Bottle-Feeding the Reluctant Breastfed Baby

Evelyn Borchard

Updated September 30, 2024 23:39

I’m returning to work in a few weeks, and my baby will not take a bottle. Help!

You are not alone, mama; other breastfeeding moms share your experience. It’s frustrating when you feel like you can’t leave your baby in someone else’s care. You have made your breast a wonderful place for baby to be, and they prefer this over anything else. There are things you can do to encourage your breastfed baby to take a bottle, though. Read on for suggestions. If you feel comfortable with the 'how-tos' of bottle-feeding, click here to jump to the bottle refusal section of this article.

When to Offer a Bottle

It’s best to devote the first few weeks to nursing at the breast only; the key being to establish breastfeeding before introducing other nipples. Babies around two to four weeks old are usually ready for bottle introduction. They have developed a preference for the breast (which is what you want), but accepting a bottle and going back to the breast should not be a problem. If baby is older, it may take some patience and experimenting.

Choosing a Bottle and Nipple

Babies use their muscles differently when taking milk from a bottle versus the breast. Let’s face it- no matter the claims made in advertisements, there is no artificial nipple that is just like yours. It’s often unnecessary to spend extra money on special bottle nipples. General advice can be given in this area, but each baby and their preferences are unique.

Flow Rate: The speed at which milk flows from the bottle nipple.

- It’s recommended to choose a slow flow rate so baby can set the pace during a feed and has to actively suck to draw milk from the nipple (similar to breastfeeding).
- Even a slow-flow nipple, when held upside down, will drip. Hold the bottle horizontally (level), and avoid tipping it up during the feeding. Check out the section below on paced bottle feeding.
- If milk is leaking out of the sides of baby’s mouth, the flow rate is too fast.
- If baby seems frustrated and is used to a faster flow of milk (because mom’s milk flow is faster), try tipping the bottle up a bit or experimenting with a faster flow rate.

Nipple Shape: Since babies have a large portion of the areola in their mouths when breastfeeding, they should have more than the tip of the bottle nipple in their mouth when bottle-feeding.

- Choose a bottle nipple that gradually changes from narrower at the tip to wider at the base.
- Avoid nipples with unnatural shapes (tilted, flat or pointed).
- Pick two nipples to try, instead of overwhelming yourself and baby with too many options.
  - Narrow base: Baby’s mouth will be nearly touching the plastic rim (O-ring base) at the bottom of the nipple.
  - Wide base: The nipple will be deep enough in baby’s mouth that there are no air pockets.

Time to Practice

Creating an environment that encourages baby to take a bottle is one of the most important first steps. Keep it light, joyful, and calm. Smile and talk in a soothing voice. Baby should be in a good mood, not fussy or tired. Offer the bottle 1–2 hours after they last nursed so they are motivated, but not starving.

- Start with a small amount (less than one ounce).
- Check the temperature to make sure it’s not too hot or too cool.
- Dip the bottle nipple in breast milk or squeeze some out, so baby can get a taste and smell it right away.
- Aim the nipple toward the roof of baby’s mouth.
- Let baby draw the nipple into their mouth on their own; do not force it.
- Lips should be flanged out (like they are when breastfeeding), not tucked in.

Paced Bottle-Feeding – This is encouraged to make a bottle-feeding session similar to a breastfeeding session, which can ease the transition from breast to bottle and back again. Click here for a video demonstration. Babies who are used to being fed at the breast like to take their time. In general, it should take baby about 5 minutes to drink one ounce. A four-ounce bottle should take about 20 minutes to finish. Take breaks to burp during the feeding, and don’t force baby to finish the bottle.

More Benefits of Paced Bottle-Feeding

- - Minimizes waste: Prevents baby from going through an entire day’s worth of milk in just a couple of feedings.
  - Lessens overfeeding: Gives time for baby’s brain to recognize that their tummy is full.
  - Decreases baby’s stress: Allows baby to determine how much and how quickly they are most comfortable eating.

If Baby Refuses to Take a Bottle

Call in reinforcements: Have someone else offer baby the bottle (mom should not be anywhere baby can see/hear/smell her).
Familiarize: Give baby an empty bottle to play with, suck and chew on.
Warm: Run warm water over the bottle nipple.
Play tug-of-war: Let baby suck on your clean finger (or a pacifier). When baby is sucking, tug your finger out a bit, encouraging baby to suck it back in. This is good practice for bottle-feeding.
Dream feed: Offer the bottle when baby is sleepy or just waking up from a nap.
Experiment with positions: Turn baby away from you so they are not in a breastfeeding position, or if that doesn’t work, snuggle them in close, similar to nursing.
Get moving: Walk around during the feeding. Wear baby in a sling while swaying or bouncing on an exercise ball.
Change the scene: Avoid places or routines that make baby think about nursing. Go outside on a nice day.
Distract: During the bottle-feeding, interest baby in an interactive toy that lights up or spins, or wear a chunky necklace for them to play with.
Praise: React with happy cues when baby sucks and swallows, even just once or twice. Keep it calm and try to avoid loud reactions.
Stop: If baby (or you) becomes frustrated, end the feeding and try again later.

If All Else Fails

When you cannot breastfeed because you are at work, and when baby refuses all attempts to take the bottle, cup feeding is an option. Educate baby’s caregivers on how to safely cup feed. Resist panicking, and take advantage of the time you are with baby by breastfeeding more, while they are adjusting to this change. Some babies will take in most of their calories while with mom. For more information on reverse-cycling, click here.

Ask for help from a lactation consultant who is skilled in this area. WIC staff and your peer counselor can help you too by connecting you with our breastfeeding specialist!

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