What to Do When Baby Refuses a Bottle

Breastfeeding moms are typically well aware of the risk of "nipple confusion," which sometimes occurs when breastfed babies are introduced to a bottle or pacifier and then reject the breast. What is not so widely known is that sometimes the reverse can happen – when babies refuse to eat from anything other than the breast. For some families, this is no big deal and poses no problems. But for those going back to work, or those who simply would like the peace of mind knowing they can spend a few hours away from baby, it can feel like a really big problem.

The non-breastfeeding parent is often the one left to struggle with a screaming, hungry baby whom they are unable to comfort. There is nothing that leaves a parent feeling more helpless and diminishes their sense of competence than being unable to provide food and comfort to their baby. It's an awful feeling, and can easily take one down a really dark road of frustration, resentment and blame.

So what's a family to do? Before I provide a listing of suggestions, let me first say that some of these are contradictory to each other. Babies are people, and not all things work the same for all people, so look over these ideas, and see if any match the little person you're trying to feed. As frustrating as it may feel, try to hang in there, offering baby a bottle one feeding per day. If baby is very fussy or frustrated stop, try again later of another day.

• Try offering the bottle when your baby is at their best. For many, this is the mid- morning feed and for many, it is not the end of the day bewitching hour (between 5:00 - 8:00 pm). Time it according to when your baby is happiest. Also try to catch the early feeding cues and offering the bottle then instead of waiting until baby is frantically hungry.
• For some babies, it works better if the person offering the bottle isn't the breastfeeding parent, for other babies it's the exact opposite.
• Feeding involves more than just satisfying hunger. It is an interactive experience involving touch and eye contact. Try offering the bottle, having baby skin to skin.
• Warm the bottle nipple by running under warm water, and then gently stoke baby's lips with the nipple from top to bottom to illicit the rooting reflex.
• Nipples that seem to work best are those with a wide base that slope gradually toward a short nipple. Start with a slow flow nipple, made of soft, easily compressible material such as silicone (to protect baby from latex allergens).

Some babies, despite your best efforts continue to refuse a bottle, and another option to try is cup feeding:

• Use a small cup (shot-glass size) that holds just 1 or 2 ounces of human milk or formula. Cups made of flexible plastic allow you to bend the cup into a spout shape. You can use a small cup that you may already have in your home or purchase cups made especially for infant feeding.
• Fill the cup at least half full with the supplement. Fill several cups so you don't have to interrupt the rhythm of the feed to refill the cup.
• Tuck a cloth diaper or small towel under baby's chin to absorb drips, or use an absorbent bib. You might want to swaddle baby in a receiving blanket to keep their hands out of the way.
• Hold baby on you lap in an upright supported position.
• Hold the cup to baby's lips and tilt it until the milk just reaches lips.
• Be patient. Allow baby to lap up the milk and swallow at their own pace. Don't pour the milk into baby's mouth; they may sputter and choke. Let baby set the pace, and let them decide when they're finished.

Hang in there, and keep your pediatrician informed if you are not progressing in either bottle or cup feeding to determine if a referral to a feeding specialist is a necessary next step.