My baby will not take a bottle

There is a particular kind of panic that arrives about a fortnight before someone goes back to work, when they realise their baby has never taken a bottle and now will not. If that is you, the first thing to say is that it is extremely common, and the second is that it is almost always solvable given a bit of time. The mistake is nearly always leaving it until the week before.

Why babies refuse

• It is a completely different skill. Feeding at the breast and feeding from a bottle use the tongue and jaw in different ways. Some babies switch easily and some do not.
• You are in the room. Many babies simply will not take a bottle from the person attached to the breast. From their point of view, the real thing is right there.
• They are too hungry. A hungry baby wants what they know works, not an experiment.
• The flow is wrong. Too fast and they choke and pull away, too slow and they give up.
• The teat is cold. A cold plastic teat is unpleasant. Warming it under the tap makes a real difference.
• It is being pushed in. Babies resist something poked into their mouth. They accept something they have drawn in themselves.
• They are being held in the feeding position they associate with the breast, which can make the substitution more obvious.

What to try

• Choose a calm moment, not a hungry one. Halfway between feeds is better than just before one.
• Get someone else to do it, and leave the room, or better still the house. Your smell carries.
• Warm the milk and the teat. Run the teat under warm water first.
• Touch the teat to their lips and wait. Let them open and draw it in. Do not push.
• Hold them more upright, and in a different position from your usual feeding hold. Sitting on a lap facing outwards works for some babies.
• Try when they are sleepy, just waking or just falling asleep, when the resistance is lower.
• Keep it short. Five minutes of calm trying, then stop and feed them normally. A battle teaches them that bottles are stressful.
• Try a different teat before buying a whole cupboard of them. A slow flow teat with a wide base suits most breastfed babies. Changing teat every day rarely helps, and gives nothing time to work.

Whoever gives the bottle should use paced feeding, which keeps the baby in charge and protects breastfeeding. There is more in Paced bottle feeding.

Start in good time

If you know a bottle will be needed, begin around three to four weeks before, and offer a small amount two or three times a week. That is enough to keep the skill alive without disrupting breastfeeding.

Introducing bottles very early, before breastfeeding is comfortable and established, can make latching harder, so most families are advised to wait until feeding is going well, often around four to six weeks. Leaving it until the last fortnight is the other extreme, and it is the one I see far more often.

If they still refuse

They will not starve, and a baby who refuses a bottle for a carer very often takes milk another way.

• A cup or an open beaker, which even small babies can manage more readily than people expect.
• A soft spouted or straw beaker from around six months.
• Milk in food once they are on solids.
• Reverse cycling, where your baby takes less milk while you are apart and feeds more in the evening and overnight when you are back. This is very common and it works, though it is worth knowing in advance so it does not come as a shock.

If you are going back to work, none of this has to mean stopping breastfeeding. There is more in Going back to work while breastfeeding.

How a consultation helps with bottle refusal

The useful thing here is usually watching someone try, because there are small mechanical details that make the difference and they are almost invisible unless you know to look. How the teat is offered, how the baby is held, whether they are being allowed to draw it in, and how fast the milk is coming. I also want to know why the bottle is needed and by when, because the plan for a mother returning to work in a month is different from the plan for someone who wants one evening out. Very often we end up with a workable answer that is not a bottle at all, and that is a perfectly good outcome.