle of expressed milk, what options do you have, and what steps do you need to consider to avoid bottle refusal?

Due to baby friendly hospital initiatives and breastfeeding targets, health professionals can only advise to introduce a bottle once breastfeeding is established, yet this “established” for some people could be 2 weeks, others it could be 12 weeks! The reason for this is, introduction of a bottle is casually linked to a short breastfeeding duration, although this is more closely linked to formula, not EBM.

But it is important to note this is not necessarily the bottle made the babies quit breastfeeding, as data collected isn’t distinguishing from mothers who were struggling to breastfeed and thus they introduced a bottle. They may have already been on the path to quitting breastfeeding. Or mothers who hated the breastfeeding experience, and again, already had the agenda of quitting. Or mothers going back to work full time who didn’t want to pump. This data is all collected together.

A recent study in the UK of over 800 mothers experiencing bottle refusal found that the babies who were offered the bottle more frequently did eventually take the bottle compared to those who infrequently were offered it. This was particularly true for the mothers wanting to discontinue breastfeeding.

This indicates that while there is a big list of things people try to help a baby take a bottle, the most boring answer might just be time and consistency.

Some of the tricks parents tried to get their baby to take a bottle in this 2020 study.

  • Partner or family member try the bottle
  • Cold turkey
  • Trying different teats and bottles
  • Using expressed milk in the bottle
  • Used a cup
  • Only offered the bottle when the baby was hungry
  • Tried different formulas and different temperatures

The other important aspect to come out of this study was normalizing how many breastfed babies refused to take a bottle! In this study over 61% were refusing the bottle at the time of the questionnaire. As soon as we normalize something we take away a little of the stress for mothers which is a great thing!

There are options too. If your baby is refusing the potte and you are sick or its an emergcnecy and wont be able to breast feed… you have options.

Cup feeding, finger feeding, syringe feeding, straws and soon feeding all have potential… although time consuming, there is potential.

Lots of experienced mothers will tell you to introduce the bottle early and often if you want your baby to take a bottle. But this study of babies refusing to take a bottle showed an average age to introduce the bottle was 8 weeks, yet it took 9 weeks of trying for the baby to eventually take the bottle. Yet the babies who were introduced a bottle at 12 weeks took a shorter amount of time to accept the bottle.

The alternative to having a breastfed baby having to accept a bottle, is to mix feed from the beginning, but this relies to your baby switching feeding mechanisms frequently, and without confusion resulting in a bad breastfeeding experience. Which is not guaranteed or even recommended!

Here’s what the community on Instagram had to say…

“Took me 5 days of cold turkey offering breastmilk in a bottle before he took it. He was 6 months, so still had food and water.”

Sounds like this mum was pumping too. So combined with the water, she was addressing the risk of mastitis for her, and the risk of dehydration for baby. 2 important considerations with cold turkey.

“Introduced at 3 months, didn’t take it, only getting baby onto one now at 6 months.”

“Just like the happy cot, pretend to be happy when giving it.”

Great tip! Feeding your baby a positive emotion (even if we are pretending and hiding our apprehension), will tell your baby the bottle is a positive experience, not a negative one. Great tip!

“Newborn took one at 2 weeks, wish we continued because they refused from 3-5 months.”

It does seem like offering one frequently – almost daily might be the key here!

“Refused a bottle until started solids, once solids started, happy drank a bottle.”

I wonder if this is due to an acceptance of more foresign feeling things in their mouth with the start of solids. Spoons, food, sippy cups.

“Took away the dummy at 4 months, and she reused the bottle ever since. Now 7 months, not ideal!”

Seems like their was a bit of an association between these two teats. I do find if your baby takes a dummy you can slip the dummy out and a bottle in with a bit of success when trying to teach a baby to take a bottle. I hook the dummy around my little finger which is holding the bottle, so the switch is fast and one handed!

“1st baby I introduced at 8 weeks, no problems, 2nd baby at 6 months, huge problems!”

There goes the solids theory!

“Started with breast milk and then transitioned to formula (that was a whole other battle). Began by latching onto the breast and then quickly slipping bottle and sitting up. (like my dummy trick above!). Eventually just laying her next to the breast and she would latch onto the bottle good as gold!”

“We tried 9 different brands. Pigeon is the winner thus far… until the next bottle strike.”

I wonder if this bottle strike is linked to baby needing a faster flowing teat? Don’t forget to change teats as your baby gets older.

“Changing from a wide teat to lansinoh was a massive game changer, and perseverance.”

Julia Daly from More Then Milk, also recommend the narrow long teats over the wide neck ones.

“Introduced a bottle around 3 weeks, then got mastitis about week 4, and she has refused a bottle ever since.”

Ouch!

“Started at 4 weeks, baby was 5 months and has 1 bottle a day. Only problem is that he doesn’t take the bottle from dad.”

This is so common!!! Just like sleep associations, babies develop feeding associations. So the advice to have someone else try the bottle isn’t the best advice as your baby probably associated feeding with you! I had 3 babies eventually all bottle fed after a period of breastfeeding, and I learned by baby number 3 to share the bottle feeding around from the start, or I would be stuck doing all the feeds again.

“3 months old will not take bottles so I have to exclusively breastfeed day and night. =( “

This is a common theme, that bottle refusal actually is linked to negative breastfeeding experience. I guess it can feel draining, and like you are trapped with no options for a break, and then we link that back to the breastfeeding.

Interestingly, we often have clients wanting to quit breastfeeding and sleep train. We don’t recommend this, we sleep train then they can address the feeding. But we tell them, you will probably feel differently about breastfeeding when your baby is sleeping through the night and you don’t have to feed to sleep anymore. Usually, they feel a lot more positive! This is in babies much older than 3 months though, sorry!

“Introduced at 8 months, Dad only gives bottles when I am on shift. Stayed on stage 1 because he likes it. “

“Gave baby bottle at 3 weeks old, is mixed fed and does fine on both.”

There’s that baby mastering both mechanical mechanisms for feeding with no confusion. Awesome!!!

“Took it as a newborn, refused around 4 months. Took 6-8 weeks offering every day, 3 bottles types to get her back to taking it.”

That looks similar to the time it took in the study! I think if you have to go back to work and baby has to take a bottle, you might want to try a bottle sooner than we probably though we needed to!

“Introduced a bottle at 1 months old and she takes a bottle or breast with no issues now can swap it up.”

“Started with a bottle from birth to 2 months, then breastfed and at 3 months they refused the bottle..”

“Bought so many bottles, persevered until got there with maam bottles”

“ 5 months is mixed fed, strong preference to breastfeeding, will take a bottle from me but Dad was away traveling at 3 months and now wont feed for anyone but me.”

“Refused until 6 months, and now can handle the odd bottle in the day but not at bed time! Also he would only take the bottle it was me feeding and it was placed directly beside the nipple.”

What did I tell you! A feeding association too! Babies are so clever.

“A friend had issues introducing at 6 months, then served milk warmer than recommended and had success.”

“3 weeks, first feed of the day to ensure hunger was enough to take it, and it was pumped milk. Less refusal if I didn’t do it was not done at home.”

“My son is now 5 months but has been having the off expressed bottle since he was 4 weeks old. I think having already taken to a dummy made it easier to introduce a bottle to my baby.”

This is definitely a theme!

“I am a breastfeeding mumma, but gave my baby a bottle of expressed milk at least once every few days (even if it was only 20ml), just so he was comfortable with alternatives. It honestly made me feel quite comforted and like a load of pressure was off, just knowing he would take a bottle if anything happened to me, he would be sweet.”

This is great advice! Often mums don’t realise they could pump and feed immediately, so no change to breast milk demand, no need to build a stash or anything.

“We went through a stage of bottle refusal when figuring out baby had a cows milk protein allergy. It was tough!”

This is so tough, and can lead to full on feeding aversion! You did well to get them back to feeding.

“Turns out my baby wont drink my frozen breastmilk, it wasn’t the bottles!”

Yes I have heard this, that the taste can change when frozen!

“when they were old enough to drink water from a sippy straw cup, gave them milk in that instead.”

“Will only take a bottle from my husband.. and only sometimes.”

“Need this! Tried 8 different bottles, no luck so far. Will put it in mouth but wont latch.”

See the notes above on feeding mechanisms, totally different bottle vs breast, so it is something they have to learn.

“All of a sudden screaming when eating, wont finish full feed. 4 months old, bottle refusal or teething.”

This is often not hungry! Especially if there are 2-3 night feeds. Then they don’t finish a day bottle, so we offer more frequently, they get annoyed and scream…. Vicious cycle. Try 3.5-4 hourly day feeds instead.

Ok that’s a lot of advice and experience. Hopefully something here is helpful. Feel free to comment below with any other bits of advice for mums experiencing bottle refusal. The scientific community doesn’t have a consensus on this yet!

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