I am often asked, how do I get my breastfed baby to take a bottle?
The baby may be refusing to accept a bottle and, especially if the mum is returning to work and can’t go to the baby during the day to breastfeed, this can be very stressful.
Sometimes a mother has been advised to supplement feedings at the breast because baby isn’t thriving so needs some extra milk. Of course, if this is happening, it’s important to seek a carer such as an IBCLC lactation consultant to help address breastfeeding problems that may be contributing to low weight gains or concerns about milk supply.
Whatever the reasons for offering bottles, there are gentle ways to do this that won’t compromise either your own or your baby’s breastfeeding experience. For instance, some babies will find the fast flow of a bottle much easer than breastfeeding so will refuse the breast – this can be heart breaking for you.
Let’s discuss how you can offer your baby a bottle respectfully, without stress or risking your breastfeeding experience.
What’s the difference between breast and bottle?
Feeding from the breast is a very different tongue, jaw and sucking action from bottle feeding: when your baby latches onto the breast, he needs to open his mouth wide, flange his lips and draw the nipple deeply into his mouth, while his tongue has to ‘milk’ the breast with rhythmic movements; when bottle feeding, a baby doesn’t have to open his mouth so wide or flange his lips to form a seal, nor does he have to work to get the milk out .
Sucking is an involuntary newborn reflex. It’s particularly strong in babies under three months. This means that when you pop a bottle teat into your baby’s mouth, it will automatically stimulate a sucking reflex. As the baby sucks, his mouth fills with milk, which he then has to swallow. The swallowing triggers the suck reflex again so your baby keeps on sucking and swallowing. It looks as though he is ‘hungrily’ gulping the bottle of formula when, in actual fact, he simply can’t control his natural sucking reflex and he needs to keep swallowing to protect his airway.
This can be a stressful experience for a younger baby who may thrust his tongue up to slow the flow or you may see signs of stress such as splayed fingers or toes or milk running out of the corner of the baby’s mouth. A baby who is big enough may turn their head or try to push the bottle away.
Wait until breastfeeding is established
If you are wanting to introduce a bottle because you are hoping your baby may take a bottle later if you are separated and there is no immediate urgency such as needing to supplement your baby’s feeds, its best to wait until your baby is at least 4 to 6 weeks old and is breastfeeding well. Offering a bottle weekly at this stage will usually be enough to help your baby ‘remember’ how to manage this different sucking action, without him becoming less efficient at breastfeeding or completely refusing the breast in favor of a faster flowing bottle.
Consider an alternative to bottles
If you are not going to be separated from your baby but you need to supplement feeds, you may like to consider using a supplemental nursing system (SNS). This is a device with fine tubing that sits against your nipple so that as baby feeds at the breast, he also receives additional milk through the tubing. This encourages baby to feed at the breast and stimulates your milk supply. It also supports bonding and a sense of confidence for mothers with milk supply challenges, adoptive mums or women who are trying to re-lactate. Another option in the early days is to learn about finger feeding, by stimulating your baby’s sucking reflex with a clean finger as you give milk with a syringe. Some mothers also find their babies will sip out of a shot glass or cup, especially if they are over 4 to 6 months and refuse to drink from a bottle but the mum needs to be separated from her baby.
Offering a bottle
Whether you are breastfeeding and offering a bottle occasionally or whether you are bottle-feeding expressed breast milk or formula, you can do this safely and respectfully:
Hold your baby upright: Sit baby up, supporting his head and neck with one hand, rather than lying him flat. This way your baby will be in control of the milk flow as he feeds. And, without gravity forcing the milk to flow down into the baby’s mouth (when he is lying down), he will have to work to get the milk, more like he does at the breast.
Use a slow flow bottle teat: Disregard the recommended ages on the teat packets and look for a slow flow teat, or a newborn teat even if your baby is a bit older. It may take some experimenting to find a teat that works best for your baby, as even slow flow teats can vary depending on the brand. It should take your baby around twenty minutes to drink a bottle – if he is finished in five minutes, the teat is probably flowing too fast and if it takes longer then 30 minutes, you could try a faster flowing teat.
Please don't believe the hype about the orthodontic style teats that are flattened at the end – if your own nipple is coming out of your baby’s mouth after a feed looking like this, there is something wrong with his attachment. Also, some wide based teats can be too wide for individual babies and may mean your baby is just sucking on the tip of the teat, which isn’t as effective for your baby to drink and may cause suck confusion or nipple feeding at the breast, rather than taking a deep latch which is important for effective breast emptying.
Warm the nipple: To help your breastfed baby accept a bottle, try warming the teat by running it under warm tap water (your nipple isn’t cold!).
Gently stroke your baby’s lip from top to bottom with the nipple: This will stimulate your baby to gape and open their mouth. Hold the teat against your baby’s bottom lip and allow him to draw the nipple in naturally, as he would draw in a breast nipple, rather than poking it into your baby’s mouth and tipping the bottle up. This can be a bit scary for a baby who is suddenly confronted with a fast flowing mouthful of milk, that he has no control over.
Let your baby begin to suck: Let your baby take a few sucks before you tilt the bottle up so he gets milk. This mimics the baby’s experience at the breast - he has to suck a little before he triggers a letdown and gets the faster flow. You don't need to worry about ‘wind’ as your baby will burp this up. Then, hold the bottle horizontal and tilted just enough that there is milk in the tip of the nipple. As the bottle empties, you can tilt the bottle higher to keep milk in the teat but you can also allow your baby to lie back at around a 45 degree angle so his head and neck are in proper alignment and his neck and chin aren’t hyper extended which can cause baby to aspirate milk.
Give baby a rest: After around 30 seconds or if your baby begins to show stress cues (splayed fingers, milk dribbling out of his mouth , turning his head or pushing the bottle away), give your baby a rest: keep the bottle in your baby’s mouth but tilt it downwards so that the teat is pointing towards the roof of your baby’s mouth and it is resting on your baby’s bottom lip and the milk isn’t flowing. As your baby is ready to continue drinking, he will start sucking again. If you remove the bottle from his mouth, your baby won’t know whether his feed is finished. This can confuse and upset him if he is still hungry but thinks his food has gone. By tilting the bottle and giving your baby little rests (this is called paced bottle feeding), you are also giving him the opportunity to decide when he has had enough to eat. Here is a great video showing and explaining paced bottle feeding:
Change sides: just as you would change sides while breastfeeding, by changing sides half way through a bottle feed, you are stimulating both of your baby’s eyes and both sides of his body and his brain. He is also getting sensory input through both hands as he grasps at your clothing and touches your skin with his most available hand. By changing sides as you bottle feed you are also reducing the chances of your baby developing a favoured side, which can make breastfeeding quite challenging.
Don’t force him to finish: If your baby doesn't continue sucking or turns his head away, you can consider he has had enough milk. Please don't be tempted to force your baby to finish the bottle by poking it back in his mouth, jiggling the teat in his mouth or tipping the bottle up high so it flows fast.
Finish at the breast: If you are supplementing a breastfed baby with bottles, you will most likely offer the breast first, then a bottle with the ‘top up’. If you offer the breast after the bottle as well, you will get some extra stimulation to help encourage your milk supply and your baby will associate a full tummy with mummy and the breast, so he is less likely to refuse the breast in favour of a faster flowing bottle.
Enjoy this time
Feeding your baby is a time of loving interaction, not just a matter of filling your baby with milk. So follow your baby’s feeding cues, make eye contact, talk to your baby, smile and take your time connecting and enjoying your baby as he feeds. Try to create as many lovely connections in your day as you can manage – skin to skin snuggles, baby massage and little games will all support your baby’s development and your connection with him, however you feed your baby or whether you need to be separated for part of the day.
If baby refuses the bottle
Be patient: if your baby refuses to take a bottle, this may be because of the different sucking action between breast and bottle so he may be finding it difficult.
Get somebody else to offer the bottle: your baby associates mama and breast as a ‘unit’ so he is more likely to accept a bottle from another familiar care-giver.
Turn baby away from you: although it's important to make eye contact and interact with your baby while feeding, at first, your baby may be distracted and accept a bottle more easily when he is looking outwards rather than in his familiar feeding position.
Try another feeding place:instead of holding your baby, try sitting him in a baby rocker and face him, talk and interact as you offer a bottle.
Try when baby is drowsy: often babies will naturally suck as they are drowsy or just waking, so try gently offering a bottle then but always make sure baby is being held while offering a bottle, do not simply poke a bottle through the cot bars while baby is lying down. This can pose a choking risk.
Check your milk: If baby is refusing to drink expressed milk, check the smell and taste. Some women have higher levels of lipase, an enzyme that breaks down fats in milk so it can taste soapy or ‘off’. See this blog for more information about what you can do to address high lipase levels (without ditching your precious mama milk).
