Check out the PedsDocTalk YouTube Video: Pediatrician and Lactation Consultant Shares Bottle Refusal Tips

If you will need to introduce the bottle, you will want to introduce it when your baby still has their primitive suck reflex (before 10 weeks) and ideally 2-4 weeks. Otherwise, introducing the bottle when they are used to the breast can be more difficult. You can be the one to introduce the bottle, however, sometimes baby will associate you with feeding at the breast. So, a partner or another caregiver can help. You can leave the home, but make sure that caregiver understands baby may refuse the bottle and to be patient and consistent with baby.

Note that if you are breastfeeding, the ideal time to introduce a bottle (again, if you will need to) would be before 10 weeks of age. The key is to start early and be consistent.

Tips when introducing the bottle:

• If breastfeeding, working with a lactation consultant can help balance breast and bottle feeding. If solely feeding at breast, introducing the bottle after two weeks and before 4 weeks is ideal if you are planning on pumping milk in future. You can wait, but waiting after 10 weeks can lead to more refusal.
• Sometimes having the alternate caregiver wearing something that smells like you can help.
• Have the caregiver feed in different locations around the house or in different positions. Sometimes they don’t want to be cradled how they are when feeding at the breast.
• Don’t wait until the baby is very hungry (and angry). Try to offer it around normal feeding times or just before their normal feeding time.
• You may need to trial various nipples/bottles. Use this guide as a reference on examples of nipples/bottles to use.
• Dream feedings may be helpful here: offer the bottle when they are drowsy to get them used to the feel of the nipple in their mouth.

Tips for bottle refusal:

• Practice with the nipple, but without the bottle when your newborn is calm and not frustrated. The parent can hold and place the nipple and allow them to open their mouth around it and take it in to get accustomed to sucking the bottle nipple.
• Make sure the milk is their preferred temperature.
• Try different brands and types of bottles. If they take a pacifier, consider a nipple similar to their pacifier.
• Offer the bottle in a calm, quiet, non-stimulating environment. Avoid feelings of pressure and anxiety since they can feel your emotions.
• If breastfeeding, try having someone else offer the bottle to the baby. Sometimes you might have to leave the room or the house completely.
• Lastly, continue offering a bottle and give it time. Keep trying and allow your baby to become familiar with a bottle.

Watch this PedsDocTalk YouTube Video for more tips on navigating bottle refusal!

When to seek out additional help for bottle feeding:

• Difficulties with latching to breast or bottle
• Concern for a tongue tie
• Has a lot of milk dribbling out of the sides of their mouth during feedings. If bottle feeding, you have reduced nipple flow and it’s still an issue
• Concern of poor weight gain
• Consistently coughing or gagging during feeds
• Frequent or large spit up/reflux
• After 3 weeks, takes more than 30 minutes to feed and you have adjusted nipple sizes for your bottle fed baby with no improvement
• Is refusing the bottle even though you know they’re hungry (it’s been more than 4 hours during the day as an example)
• Will only feed when sleepy or drowsy
• Sleep is impacted in that they’re not sleeping stretches and waking up hungry or they’re sleeping a lot and still not interested in feeds
• After 4 weeks, is a grazer and unable to go at least 2 hours between feeds

A newborn and infant feeding specialist may be helpful in these situation to maximize the feeding experience

Be patient and consistent: Many times our stress and fear of bottle refusal is a vicious cycle that leads to more stress around feeding times and more refusal. It’s often about bringing joy back into the process versus pressure for your baby. Being relaxed, being patient, and giving them a break and trying again later after connecting with them.

Watch the PedsDocTalk YouTube Video HERE!