Oh, the dreaded bottle refusal. You never know who, why or when it will strike. It’s every working parent’s nightmare.

For many years, lactation consultants assumed that babies were choosing to “refuse the bottle” and would therefore advise parents to “trick” babies by letting them a) get hungry (the “starve it out” approach), and b) have someone other than the breastfeeding parent give the bottle (the old “it’s mom’s fault for being so loving” approach). One of the biggest problems with this advice is that it sets up a combative relationship between parent and child.

Your bottle refusing baby is not pushing the bottle away to make your life more difficult or to manipulate you into breastfeeding them.

Babies under 12 months old just don’t have the cognitive function to do that, and when we assume that they do, we enter into an “us vs. them” mentality.

I get it. We adults live in a world with complex relationships, where people can say one thing and mean another, be overly dramatic to make a point, or use tactics like silence and defensiveness.

These tactics are not yet available to our under 12 month olds.

So why is your baby pushing that bottle nipple out of their mouth and turning their head away and crying?

Your baby is actually telling you that it’s hard for them.

Babies lack the communication skills to say “Hey mom/dad, I know you want me to drink from this thing, but I am not sure how to not gag on that firm nipple, then get my tongue and lips around it to create vacuum pressure inside my mouth, then adjust to the flow while coordinating sucking, swallowing and breathing.”

Instead they cry and push it away. It certainly looks like bottle refusal, but I think of it as bottle difficulty.

If your baby is having a good ole time with breastfeeding, it means that they have figured out the mechanics of that really well. There is a good chance that it took them a minute to become a breastfeeding expert, so it may take them time to become a pro at bottle feeding.

You may be thinking, how different could bottle feeding and breastfeeding be? It’s all just sucking, right? Nope.

While it’s true that the mechanics of sucking, swallowing and breathing are pretty similar regardless of whether we are using a breast or a bottle, babies actually rely on very different muscles of the jaw to get milk out of a bottle or breast and into their mouth.

Not to mention that our nipples are not the same as bottle nipples (despite some really clever marketing by bottle companies, there still is no “just like breast” bottle nipple) and how one feels in a baby’s mouth affects how they feed from it.

If you are a parent of a baby, you are well aware of the vast array of bottle and nipple shapes, sizes, materials and flow rates.

It’s beyond confusing. Did you know that there is almost no regulation on what bottle companies have to say on their packaging? All they’re required to say is what the material is. So claims like “soft, breast-like shape”, “anti-colic”, and “like breastfeeding” are all just marketing.

Did you know that flow rates aren’t regulated either? One bottle’s “slow flow” is completely different from another. Heck, one batch of “slow flow” nipples coming off the assembly line can be different from the next batch.

No wonder parents (and babies!) are so confused. No one is minding the store. (If you would like to learn more about actual flow rates, check out the work of Infant Feeding Labs.)

Here’s another head scratcher:

Parents will often say, “But she took a bottle with no problem at 3 days old when we were giving a bit of formula supplementation. Why is it a problem now?”

The answer is that newborns are hard wired to suck. It’s a strong reflex that is built into every healthy, full term infant. Sucking is not a choice that they make - it’s reflexive and automatic.

However, this suck reflex goes away at around 3 months of age, so after that, sucking does become a choice.

At that point, sucking doesn’t just happen; a baby has to decide to do it. This is why we see bottle difficulties crop up later on.

Another reason it can become difficult later is that the baby gets bigger. When we put a bottle nipple into a newborn’s mouth, it pretty much fits like a glove in there. The oral cavity is small, allowing the nipple to stabilize and the tongue to easily cup around the nipple.

As the baby grows, the oral cavity gets larger, making it more difficult for some babies to stabilize the nipple and get a good grip on it with their tongue.

By this point, you’re probably saying to yourself, “OK, Sharon, interesting info, but I’m going back to work and my baby won’t take a bottle. How do I fix this???”

Let’s get into it.

Step One:

Re-frame the problem. Your baby isn’t just trying to get what they want — they need your help. You and your baby are on the same team.

Step Two:

Start with a content, not-super-hungry baby. No good will come if your baby is hangry.

Never force your baby to take a bottle or keep it in their mouth if they don’t want to. You want to keep this light and fun.

Step Three:

Let your baby play with and suck on an empty bottle nipple, just like a pacifier. If your baby can’t reliably bring something to their mouth yet, you can hold it for them.

The most important thing here is to keep it very casual and low stress. Treat this as play. If your baby isn’t into it, take it away and try again later.

Step Four:

Once your baby has gotten the hang of keeping the nipple in their mouth and sucking, start dipping the nipple in a bit of milk or formula first.

This will allow your baby to incorporate swallowing into the skills they’re building.

Step Five:

If your baby is coordinating this well, it’s time to connect the bottle and put milk in it! Start with a small amount like 1 ounce.

The most important thing is to start with stability. Babies get confused when their food is moving from side to side. Imagine if your sandwich was moving around while you were trying to take bites from it!

Get your baby into a comfortable, stable position with their chin away from their chest and hold the bottle in place. It helps to gently anchor your hand on the baby so that you both feel like the bottle is not moving around.

Baby feeding from a bottle — This parent is stabilizing their hand on the baby’s chest to anchor the bottle. The baby’s head is tipped back a bit to allow for good swallowing. Also, check out that wide latch around the nipple!

Start without milk in the nipple. No, your baby won’t swallow a bunch of air if you do this. They just breathe it right back out their nose.

Once your baby is sucking well, tip the bottle up a bit to allow milk to fill the nipple. Go slowly and watch your baby’s reaction.

If, at any point, your baby looks overwhelmed by the flow, you can just lower the bottle to stop the flow.

Side lying is another good bottle feeding position. Parent and baby are stable.

You can always slow down or go back a step if your baby needs more time.

But, if your baby continues to have trouble, they may have a more complex problem. Consider working with an infant feeding specialist or IBCLC who can help you choose the best nipple for your baby and give you specific exercises to work on at home.

If that isn’t easily available to you, here are a few things you can try for the following problems:

Gagging:

Make sure you are aiming the bottle nipple towards the roof of your baby’s mouth, not towards the back of their throat.

If touching the roof of the mouth frequently elicits a gag reflex, you may need to work on slowly desensitizing your baby by starting with a clean, upside down pinky finger.

Begin by placing the tip of your pinky right behind the upper gum ridge and as your baby allows, start “windshield wipers” back and forth, eventually making your way along the hard palate.

The point is NOT to cause gagging, but to build up your baby’s tolerance to something touching their palate by gradually moving towards it.

Do this about 5x per day for about 1 minute. Only do this when your baby is ok with it. If your baby really wants you to stop, you should stop.

Tongue not cupping around the nipple:

If your baby looks like they don’t know where to put their tongue, first make sure the bottle is stabilized. You may want to start with your baby laying on the floor or on a changing table.

If this doesn’t help, consider doing some suck training.

With a clean, upside down pinky finger, guide your finger into your baby’s mouth once they allow you to do so (consent is important at this age too!).

Once your baby creates a strong vacuum around your finger, start playing “tug of war” by pulling your finger out slightly.

Practice suck training until your baby is reliably able to hold your finger in their mouth without losing suction. Then try with the bottle nipple again.

Baby gets upset just seeing the bottle:

This is bottle aversion and you will need to work on making friends with the bottle before your baby will even consider drinking from it!

Start by keeping the empty bottle in baby’s environment so it becomes familiar.

Once your baby seems cool with having it around, start using the empty bottle as a toy, maybe using it as part of a game like peekaboo. Once your baby makes friends with it, you can start the process of building bottle skills.

Bottle difficulty is really stressful. Especially if you need your baby to take a bottle in order to be fed.

The good news is that by working with your baby on building skills, you not only have a bottle feeding baby, you also feel empowered as a parent.

Your child’s life will be full of challenges, and you’re there as a guide to help them navigate these difficulties. Bottle feeding is one of the first times you’ll do this, but certainly not the last.

If you need support for your baby’s bottle difficulties, I can help! Contact me by clicking the button below. Let’s work together to solve this very stressful problem.

Get help with bottle refusal