If you’re reading this, you may have tried more bottles than you can count. Would you be surprised to hear that bottle refusal usually has nothing to do with the actual bottle type or nipple shape? 

Bottle refusal is usually due to a combination of factors. Most often, bottle refusal happens when a breastfed baby older than 2 to 3 months is not used to a bottle (due to it not being offered regularly in the 4-6 weeks of life). Bottle refusal can also happen seemingly out of nowhere, even if your infant was previously taking a bottle on a regular basis with no issue. 

Bottle refusal can be very stressful, especially if you have to be separated from your baby for work. Instead of focusing on the bottle itself, focus on how the bottle is offered. Here are some strategies to try:

• First, let’s start with the basics: When you’re offering the bottle, make sure you’re not placing the nipple onto their tongue. This will initiate the tongue-thrust reflex, which is a protective mechanism to prevent choking. When this reflex is activated, infants will push the tongue (and thus the bottle) out of their mouth, making it seem like they are refusing the bottle. Instead, tickle the bottle nipple to their top lip, wait for them to open wide, bypass the tongue and gently touch the bottle to the roof of their mouth. This will activate the sucking reflex.
• If your baby is consistently refusing the bottle, try frequently, but don’t make each attempt a drawn-out battle. Meaning, try for a few minutes once a day but then move on if it’s not happening. Try with small amounts of breastmilk to avoid wasting too much. If it’s been a huge battle, take a break for a few days and then retry.
• Infants can be particular!  Sometimes having someone other than the breastfeeding parent offer the bottle first can help. Usually in this case mom will need to be out of the house. However, some babies prefer to take the bottle from the breastfeeding parent.  Try both options and see which one your baby prefers.
• Dip the nipple in breast milk.  This will taste familiar and will encourage your baby to open their mouth and accept the nipple.
• If your baby is refusing breastmilk at room temperature, try warming it to body temperature (98°F / 37°C) as this is the temperature of breastmilk when your baby is nursing.  Always test the temperature on your inner wrist prior to offering it to your baby.
• Some infants have no problem going between formula and breastmilk and some do.  If you offer formula and your baby is refusing, try again only this time offer ¾ pumped breastmilk and ¼ formula. Gradually increase the amount of formula as your baby tolerates.  Do not add powdered formula to breastmilk. Prepare the formula first with water as directed, and then combine with breastmilk.
• Use the hug position and/or skin to skin during the feed.  Try to mimic the closeness and secure feelings of breastfeeding by keeping your baby close to you while offering the bottle. To do this, keep your baby upright in the paced feeding position, wrap their arm closest to you under your arm and around your back.  This almost puts them in the belly to belly position that is optimal for breastfeeding.
• If the “hug” position doesn’t work — try movement. Hold your infant upright, and facing away from you (their back to your belly) and use motion (walk them around, bounce on an exercise ball).
• Try offering the bottle while your baby is sleepy — often the middle of the night feed or at the end of a nap works well here.
• Let your baby play with an empty bottle to help them get used to touching it and putting it in their mouth.
• Some infants who refuse a bottle will skip right to a cup.  If your baby is over six months old, you can practice using a straw cup or an open cup.  You may find your baby takes more volume using a straw sippy compared to an open cup (plus it is less messy).  Pro tip: start with a straw cup that has no leak-proof valve when your baby is first learning. The simpler, the better!
• If your baby accepts the bottle initially but then gets frustrated after only drinking a small amount, try a faster flow nipple. They may be used to a quicker let down from you than they are getting with the bottle flow. 
• Try to remain calm when offering the bottle. Babies can sense and absorb our stress. If the feeding adult can stay emotionally regulated, there is more of a chance we will see success.
• Another strategy to try is the “bait and switch”. Set yourself up with your infant like you are going to breastfeed. In the same spot and position as you normally would. Then, offer the bottle instead of the breast. This can work because the baby is primed and mentally ready for feeding. Please note that this is not something to try more than once or twice, as we don’t want to create a feeding aversion.

• You may have heard the advice “if they’re hungry enough, they will drink from the bottle.” However, we do not recommend withholding milk from a hungry infant! If your infant is refusing the but they are due for a feeding, pause a few minutes between trying the bottle and offering the breast. Take a 5-10 minute break by walking the baby around or doing something else they enjoy, then offer the breast. This way the breastfeed is not immediately associated with the bottle refusal.

  If you have tried absolutely everything and nothing is working, and you need your baby to take a bottle because you will be separated from them, they can be fed with syringes or a small open cup. This takes time, but it’s better than nothing! And these are hopefully temporary solutions to employ while your baby learns to accept the bottle. 

  Need more support with feeding challenges? Don’t forget to reach out to us, we’re happy to help!

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