Feeding
Bottles, teats and getting a baby to take one
Bottle refusal is common, is not stubbornness, and responds to changing the circumstances rather than persisting harder.
A breastfed baby who refuses a bottle at the point a parent needs to return to work is a common and stressful situation with a reasonably reliable set of solutions.
When to introduce one
A balance rather than a rule.
Introducing too early can affect breastfeeding establishment; introducing too late makes acceptance harder.
Many find a window of around three to six weeks works, once feeding is established, with a bottle offered regularly — a few times a week — thereafter to maintain acceptance.
Babies who have accepted a bottle can refuse it later after a gap, which is why regular practice matters more than the initial introduction.
Paced responsive bottle feeding
The method that suits breastfed babies and is better for all babies.
Hold the baby fairly upright rather than reclined.
Hold the bottle close to horizontal, with the teat only partly filled, so milk flows only when the baby sucks.
Touch the teat to the lips and let the baby draw it in rather than pushing it into the mouth.
Pause every so often, tipping the bottle down, and let the baby decide whether to continue.
Switch sides midway, which mimics breastfeeding and gives visual variety.
Stop when the baby shows they have finished, without encouraging them to drain the bottle.
This reduces overfeeding, reduces the tendency for babies to prefer the faster bottle, and makes the experience closer to feeding at the breast.
Teat choice
Less important than the technique, and not irrelevant.
A slow flow teat is appropriate for young babies and, contrary to intuition, many breastfed babies continue to do well on slow flow throughout — there is no requirement to increase flow with age.
Teat shape matters less than marketing claims; babies have preferences and trying a different shape is reasonable if one is rejected.
Anti-colic designs vary in whether they help.
Check teats regularly for damage and replace them.
And note that a flow that is too fast produces gulping, milk spilling from the mouth, coughing and distress, which is frequently mistaken for reflux.
When the baby refuses
What to change, one thing at a time.
Have someone else offer it, ideally with the breastfeeding parent out of the house entirely, since babies detect the alternative.
Try when the baby is calm and mildly hungry rather than desperately hungry, since a distressed baby will not experiment.
Try a different position: facing outwards, sitting up, walking around, or in a sling.
Try a different temperature, since some babies want it warmer than expected.
Try expressed milk rather than formula initially, and rub a little on the lips.
Try a different teat.
Let the baby play with the teat without feeding, to reduce the association with a battle.
And stop if it becomes distressing, trying again another day, since repeated forced attempts create aversion.
The alternatives
Worth knowing, since some babies never take a bottle.
Cup feeding, which is used in neonatal units and works from a young age with a small open cup.
Free-flow open cups and soft spouted cups, which are appropriate from around six months and which many babies who refuse bottles will accept.
Syringe or spoon feeding for small volumes.
Reverse cycling, where a baby takes less milk while separated and feeds more when reunited, which is a normal adaptation and works for many families with older infants.
And for babies over six months, solids and water reduce the reliance on milk during separations.
Common problems
Taking too little during the day when in childcare, which is very common and generally compensated for at other times.
Taking too much, where responsive feeding and paced technique help.
Wind and discomfort, where the position, teat flow and pacing are the variables.
Milk running out of the mouth, which indicates flow that is too fast.
And falling asleep partway, which is normal in young babies.
Hygiene
Which applies to expressed milk as well as formula.
Sterilise bottles and teats until around twelve months.
Wash thoroughly before sterilising, since sterilising does not clean.
Discard milk left in a bottle after a feed.
Do not save a partly drunk bottle for later.
And never prop a bottle or leave a baby to feed unattended, which is a choking risk and increases ear infections.
General information only, not medical advice. Consult a health visitor or lactation professional about feeding difficulties, and follow sterilising guidance for feeding equipment.
