Most babies receive bottles during their lifetime - it might be full-time or occasional, or somewhere in between. When to give a bottle varies on your situation, and is not covered in this post - this page is about how to provide a bottle - using paced bottle feeding, and also what to do if you baby won’t take a bottle - bottle refusal.

Bottle feeding is a skill well worth working on for any baby - in fact it is a red flag for feeding issues if your baby can not take a pacifier or bottle.

Paced Bottle Feeding helps babies feed better!

It’s very traditional to hold a baby in a reclined position while bottle feeding -and tipping the bottle toward them. However, we now know that babies fed this way are eating too rapidly - leading to gulping, air intake, tummy upsets and overfeeding.

Breastfeeding has a natural pace, one that usually supports a slower method of feeding and provides the amount of milk that a baby wants at a particular feeding. Paced bottle feeding mimics many aspects of breastfeeding - providing baby with milk at a slower pace, and the amount that they want/need to drink. This type of feeding is good for all babies, no matter how they are fed.

And, for the baby who is having trouble latching, paced feeding supports the flow and mouth position of breastfeeding - which allows for an easier return to the breast once nursing difficulties have been overcome.

Top recommendations for paced bottle feeding

Use a soft, gently tapered, slow flow nipple. Wide nipples that look “like a breast” only look like a breast that is not being nursed! These nipples (whether shouldered or have a protruding nipple on a wider base) usually cause a shallow bottle latch - babies who pinch their mouth around just the nipple (and often take in a lot of air too). This excellent piece by Rachel O’Brien, IBCLC explains why some bottles are better than others - and suggests the bottles that we most highly recommend - ones that fils the babies mouth (the way the breast would with a deep latch).

Hold the bottle horizontally. This allows for slower/calmer drinking, and encourages baby to use their breastfeeding muscles - promoting oral development. Don’t worry about air in the nipple - that comes from gulping!
- This fantastic video shows how to pace feed with the baby upright.
- Alternatively there is Side lying while bottle feeding which is very calming/supportive for parent and baby. The video in this Instagram post also shows under the tongue support - helping babies who lose vacuum or spill - and can also be used while breastfeeding.
  - Here are a few more side lying videos on a parents legs - One, Two
  - And this page shows side lying bottle feeding on pillows or other surfaces.
- Here are a few more helpful paced feeding videos - one with an infant, and one with a doll
- And two informative articles on the topic of paced feeding - by Kelly Mom, and by Rachel O’Brien, IBCLC

Bottle Refusal

Here is a fantastic article about bottle refusal by Rachel O’Brien IBCLC, and this is a very informative and thorough Instagram video presentation by Susan Howard, IBCLC - “Bottle Skills for the Bottle Refuser”

Contrary to popular opinion, overcoming bottle refusal is rarely about finding the perfect bottle, and more often about figuring out what is making bottle feeding hard for you baby. Very often the reason a baby is having trouble with bottles is related to the way they are using their oral muscles (which usually relates to breastfeeding and/or a baby’s digestive issues).

The approach for working with bottle refusal starts with taking a step back:

looking at a baby’s oral and body range of motion
helping their feeding/oral skills in the best way possible
letting them “become friends” with an empty bottle nipple
Then - only after the above ideas - adding milk to the bottle

Bottle refusal is an excellent reason make an appointment with an IBCLC!

And, here are some ideas to consider trying in the meanwhile:

Examples of cups to try as alternatives to bottles
- Silicone training cup
- Straw cups
- This multi-functional TalkTooks Itsy Cup (can be used as an open cup, a cup with a lid, or a straw cup)
- The Doidy Cup (comes in many other colors)
- Or a “sippy” cup but use them without the valve so the baby can drink from it similarly to from a cup, but the cover can somewhat limit spills - here are many examples (again, some have valves - don’t use that part, just the cup and the lid)
- This cup that limits flow of the liquid similarly to the sippy cup but doesn’t have a spout. Similar but larger are the Reflo smart cup, and this First Years cup.