In the United States, about two-thirds of mothers who have children under three years old are in the workforce. While infants make up a portion of this under-three-year-old set (take a peek at the current breastfeeding rates in the U.S.), I work with many parents who are returning to work after the birth of their baby. Many of them need to provide bottles of expressed breastmilk. And, sometimes, a baby might turn their cute little button noses up at bottles, which can make an already-stressful transition worse. Returning to or entering the workforce after having a baby is stressful enough without worrying if your child will starve while you’re apart.
Folks outside of the U.S. will likely read this and shake their heads sadly and wonder why we need to approach this topic. We could lament the U.S.’s cruddy-slash-nonexistent family leave policies (a totally legitimate complaint). But, sometimes, babies need to be separated from the person who breastfeeds them, and, at least in areas where bottles can be cleaned appropriately, bottles are the most logical and efficient method of feeding. (Note: Of course, babies also occasionally need supplementation or bottles for other reasons, but we’re focusing on “breastfed babies who refuse bottles” here.) Whether or not you feel this should be the scenario doesn’t change that it is.*
30 ml of prevention…
Bottle refusal is most likely to occur in those babies who have been fed only from the breast (i.e., not given bottles) past six weeks of age, or given bottles prior to six weeks of age but not consistently. The primitive sucking reflex weakens over time, reaching total extinction by four months of age. (In my experience, it’s significantly decreased much earlier than that.) You can see the sucking reflex at work when you see a baby latching onto anything—a nipple, a bottle teat, a finger, grandma’s nose.
With that in mind, the recommendation to introduce a bottle around four to six weeks of age makes sense. After this point, it becomes less likely a baby will accept a bottle nipple. My suggestion is that if you will need to introduce a bottle, take advantage of this window of opportunity, offering a bottle of expressed milk every couple of days. It doesn’t have to be a full meal; an ounce will be enough volume to develop the skill with without replacing a feeding.
Some babies accept a bottle without a fuss, even when it’s introduced later than this, but the babies who don’t are so adamant about it that it can save a lot of trouble down the line, hence the recommendation to start early even if your parental leave extends beyond this period.
A lactation consultant’s role in helping with bottlefeeding
I have helped—or have at least attempted to help—quite a few families with bottle refusal. Sometimes there’s success while I’m present; often, there is not. It’s hard to know if it’s persistence or the techniques I suggest that help.
Sometimes assessing a breastfeeding session can give me clues about how a baby prefers to eat, and at times a feeding assessment shows me that there may be issues beyond my scope. If a baby doesn’t breastfeed or bottlefeed well and I’ve exhausted my toolbox, I will refer them to their primary care provider as well as a speech-language pathologist with expertise in infant feeding.
Most of these visits are me throwing out possible solutions and hoping something sticks. Families have often tried a whole lot of things by the time they reach out for professional help, but it’s always possible there’s something that hasn’t been tried or considered. With that in mind, here is…
My non-exhauastive list of suggestions for caregivers of babies having a difficult time taking a bottle
- Try different caregivers. Sometimes a baby won’t take a bottle from its primary food source. Daycare providers have a lot of experience with different babies and may be the best option out of everyone. (But make sure they understand bottlefeeding a breastfed baby.)
- Leave the house. Babies are smart and may hold out for you to feed them directly.
- Try different temperatures: hot, cold, room temperature.
- Try different times of the day and different levels of hunger.
- Taste the milk. Is it sour? Soapy? Maybe it’s been stored too long, wasn’t kept cold, or you have a lipase issue.
- Test out different bottles, different bottle nipple shapes, and different flow rates. Sometimes it helps to attempt to match the flow to the breast “flow”; if you have a fast letdown, a baby may need a faster flow. Try to start with the less-expensive bottles and work your way up, though, as the cost of fancy bottles can add up quickly. Slow-flow nipples are generally the best to start with; there is no standardization, so go with what your baby handles well.
- If your baby reacts to having milk pour into their mouth right when the nipple hits their lips, try holding the bottle upside down (with a cloth to catch drips underneath) until the nipple stops dripping. Then try offering the nipple; as long as the teat’s hold remains covered by milk, it should be harder to extract the milk immediatley.
- Don’t fight it! Keep practice playful and low stress.
- Experiment with different positions: Similar to breastfeeding or as different as possible. Side lying or sitting up. Standing up, bouncing, in the bathtub, in a carrier…
- Offer the bottle before your baby is hungry. Another good time is when your baby is waking up from a nap or otherwise sleepy.
- Bait and switch: Breastfeed for a bit, then encourage baby to latch onto the bottle nipple.
- Adjust the angle of entry of the bottle. Encourage baby to root and open wide. If baby can’t or won’t do that, try slipping the nipple into the side of baby’s mouth, or see if baby likes the nipple up, down, or in the middle of their mouth. (Babies with high palates seem to dislike having the nipple pointed upward when it enters the mouth.)
- Stick a bottle nipple in your bra and use that, or have a caregiver hold a worn-by-you piece of clothing along with your baby.
Sometimes what ends up working is a combination of several of the above.
If you have more suggestions, drop them in the comments!
Alternatives to bottles for those opinionated tykes
None of these are very easy or convenient, and come with their own challenges. Sometimes we do what we gotta do, though.
- For the littlest ones: Feeding with a cup, syringe, or dropper, or finger feeding.
- For babies 4+ months old: Sippy cups with a soft spout.
- For babies 6+ months old: Cups with a straw, or feeding solid food.
- For all babies: Direct breastfeeding when possible (such as visiting baby or having baby brought to you at lunchtime instead of pumping); reverse cycling (increasing intake at night to make up for lack of intake during the day).
Practice and patience are essential. One last point is that most daycare providers are really, really good at things like encouraging babies to eat from a bottle. Sometimes a bit of time with an expert is all your little one needs. There is always stress around transitions, and it may take some time for you to work out what is best for you and your baby. Whether your baby eats well when they’re apart from you, they will want to be close to you at night, and likely want to nurse frequently. Remember, breastfeeding (and bottlefeeding, for that matter) is not just about food, but comfort, connection, and love.
*I felt like making this disclaimer.
