Overcoming Bottle Refusal

Bottle refusal is so stressful. It can happen for a lot of different reasons. It’s important to determine the cause of the refusal, in order to find the correct solution, here are some strategies to try. I highly recommend getting help for bottle refusal in order to avoid further feeding challenges.

Causes of bottle refusal:

  • baby has been exclusively breastfed and hasn’t figured out the mechanics of feeding from a bottle

  • not enough practice

  • a missed window of opportunity

  • oral motor dysfunction

  • tongue tie

  • pressured feedings

  • oral trauma

  • taste

What to do if your baby won’t take a bottle?

The solution to bottle refusal is going to differ based on the cause of the refusal. If your newborn is not taking a bottle, they may need help learning the mechanics of bottle feeding. I recommend introducing a bottle at 4-6 weeks, especially if you plan on being away from the baby for any significant amount of time. If you know you are going to return to work, it’s important to regularly practice bottle feeds. I recommend doing snack feeds (.5 oz) once a day to get started. Once your baby has gotten used to the bottle you can scale back.

How to Bottle Feed a Baby:

When feeding with a bottle make sure to:

  • choose a slow-flow nipple (this helps to avoid bottle preference)

  • stroke the baby’s lip and wait for them to open its mouth. Never force a bottle into a baby’s mouth

  • pace bottle feed - make sure that the rate is appropriate and that the bottle is held horizontally. There is more info on paced bottle feeding in another post on bottle feeding, see the archive below).

  • make sure the bottle temperature is appropriate (don’t want to scald the baby)

  • give your baby a bottle when they are not too hungry

  • give your baby snack feeds and offer small bottles regularly

  • look out for stress cues

Tips for Bottle Refusal

What to try if you are still having bottle challenges:

  • try different positions for feeding - side-lying is a great alternative position

  • make sure you are pacing feeds - if you see milk leakage, sputtering, or choking, then you likely need to slow your bottle flow down

  • try going outside - babies are often calmed by being outside, this is a great way to help them get regulated for a feed

  • if feeds have been pressured before - then you need to take a responsive feeding approach. I highly recommend getting help from a skilled occupational therapist specializing in infants or a lactation consultant

  • consider if a taste is a factor in refusal - have you recently introduced a new formula or is your baby refusing previously frozen milk? If your baby is refusing previously frozen milk, there is a big chance that you have high lipase and it is affecting the flavor of the milk when defrosted. If you have recently introduced a new formula (like a hydrolyzed formula) know that the taste is different for these. Consult with your doctor or lactation consultant to see if there are alternatives to this formula.

  • try a different shaped nipple - you may want to try a differently shaped nipple, like a pyramidal-shaped one. Often breastfed babies do better with this shape

  • try different temperatures to see if the baby does better - this might mean making a bottle colder or warmer

  • you can also try having the non-lactating parent try the bottle. Sometimes babies feel more comfortable trying a bottle with their lactating parent, but sometimes the non-lactating parent has more success at the beginning.

  • If your baby shows signs of stress, it’s important to stop feeding and not force it

Stress cues

Keep an eye out for stress cues in your baby. The baby may need a break or the feed needs to stop. You never want to pressure a baby to feed because this can cause bottle aversion.

Signs of stress when bottle feeding:

  • Fingers splayed

  • Changes in skin color

  • Wrinkled eyebrows

  • Arching

  • Change in respiration (fast breathing, wheezing)

  • Coughing

  • Pushing the bottle away

  • Crying

Getting Help

Still, having trouble bottle feeding? Reach out for help. Visits are covered through The Lactation Network for many insurance plans. Find out if your are covered!