Blog posts
Bottle Feeding and 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.
This page is about how to bottle feed, and also what to do if you baby won’t take a bottle.
Table of Contents for all blog posts
Paced Bottle Feeding helps babies feed better!
It’s very common to see babies in reclined positions, with the bottle tilted down into their mouths. We now know, though, that babies fed this way eat too rapidly - causing to gulping, air intake, tummy upsets and overfeeding.
Breastfeeding, when effective, goes a natural pace, one that supports slower feeding and provides the amount of milk that a baby wants/needs at a session. 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 a baby who is having trouble latching - paced feeding supports the flow and mouth position of breastfeeding, ideally aiding return to the breast once nursing difficulties have been overcome.
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 those with a protruding nipple on a wider base) usually cause a shallow bottle latch - with babies pinching their mouth around the nipple. This usually causes a lot of air intake, as well, because the mouth is not filled with the bottle - 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 fill the baby’s mouth (the way the breast would with a deep latch).
Hold the bottle horizontally (a slight tilt is fine if needed!) for slower/calmer drinking, and to encourage baby to use their breastfeeding muscles. This promotes better oral/facial development too. Don’t worry about air in the nipple - that comes from gulping!
Resources for paced feeding
Video - Baby sitting upright
Video - Baby in side lying and using tongue support - side lying is very calming/supportive for both parent and baby, and tongue support often aids babies who lose vacuum or spill (Side note - tongue support can also help while breastfeeding!
Side lying video - baby laying on a pillow or a flat surface
And, a few more helpful paced feeding videos - one with an infant, and one with a doll
As well as two informative articles on the topic of paced feeding - by Kelly Mom, and by Rachel O’Brien, IBCLC
Bottle Refusal
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 your baby. Very often the reason a baby is having trouble with bottles is related to the way they are using their oral skills (which usually relates to breastfeeding issues and/or digestive issues).
Bottle refusal is an excellent reason make an appointment with an IBCLC - we will work with bottle refusal by taking a step away from bottle feeding directly, and:
Looking at a baby’s oral and body range of motion to determine where in the sequence of feeding they are getting stuck
Help their feeding/oral skills in the areas they are having trouble with.
Work with oral exercises, empty bottle nipples and oral/motor implements (toys, teethers, pacifiers) to help them re-learn how to suckle correctly from an empty bottle nipple
Then - after the baby shows skill withe the above ideas - add milk back to the bottle
Learn more about this approach from these fantastic resources
Article about bottle refusal by Rachel O’Brien IBCLC
video by Susan Howard, IBCLC - “Bottle Skills for the Bottle Refuser”
Alternatives to bottle feeding
Try them while working on bottle skills (above), or for older babies (say 5-6 months and up) these are great alternatives to bottles. However, because bottle feeding difficulties sometimes indicate and underlying oral issue - it’s still important to work on those issues.
Vessels to consider instead of bottles
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.
Videos of alternative feeding methods
Cup feeding (and here’s another one of cup feeding)