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

Our pediatric rehab therapist offers some ideas for how to get a baby to take a bottle.

By Roxanne Voehl, MA, CCC-SLP
March 28, 2019

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When your baby won’t take a bottle, it can be a stressful, even scary, thing. Babies are not always on board when transitioning from breast to bottle. Whether you’re going back to work or wanting others to help feed your baby, you might start to wonder, “What if my baby never takes a bottle?”

I’ve been helping moms and families who struggle with the transition to bottles for almost a decade. It’s part of my work as a speech therapist at Park Nicollet. You might think, “My baby’s problem is with eating – not talking. What does speech therapy have to do with that?” The answer could be, a lot!

A baby’s mouth has to be able to make certain movements to speak as well as to eat, and those movements are very much the same. Sometimes the problem is related to those movements. I look at the function of a 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 families 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?

There’s not a one-size-fits-all answer to this question. In most cases, though, bottle feeding problems are not 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 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 to 3 months 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 may have developed a “preference” for that method of milk delivery. Babies establish a suck-swallow-breathe pattern that works for them and lets them handle their mother’s milk flow. When given a bottle, the milk flow is different. A baby has to adapt to a different nipple shape and texture. They also 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

There is an ideal window of time to introduce your baby to a bottle. You want to avoid doing it too late, for the reasons mentioned above. But you also don’t want to do it too early. It’s important to give your baby enough time to get fully comfortable with breastfeeding first, so we usually recommend waiting about 2 to 4 weeks after your baby is born before trying to also bottle feed. Unless they were born early, most babies are ready by then.

Tips to get baby to take a bottle:

  1. Switch back and forth between breast and bottle.

    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.

  2. Try giving the bottle when your baby is waking up.

    No matter the time of day, babies are more likely to take a bottle when they’re just waking up. The instinct to eat takes over when babies are still a little sleepy. Don’t let your baby get overly hungry before feeding. That can result in fussiness and crying (a late feeding cue), and make it harder to initiate feeding either by bottle or breast.

  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. Having a quiet, dark room with few distractions can help too. 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, 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. When your little one can get used to these differences early, it helps 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 few at-home strategies you can try:

Give your baby more practice with a pacifier. 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. This helps your baby learn to organize their mouth movement, which will 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.

Try giving your baby a different type of bottle or nipple. Sometimes, the solution to bottle feeding problems is as simple as finding the right bottle or nipple. There are many different types out there. Trying to figure out the best choice can be an overwhelming process. Finding the right fit is something a specialist can help you with.

What if I try these strategies and my baby is still not feeding from a bottle?

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, call your baby’s doctor.

Late introduction is not the only reason a baby refuses a bottle. As a rehab specialist, I can also take a look at your baby’s symptoms and help pinpoint whether there are any specific issue(s) your child is facing.

Other reasons for a baby not feeding from a bottle can include:

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:

  • Thin cheeks with little to no fat pads makes it hard for a baby to hold their tongue in place to feed
  • A tongue-tie and/or lip-tie can limit a baby’s 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 requires a baby to re-learn how and where to move their tongue to feed and create new muscle memory
  • A “vaulted” palate (where the roof of the mouth is higher and narrower than the typical flat U-shape) causes additional space in a baby’s mouth that can make it harder for their lips 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 may 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

Also know these actions can occur and not be related to reflux. It’s common for babies to have a fussy time of day or be more tired some days than others. If symptoms are ongoing, a baby can be evaluated and treated for reflux.

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. If needed, they can refer you to a medical professional who specializes in feeding issues.

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

If your baby continues to struggle with bottle feeding, our organization has pediatric rehab therapists who are available to help. Ask your baby’s pediatrician or primary care provider for a pediatric rehab referral. And then give us a call to make an appointment:

Our organization also has lactation consultants who can help with bottle feeding issues and provide other breastfeeding support. Check out where you can connect with one of them in these communities and beyond.

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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