Bottle refusal can be very stressful for families. Often times parents assume it is the bottle style that baby is rejecting, and if they can just find the magic bottle, baby will eat. Or there is the {often} unsolicited advice, "If they are hungry enough, they'll eat". Moms can easily feel overwhelmed when baby will only breastfeed, and there is no alternative. While partners may feel helpless in being able to provide feeding support. Whether the goal is to return to work, or just be able to get out of the house alone from time to time- it is absolutely okay if you want baby to take a bottle. But what happens when they won't? Bottle refusal comes down to two primary situations, won't and can't. Let's unpack each.
Baby Won't Take a Bottle. A baby may acquire a bottle aversion due to a history of pressure feeding, or overfeeding. This refusal often presents after 3-4 months of age, when baby has more control over choosing to suck. This is because the suckle reflex has integrated, and baby has more control over sucking when presented with a bottle. Refusal can look like a baby who begins to cry and fuss when they recognize the routine that indicates a feeding is coming. They may arch away from the bottle or turn their head.
Overfeeding. No parent intentionally overfeeds their baby. It may be that early crying is difficult to interpret- are they hungry, need changing, overtired? And, since sucking soothes babies under 4 months, it may seem that every cry is a hunger cry. When in reality, babies find comfort in sucking even if they aren not hungry.
Pressure Feeding. Again, this comes from a place of love. Perhaps baby has a history of poor weight gain. Parents may be nervous about growth, and encourage large volumes or frequent feedings that do not align with baby's hunger cues. Once the suck reflex integrates and baby can refuse, they will.
What are babies nutritional needs? How is a parent to know when they have had enough, and feel secure that they are gaining and growing well?
Indications that baby is gaining and growing:
Daily output: 6+ wet diapers and 3+ dirty diapers a day
Content after feeding
If breastfeeding, breasts feel soft after feeding
Baby's nutritional needs:
If you are breastfeeding, or doing a combo of breast and bottle. Do not focus on volume. Let baby's output and disposition be your guide. If you are bottle feeding, it is easier to accidentally overfeed. A good rule of thumb is: after one month of age, the average intake is 25-30 ounces/day. Forever. But ounces per feeding can vary drastically! Some babies will take larger volumes, and eat less often. While others may continue to accept smaller, 3-4 ounce feeds every 3 hours. And that generally goes for breastmilk or formula.
When offering a bottle, watch for baby to indicate that they are full. This may look like a baby who sucks less frequently, breaks eye contact, just holds the nipple in their mouth, becomes distracted or disengaged. Always follow baby's cues for hunger and satiety.
Baby Can't Take a Bottle. In this situation, baby never accepted a bottle well. Perhaps family has tried multiple bottles on the market, and nothing works. Baby can't latch. This is likely due to oral motor dysfunction (or delayed bottle introduction after 12 weeks of age).
Oral motor dysfunction; what does that mean? Baby does not know how to use their tongue and jaw effectively to latch onto a bottle and move milk. This can be the case even when breastfeeding is presumably going well. Often times this is because maternal milk supply is so robust, that is actually masks the lack of sucking skills. But just because mama is compensating, doesn't mean it should be ignored. Breast/bottle feeding are foundational skills that set the stage for advancing to solids, and correctly using muscles and coordinating movements later on for speech development.
Signs of oral motor dysfunction:
Chewing on the bottle nipple
Pushing the nipple out with their tongue
No lip seal, bunched tongue
On/off the nipple
Gulping
Coughing
Highly sensitive gag
Clicking sounds
Milk leaking from the mouth
Poor breath control
Lip blisters
Lots of spit-up
Gassy after feedings
LONG feeding times (>30 minutes)
Sleeps through most of the feeding
Barely transfers any milk
What Now?
It is important to understand what caused the bottle refusal in the first place, as this will determine how to treat it. The first step should always be gentle, responsive feeding strategies intended to undo any aversions. Then, a feeding therapist can assess oral motor skills to determine their role in bottle refusal. Feeding therapy can help baby learn to use their tongue, jaw, lips, and cheeks more effectively for feeding. We will also make a skilled analysis for matching baby to a bottle that supports their current skills. In my practice, the ideal bottle may change as their skills improve. Another consideration, sometimes oral motor dysfunction is associated with a tongue tie. Therefore collaboration with a pediatric dentist may also be recommended. It is important to note that a tongue tie release alone does not correct oral motor dysfunction. It is always recommended to coordinate feeding therapy before/after a release for best results.
If you are struggling with bottle refusal schedule a free phone consultation. We would love to help you and baby enjoy feeding, and ensure their oral motor skills are on track!