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When your baby refuses the bottle...

It is not uncommon to hear mothers complaining about their breastfed babies refusing the bottle. Some come desperate to consult, wondering how they will do when they return to work, or struggling to separate from their babies to run some errands.

But, tracing back the history of that breastfeeding dyad brings us to the same point, WHEN that introduction occurred.

There's not a lot of evidence that points out a specific time. On one side, we have the AAP and WHO warning that an early introduction of the bottle is potentially detrimental for breastfeeding. It's true. I've witnessed it many times; babies having trouble breastfeeding simply because of a premature bottle introduction.

Timing has a lot to do here. But, when is the right time to present them with a bottle?

As soon as lactation is well-established! And this means three things:

  1. That the baby is gaining weight consistently.

  2. That he's breastfeeding without a problem.

  3. And mommy has no breast pain.

When these three things happen, we can consider the breastfeeding relationship is already established, and your baby is ready to meet the bottle. For most babies, this happens at 3-4 weeks (assuming they began breastfeeding from day one); others take longer. Be mindful of his own timing.

On the other hand, you want to present the bottle to your baby when his sucking reflex is still active. Babies suck by reflex for the first 3-4 months. After that, the reflex disappears and integrates, and the suction becomes a conscious action. It's more likely he'll take the bottle when his suction reflex is there and is activated by touching his palate with the tip of the nipple.

You may check how active is his sucking reflex by rubbing his palate with your finger pad and noticing how he starts sucking right away.

But what happens when your baby is consistently refusing the bottle? You're not sure if you introduced it at the right time or not; who cares! You probably have one or two reasons why you need your baby to take the bottle when you're not around.

Since it's a recurrent question at work, I decided to explore different practices among my families, resulting in a select list of tricks and hacks. The following is a list of things you could try for your baby to accept the bottle. These recommendations combine what the literature says and what has worked for my clients.

I want to thank these families for sharing their experiences and adding a bit of spice to the wonderful world of feeding. Enjoy!

NOT TOO HUNGRY. "Do it when he's hungry! That way, he won't have a choice." It may sound logical to some, but if you take a minute to think about it, you'll realize that your baby doesn't know there's food in the bottle. Your baby's been used to eating from your breast, and that's the only source of nutrition he knows. Putting him in the difficult task of finding a new way to eat when he's hungry and impatient might not be the best idea. It would probably be more beneficial to introduce the bottle to your baby when he's not as hungry or in-between feedings.

LET HIM PLAY. Play is the language of children and babies. Allow him to familiarize himself with the bottle before you try to feed him with it. Babies explore through their mouths, so it's very likely he'll bring the bottle to his mouth and figure it out by himself. But for that, he needs space and time. He doesn't need an anxious parent staring at him while he plays with his new "toy." You may intervene from time to time and show him how the milk drips from the nipple, or you can put it in your mouth and show him. Babies love to copy you!

SOMEONE ELSE. Your baby is used to nursing from you, and this is what he'll expect at mealtime. You may want to try your partner or the other caregiver to feed him with the bottle. He can't expect the same from the other caregiver, so he'll probably be more willing to accept the bottle from somebody else.

CHANGE POSITION. Present the bottle to your baby in a different position than when you breastfeed. Still hug him and offer him human contact, but in a way where he won't expect to nurse. When I introduced the bottle to my baby for the first time, I sat him on my lap with his back on my tummy and hugging him, I touched his lips with the tip of the nipple to encourage the rooting reflex. Once he opened the mouth, I introduced the nipple pointing to the roof of his mouth to stimulate suction. My baby was 2.5 months, and his sucking reflexes were still strong.

Some parents report that when they present the bottle to their babies walking around, they tend to accept it easier. This is another tip you may want to try.

TRY DIFFERENT SHAPES OF NIPPLES. You may have to get several nipples to try. The best shapes are not the ones that look like a breast. When a breast is at work, meaning it is inside the baby's mouth and he's sucking, it seems pretty different, more of a long and narrow shape. Find a nipple that looks like a breast at work and not at rest.

SLOW FLOW. Believe it or not, one of the biggest problems of the bottle is not the shape; it's the flow. The beauty of breastfeeding is that your baby can control milk flow with his suction. With the bottle, especially a fast flow one, he can't do that, as it literally drips in his mouth without him having to do much of a sucking. You can check for yourself the flow of your bottle by placing it upside down and noticing how fast it drips. A truly slow flow nipple won't do that unless you squeeze it.

TEMPERATURE OF THE MILK & NIPPLE. A few of my clients report that when they warm up the nipple, their babies are more willing to take it. So the temperature of the milk -whether breast milk or formula- should be at room temperature or slightly warmer and never cold from the fridge.

OTHER WAYS. If, after trying all of these tips for a reasonable amount of time, your baby still refuses the bottle, you may want to consider other forms of supplementation, such as the cup or the spoon. If your baby has already started on solids, a cup with a straw could be a good option as well.

BE CONSISTENT. No matter what you try, if your baby accepts to put the bottle in his mouth, even just for playing, let his curiosity flow. Stick to that and offer every day. Consistency is the key to success.

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