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What to do when your baby won’t take a bottle

There are a few keys to how to get a baby to take a bottle. Our pediatric rehab therapist explains.

By Roxanne Voehl, MA, CCC-SLP
February 5, 2019

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When your baby won’t take a bottle, it can be a scary thing. It might feel like stepping out to take some time for yourself – or getting help feeding – can’t happen. It can also make going back to work seem like it will never be possible. Suddenly, you feel trapped. You might start to wonder, “What if my baby never takes a bottle?”

I’ve been helping moms and families go from breastfeeding to bottle feeding for almost a decade. It’s part of my work as a speech therapist at Park Nicollet. You may be thinking, “My baby’s problem is with eating – not talking. What does speech therapy have to do with anything?” And the answer to that thought is a lot! The mouth has to be able to make certain movements to speak as well as to eat, and those movements are very much the same.

I look at the function of your baby’s lips, tongue and jaw to identify the root of the problem that’s keeping them from taking a bottle. I then work with your family to develop and practice exercises to correct that specific issue.

Newborn bottle feeding problems

Not all bottle refusal looks the same. There can be a range of signs that your child is struggling to take a bottle, including:

  • Turning away from the bottle
  • Gagging or fussing as the bottle’s nipple nears their mouth
  • Being unable to latch/compress the bottle’s nipple and express milk
  • Chewing on the bottle’s nipple
  • Sputtering or coughing while feeding
  • Not being able to completely swallow their sip of milk, so that some drips from their mouth

Why do babies have breastfeeding to bottle feeding problems?

I want you to know there’s not a one-size-fits-all answer to this question. But also rest assured that bottle feeding problems are not usually due to abnormal oral motor function. Nor are they usually due to an underlying medical issue. (Yet note that they can be. See below)

For most babies, refusing a bottle simply stems from not being introduced to one early enough in their growth. In fact, the number one mistake families make is offering a bottle too late.

Babies are born with an automatic sucking reflex. But at 2 or 3 months old that reflex becomes voluntary. In effect, that gives babies the ability to turn down a feeding if they’re not comfortable with it.

If a baby hits this stage in their growth and has only fed from their mother’s breast, they will likely have developed a “preference” for that method of milk delivery. They’ve come up with a suck-swallow-breathe pattern that works for them and lets them handle their mother’s milk flow. So when they are given a bottle, they find that the milk flows differently. They have to adapt to a different nipple shape and texture. Plus they need to slightly adjust their posture from what they’re used to. For someone so new to the world, making these kinds of changes can be hard and overwhelming. Hence, the fussing, tears and why your breastfed baby won’t take a bottle.

How to get a baby to take a bottle

The third week after your baby is born, introduce a bottle to them. This is the key to avoiding breastfeeding to bottle feeding problems from the get-go – especially if your baby was born full-term. (If your baby was born more than two weeks early, you can wait a little longer.) Here’s what to do:

  1. Try to persistently offer a bottle at the beginning of all feedings.

    If your baby puts up a fight that lasts a while, it’s okay to give up and breastfeed. In fact, you give your baby the best chance at developing their feeding skills if you regularly switch between bottle and breast in the midst of feedings. But with that said, it’s important to make sure you start with the bottle every time.

  2. Especially push the bottle when your baby is at their hungriest.

    For most babies, this tends to be first thing in the morning at breakfast and then again around dinner time.

  3. Create a relaxing environment each time you offer the bottle.

    Put on soft, calming music – like classical or folk. Sit down someplace where you can gently rock back and forth. And swaddle your baby with their hands near their face. Doing these things will relax your infant – in part because they will also relax you. Children sense and feed off the energy of the adults around them. And it’s no different when you and your baby are adjusting to bottle feeding. If you can be at ease with the varied routine a bottle brings, your baby will be more content with it, too.

  4. Have a family member other than mom offer the bottle whenever possible.

    Each person will hold your baby a little bit differently for feedings. So get your little one used to these differences early. Doing so will help them learn how to adjust their posture so it’s less likely to be an issue when their sucking reflex becomes voluntary in the future.

If your baby won’t take a bottle and is already 2 to 3 months or older, there are still a couple at-home strategies you can try.

  1. Give your baby more practice with a pacifier.

  2. This will help them form and strengthen their sucking.

    • Consistently offer a pacifier to help soothe your baby when they’re fussy, if you’re not already. They’ll learn how to organize their mouth movement, which will simultaneously calm them. Once that becomes routine, begin offering your baby a pacifier for 20 to 30 seconds when you go to make a bottle. Doing so will help them prepare for the bottle feeding attempt calmly.
    • Gently pull on the pacifier as your baby sucks it. Make sure to do this at least 3 to 5 times a day, including when your baby is using the pacifier to prep for a bottle feeding. These slight tugs will help your baby learn how to resist releasing the seal they’ve formed on the pacifier’s nipple. And that can strengthen their latch on a bottle’s nipple, too.
  3. Try giving your baby a different type of bottle.

  4. Sometimes, the solution to bottle feeding problems is as simple as finding the right bottle.

    • Note: There’s a whole slew of different types out there. Choosing from them can be an overwhelming process. Finding the right fit is something a specialist like me can help you with.

If my baby is still not feeding from a bottle, should I be worried?

If you’ve been trying at-home strategies for a few days and your baby doesn’t seem to be getting more comfortable taking a bottle, please connect with a professional!

As I mentioned before, late introduction is not the only reason a baby refuses a bottle. We’ll take a close look at all of your baby’s symptoms and help pinpoint what specific issue(s) your child is facing. I also help families whose babies have:

    Facial or oral structural differences

    The shape or structure of a baby’s cheeks, mouth, tongue or jaw can impact their feedings. That’s because these body parts affect how they’re able to latch both to the bottle as well as to the breast. For example, if a baby has:

    • Thin cheeks with little to no fat pads, it can be hard for them to hold their tongue in place to feed
    • A tongue-tie and/or lip-tie, it can limit their ability to move their tongue from side to side in their mouth and/or past their lower lip to feed
    • A tongue-tie that’s been clipped, it requires them to re-learn how and where to move their tongue to feed
    • A “vaulted” palate so that the roof of their mouth is higher and narrower than the typical flat U-shape, the additional space in their mouth can hinder their lips’ ability to form a tight seal

    Reflux issues

    When a baby has reflux, it causes them to feel discomfort or pain when eating. And that, understandably, will affect feedings. Symptoms that sometimes point to reflux issues include:

    • Arching or stiffening their back when feeding
    • Crying, fussing and getting red or watery eyes while feeding
    • Coughing regularly during feedings, or right after them
    • Refusing to drink, or accepting only 1 ounce of milk or less
    • Falling asleep while feeding
    • Having poor sucking and breathing coordination
    • Taking a long time to eat or drink

    Weak oral muscle tone or lack of oral stimulation

    It’s possible that a baby just doesn’t have the strength to get what they need during a feeding. This could be the case even if they have very normal oral motor actions.

The bottom line on what to do if your baby refuses a bottle and you feel like you’ve tried everything

Give your baby’s doctor a call. Let them know you need extra help. They can refer you to someone like me – a medical professional who specializes in feeding issues.

Looking for feeding help for your baby in the Minneapolis/St. Paul metro area, central Minnesota or western Wisconsin?

If your baby is not feeding from a bottle, my organization has pediatric therapists like me who are available to help. To connect with one of us, first ask a primary care provider for a pediatric rehab referral. Then, make an appointment with us that will work for your family’s schedule:

Our tips to get a baby to take a bottle vary depending on each unique situation. But what stays the same is our commitment to getting every family and baby on their way to success!

About Roxanne Voehl, MA, CCC-SLP

Roxanne Voehl has practiced Speech Language Pathology at Park Nicollet Pediatric Rehab since 2002. As a parent and clinician, she believes early intervention and education can truly make the difference in establishing a healthy foundation for children. Through her role of working together with families to alleviate concerns, improve communication abilities and support children in becoming happy and healthy eaters, Roxanne believes she can help children reach success in their future. Her specialty interest is in infant feeding, preschool stuttering and all areas of speech and language disorders. In her spare time, Roxanne enjoys spending time with her family and friends, traveling, dancing and playing the piano.

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