Integrative Lactation Care

I have started seeing more clients for bottle refusal over the last few months and the consults often start the same way: “I should have done X”, or “We just didn’t try hard enough at Y”, and it breaks my heart because bottle refusal isn’t the parent’s fault.

It’s not your fault that you didn’t introduce the bottle earlier. Or that you DID introduce it earlier, paused, and then tried again later – and it didn’t work. Or that you tried 24 bottles but not 25. It shouldn’t be this complicated!

And it’s also not baby’s fault. Your baby isn’t manipulating you, intentionally making your life difficult or trying to prevent you from returning to work. Feeding in the first few months is largely reflexive and a baby who CAN eat from a bottle WILL eat from a bottle. It often helps parents in my practice to know that this is an issue of “can’t”, not “won’t”.

Often, these issues arise due to a mismatch of several (sneaky!) factors rather than any individual failing.

What’s Really Going On

It’s important to understand that breastfeeding and bottle feeding engage different muscles. Functional nursing primarily uses the tongue and jaw, while bottle feeding involves more lip and cheek muscles. However, if babies have tension or restriction in the mouth or body that prevents them from feeding optimally, they may develop compensations, or ways of feeding that engage other muscles not usually used for nursing.

Think of the last time you tweaked your ankle, or stubbed your toe hard. It might not have been hurt enough to need any medical care, but it might have caused you to walk a little more gingerly on that side for a few days, utilizing the muscles on one side of your body more than others. Those muscles were compensating for your injury.

But some of you reading this may be you saying: but nursing is going fine! We don’t have any pain or latch issues, and baby has been gaining well. While I’m thrilled to hear that (!), compensations can sometimes be subtle, and/or may not show up until down the road.

When a baby is using compensations to nurse at the breast/chest, and then they try to apply these mechanics to the bottle, it can often look like:

• playing with the bottle nipple
• chewing on the nipple
• compressing the nipple
• pushing it out of their mouth

It’s important to know that baby isn’t doing any of these on purpose! They aren’t willfully trying to make your life difficult. These are all indicators that a baby’s brain doesn’t know how to properly seal & suck from the bottle nipple – it is a skill deficiency, not a manipulation tactic.

What Can I Do?

The key is to employ an optimal bottle feeding technique and utilize bottles that support oral function. If problems persist, it’s crucial to look into the baby’s oral function more closely, examining muscle use during feeding.

• Choose an Optimal Bottle: There are a gajillion bottles out there and most of them are 1. too fast and 2. not an optimal shape for functional feeding. Check out this post to learn more.
• Support Baby’s Body: Make sure baby’s body is supported and comfortable, and not slumped or twisted. Aim for at least 90 degrees of neck extension.
• Feeding Timing: Ensure that the baby is slightly hungry but not starving when trying new feeding methods, as learning new skills is easier for everyone when the baby is calm and regulated.

What Not to Do

• Avoid Blaming Baby: Bottle refusal should not be seen as a battle between parent and child. It’s about skill development, not manipulation. Babies don’t have the complex cognitive ability to prefer one feeding method over another; they’re largely driven by reflexive needs and biological instincts.
• Don’t Blame Each Other: Aim to be on the same team with your co-parent. Avoid making it about who is right or wrong, or who is doing it better. It’s vital that both parents feel supported, not blamed.
• Don’t Force Hunger: Starving the baby in hopes of forcing bottle acceptance can be counterproductive.

If you’ve tried all of these strategies and you’re still stuck, a bottle refusal consultation may be helpful to dig deeper into oral function challenges. A skilled IBCLC can help assess where the skill deficits are and provide exercises & strategies to make targeted progress.

And remember: bottle feeding struggles are common and solvable challenges that do not reflect personal failings as a parent. Remember, you are all on the same team, working towards the best outcome for your baby.

Are you a parent struggling with bottle refusal? Book a consult with me:

Expecting or new parent hoping to avoid bottle feeding challenges? Join my Better Bottle Feeding class!