Inability to bottle-feed

What if my baby won’t drink from a bottle?

Some babies just won’t drink from a bottle from the first time it is offered or can at one point but then lose the ability. If a baby won’t take the bottle, mothers can try a different bottle or a different type of nipple. They should wait until the baby is calm and try to recreate breastfeeding conditions by using warmed, expressed breast milk and keeping the baby close. Mothers can try letting the baby play with the bottle or feeding in different situations or at different times. It is important to be patient and understand that the baby may not be able to use a bottle.Other options to breastfeeding are finger feeding and lapping or drinking from a cup or spoon. No matter how mothers feed their baby, it is important to ensure that the baby gets enough milk and grows well.

A) Describing babies who cannot bottle

We have seen many breastfeeding babies who either:

  1. Were unable to use a bottle from the first time it was offered, or
  2. Could bottle-feed well during the first few weeks and months after birth but then lost the ability.

One online survey (Maxwell 2020) reported that of babies who couldn't to use a bottle, only about 2 of 5 babies learned to use a bottle and it took an average of 9 weeks to do so.

The survey also found that every method to get a baby to take a bottle had a low success rate.

A small number of babies are physically unable to create suction in the mouth because of a medical problem. They may have an abnormality in their mouth or have a disease that causes muscle weakness. These babies cannot take in milk from the breast or the bottle and will quickly lose weight if not diagnosed. They need immediate attention from a health-care provider.  

B) Try to keep bottle-feeding similar to breastfeeding

When offering the bottle, try to recreate breastfeeding conditions:

  • Use warmed, expressed breast milk.
  • To keep the taste of the milk the same, avoid:
    • Previously frozen milk and milk that has been stored for more than 12 hours in the fridge. It can develop a different smell and taste.
    • Infant formula.
  • Keep the baby close to you to simulate your breastfeeding position.

C) Get the baby used to the bottle

Some babies benefit from feeling the bottle in their hands and mouths:

  • Let the baby play with the bottle and put the nipple in the mouth themselves.
  • Make a game of gently placing the bottle nipple on your finger and moving it over the baby’s gums, tongue, and on the inside of the cheeks.

D) Try different bottle nipples

There are many types of nipples. Some babies will take one but not another. Consider trying nipples with different:

  • Textures (hard or soft)
  • Shapes
  • Lengths
  • Flow rates
  • Materials (latex or silicone)

E) Keep the baby calm and offer the bottle

It is important to keep the baby calm when offering the bottle. Babies will not feed when they are upset. They may also remember being upset, which can make future bottle-feeding attempts even less likely to be successful.

Try bottle-feeding:

  • When the baby is only slightly hungry and not frantic or crying.
  • With the baby indifferent positions.
  • Indifferent situations.
  • While standing and swaying slightly.
  • While humming or quietly singing.
  • When the baby is sleeping or nearly asleep (also known as dream-feeds).
  • When the mother is out of the baby’s sight and another person tries to bottle-feed the baby.

F) Forcing the baby to accept the bottle

This is a much more aggressive approach to getting the baby to take the bottle. It involves the mother leaving the house for a number of hours while another caregiver tries to bottle-feed the baby.

The risk is that the baby goes for an extended period without milk and associates the bottle with being very upset and hungry.

In our clinic, we have heard of this working on the rare occasion but do not endorse it.

G) Feeding a baby who will not take a bottle

It is important to be patient and understand that your baby may not be able to use a bottle. This is not about the baby’s preference or the baby being stubborn. Just as you accept that your baby can’t walk and can’t talk when young, similarly try to accept that right now your baby can’t use a bottle.

1) Other ways to feed babies

Babies who can’t take a bottle can be fed in other ways, including:

If the mother is able to breastfeed, she can use a tube-at-the-breast system.

Some mothers find the baby's inability to bottle particularly challenging when they return to work as other caregivers may be uncomfortable with other feeding tools. 

Some babies respond to their mother’s absence during the day by breastfeeding more frequently at night. This is sometimes called reverse cycling. This may result in the baby needing slightly less milk during the day.

No matter how you decide to feed your baby, it is important to ensure that the baby gets enough milk and grows well.

2) Solid foods

If the baby has started eating solid foods, all the solids for the day can be given while the mother is away. In this way, the amount of milk needed during the day when the mother is away can be slightly reduced.

H) Using practice bottles

Some mothers think they can keep the baby bottle-feeding by giving a daily bottle of expressed breast milk or infant formula. But we have heard from patients that breastfeeding babies can still lose the ability to bottle-feed even if they are given regular “practice” bottles. So practice bottles are no guarantee that the baby will continue to bottle-feed. This was also reported in an online survey (Maxwell 2020).

If mothers choose to use practice bottles, they can give only very small amounts of expressed breast milk in order to minimize the effort of expressing. Ideally, mothers avoid the use of infant formula because even small amounts of infant formula have risks and can be expensive. If using water for practice bottles, the amount should be very small as there is no nutrition in water.

References

Maxwell C, Fleming KM, Fleming V, et al. UK mothers' experiences of bottle refusal by their breastfed baby. Matern Child Nutr. 2020 Jun 17:e13047