There is a phenomenon that occurs with some breastfed babies that many parents and some health care professionals are unaware of.  This phenomenon occurs when the successfully breastfeeding baby who is nursing and gaining weight well, refuses to accept the bottle.  This unfortunately seems to occur when the baby is around 3 months of age and often coincides with the time when new mother’s need to return to work, and their babies will need to be bottle-fed by other caregivers. There is nothing more stressful to a new mother than being back at work for the first time and worrying whether their baby will accept the bottle. This stress can also negatively impact the mother’s milk supply, especially when she is pumping and attempting to maintain her supply during her workday. Lactation consultants often get frantic phone calls from distressed mothers asking what to do. 

Why does this occur?

Unfortunately, we never know which babies will be the ones that refuse to accept the bottle. Some babies have no difficulty transitioning back and forth between breast and bottle.  Other babies will fight it and outright refuse to accept it, sometimes never accepting a bottle at all.  It’s important to realize that breastfeeding is more difficult than bottle-feeding. If a baby can breastfeed, they can most certainly take the bottle.  Very often, when new parents attempt to give the bottle to their babies, they present it early on in the first month. If the baby accepts the bottle well, most parents feel they are “in the clear” and many times don’t even attempt to present the bottle again until it becomes necessary, e.g. the week prior to the mother starting back to work.  Young babies, under 3 months of age, are pretty flexible in accepting the bottle, however, as they get older and more accustomed to breastfeeding, they  may refuse it. This is not a result of lack of ability on the part of the baby.  It’s the result of behavior and a preference not to. It occurs as a result of the suck reflex becoming integrated and voluntary, resulting in the baby deciding not to accept the bottle. It is important to remember that breastfeeding is the biological norm. If an older and wiser baby becomes accustomed to the warmth of the mom’s breast and is comforted by being held and nursed, they often prefer this to accepting the bottle. Some babies may never accept the bottle and begin to do reverse-cycle nursing.  This is when they sleep during the day and then are up during the night so that they can breastfeed.   Most parents in a panic and effort to get their baby to accept the bottle before the dreaded return to work, will try every bottle system available on the market, thinking one certain bottle will magically make the baby accept a bottle-feeding.  They become frustrated, panicked and distraught seeking help from their pediatricians, family, friends and lactation consultants.

What to do to prevent your baby from refusing the bottle?

 Make sure that when your baby is between two to four weeks of age, that you introduce the bottle every few days, so the baby becomes accustomed to the artificial nipple. Someone other than the breastfeeding mother should feed the baby the bottle.  Present small amounts of expressed breast milk every few days from the bottle.  You don’t need to give a full feeding and can give as little as a ¼ to a ½ an ounce. Your goal is to get the baby accustomed to the artificial nipple, not to give a complete feeding. This is an especially important thing to do if you know you will be returning to work.  While this doesn’t assure that your baby won’t refuse the bottle, it may serve as a preventative measure. 

What to do with babies who refuse the bottle?

• Stick with one bottle system
• Have someone other than the breastfeeding mother give the bottle
• Start with small amounts of ¼ to a ½ an ounce
• Warm the bottle nipple in warm water prior to the feeding to mimic the warmth of the breast nipple
• Nurse the baby briefly to satiate hunger and then attempt the bottle (Don’t attempt the bottle with a starving baby!)
• Use alternative measures such as, a syringe, Hazelbaker finger feeder, cut-out cups, Haaka dispensing spoon, medicine cups, etc.  (Cup feeding for babies should be taught to you by a professional and it might be best to have the baby seated in a angled bouncy seat) (See links below)
• Walk around while bottle-feeding the baby, and attempt to distract them by looking at something colorful or interesting
• Allow the baby to hold and play with the bottle so it becomes more familiar to them
• Keep bottle-feeding attempts short
• Be patient and persistent

If your baby refuses to accept a bottle, despite persistence in presenting bottles, there are ways to “get around it.”  Some mothers will nurse their babies before they arrive at daycare or before their caregiver arrives.  Mothers can also nurse their babies during breaks or lunch hours, if they are in close proximity to where the baby is cared for.  Also, caregivers can learn the alternative measures to get milk into your baby, until they are ready to accept solid food feedings at age six months.  Mothers who want to go out for an evening with their spouse, can nurse their baby before they go to bed, and then leave for the evening, once their baby is sleeping through the night. While a baby who refuses to accept a bottle can create stress for mothers and caregivers, there are ways to work through it. 

References:

Maxwell, Clare, et al. “UK Mothers’ Experiences of Bottle Refusal by Their Breastfed Baby. ”Maternal & Child Nutrition​, vol. 16, no. 4, 2020, doi:10.1111/mcn.13047.

Peterson, Amy, and Mindy Harmer. Balancing Breast and Bottle: Reaching Your Breastfeeding Goals​. Hale Pub., 2010