Many parents use bottles at some point, whether just for the occasional night out or because they will be returning to work, and send their pumped milk bottles for the caregiver to feed the baby. But what do you do if your baby refuses to take the bottle? Have you tried to give your baby a bottle, and they are just not having it? Getting your baby used to a bottle can be very stressful when they refuse. Don’t worry; there are strategies to help you when your baby has bottle refusal. Also, remember that what your baby does or doesn’t do gives you clues into how well they are able to feed and challenges with it. (3) It can take some experimenting and diving deeper looking into why they are having a hard time, but when you uncover the why, it often holds the solution for how to help them.

Babies use different muscles when they nurse compared to how they drink from a bottle.

• For nursing, a baby opens their mouth wide with their tongue coming out over the bottom gum line and the tongue draws the nipple and a portion of the areola tissue into their mouth. Their lips flange and form a seal on the breast. The tongue needs to be able to remain extended, cup the breast tissue and move in a wave like motion to move milk from further back in the ducts towards the nipple as well as help create suction.
• At the bottle, a baby uses their tongue in a different way which helps control the flow of milk. Instead of a wave-like motion, we see a movement more like a piston firing forward and back with the back of the tongue rising and thrusting forward.(1)

• Bottle nipples differ in shape, flow and firmness. Choose a bottle nipple that supports your baby’s oral abilities.
• Use a slow flow nipple. There is no need to graduate to a faster flow nipple as our baby gets older.
• A nipple that has a gradual slope from nipple to the shoulder base allows your baby to have a wider latch at the bottle instead of pursed lips used with a shallow latch
• Do not fall for marketing of “closest to breast” labels on the bottle packages.
• Do start with the bottle touching your baby’s chin before their lips. This supports them opening their mouth wide rather than slurp the nipple in or feel like it is being pushed in their mouth.
• Give your baby a teether to use in between nursing or trying the bottle. It helps strengthen their tongue muscles. They will use their tongue in different ways like moving it side to side, sticking their tongue out and pushing against parts of the toy.

• Let your baby play with the empty bottle. Forcing the bottle will likely only cause more refusal and aversion. We can do this on their time and allow them to get comfortable so they are bottle feeding champions.
• Only offer the bottle when your baby is calm and relaxed. None of us are good at learning something new when we are upset or feel stressed out. The time to try to get your baby comfortable with the bottle is not when they are already hungry and ready to feed or crying. Bottle practice will lead to success when your baby is happy and already content.
• Do a taste test - If you are giving your baby stored breast milk, try it and see how it tastes. Some people find that they have high lipase. Lipase is an enzyme in your milk that helps break down fats. In breast milk with high lipase, this process is sped up and it can make your milk taste different. It can taste soapy or metallic. Reducing the amount of light exposure to your stored milk may reduce the effects of high lipase. Milk that tastes more rancid after being frozen because of chemical oxidation during the breakdown of fat can be reduced by using milk stored less than 7 days in the freezer.(4) Diet can affect your lipase status.
• Movement is your friend - babies love movement. They learn while moving and it can help calm you and your baby down. Try wearing them in a carrier or sitting on a yoga ball while offering the bottle.
• Distraction - play with your baby using toys and other distracting objects and then place the bottle near their mouth. Not having the bottle be the only focus can help divert their attention from just the bottle and they may be more receptive to taking the bottle.
• A method used by Katherine Morrison, IBCLC of Atlanta Lactation can work wonders for babies who are really resistant. Sit in an office chair with wheels and your baby on your lap. Begin spinning the chair. As you spin, offer the bottle. It distracts your baby and works when nothing else seems to.
• Offer the bottle part way through a breastfeeding session. This is a bait and switch method. Be ready and be quick. Babies are super smart and if there is too long of a pause, they will catch on to your trick and not take the bottle.
• Offer the bottle when they are sleepy or in the middle of the night when they would dreamfeed. Watch for early cues of your baby licking their lips, turning their head side to side and putting their hands to their mouth. They may still have their eyes closed and will still be relaxed and calm, which is a good time to try offering a bottle.
• It is ok for you or other people to give your baby a bottle. Some babies will have a harder time when their mother tries to offer a bottle, but others will not show a preference between who is trying to give them a bottle.
• Temperature of your milk - try giving your baby your milk at different temperatures. Some babies prefer milk warm while others may be more receptive to taking milk in a bottle when it is room temperature or cool.
• Dip the bottle nipple in your warmed milk. Let them smell and be able to taste the drop of familiar warm, nourishing milk on the tip of the bottle nipple.
• Is your baby teething? They might like the bottle nipple to be colder to help ease and comfort their sore gums as they take the bottle.

• Start with just a small amount of milk in the bottle - an ounce at first, and then you can give more next time.

• Celebrate success - any step towards being more comfortable and accepting of the bottle, even if there is no milk in it yet, deserves to be celebrated. It is hard work, and you are both figuring it out.
• Ask your baby to take a bottle by following the same reflexes they use for breastfeeding. Start by placing the bottle nipple base on the chin, and when they open their mouth, the bottle can be brought into their mouth. It will be horizontal to the floor with milk in the tip of the nipple but not filling the entire nipple.
• Feed using paced side-lying feeding - this gives your baby the most control over feeding at the bottle. (2)
• If your baby is 4 months or older and bottle feeding is still challenging, consider trying a cup or straw cup, like the Honey Bear, to give milk. Instead of a sippy cup, an open cup can be used, supporting proper tongue posture and swallowing. Start with a small heavy-bottomed cup (think shot glass) and fill it with your milk. When the cup has less milk, it is more likely to spill because it needs to be tipped further for the milk to reach their mouth. When the cup is more full, they do not need to tip it very much at first to get milk.
• Patience and practice make perfect. If your baby has been refusing the bottle, getting comfortable and accepting the bottle won’t happen overnight. Practice at least once per day around the same time each day. Being consistent helps.

If your baby still has difficulty taking a bottle after trying these strategies, more may be going on. Get in touch with your IBCLC (International Board Certified Lactation Consultant) to take a deeper look at what the root of the issue may be. They can also help co-create a care plan specifically for your baby, their feeding needs, and your goals.

Bottle refusal can be a challenging situation for both parents and babies. Understanding the differences between breastfeeding and bottle feeding can help bridge the gap and make the transition smoother. By implementing strategies such as choosing the right bottle nipple, offering the bottle at the right time, using distractions, and practicing patience, parents can help their baby become more comfortable with bottle feeding. However, if the problem persists, it is advisable to seek assistance from an IBCLC who can provide further guidance and support tailored to your baby's specific needs and feeding goals. Remember, with time, patience, and persistence, your baby can overcome bottle refusal.

1. https://www.brianpalmerdds.com/bfeed_oralcavity.htm
2. https://pubmed.ncbi.nlm.nih.gov/31280248/
3. https://tonguetieal.com/does-a-lip-tie-or-tongue-tie-affect-bottle-feeding/
4. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5833047/

https://www.facebook.com/groups/2725880074090272/search/?q=bottle%20refusal

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC2684040/

https://shaker4swallowingandfeeding.com/2012/07/05/q-a-time-sidelying-position-technique/

https://kellymom.com/bf/pumpingmoms/milkstorage/lipase-expressedmilk/