I wrote a blog on Baby Refuses a Bottle a few months ago. “So, what’s changed?” you might ask.
As part of my professional development as a postpartum doula, my learning and exposure to new information is ongoing. I recently attended a workshop on “Bottle Refusal,” given by Susan Howard, a nurse and IBCLC (International Board Certified Lactation Counselor) at Arlington (VA) Lactation and Feeding Therapy.
Some common tips for feeding, when a baby refuses a bottle, have traditionally been:
- have someone else give the bottle
- make sure mom is nowhere to been seen, heard or smelled
- try different types of nipples
- try different positions, like standing or swaying with baby
Howard supports none of those and says we need to look at the fuller picture of what’s going on with baby before taking action.
She affirms that bottle refusal is a symptom of another problem.
First, look at the physical features of the baby and start asking questions. Examine tongue shape, lip blisters, tension and range of motion in shoulders, top and bottom gum alignment, oral restrictions, tongue extension or elevation, tongue or lip tie, high palate. Ask questions. Has breastfeeding also been a problem? Are there issues with pacifier skills? Can they hold one in their mouth? Do they get muscle fatigue? How do they sleep? Is baby able to tolerate or enjoy tummy time? Do they suffer from reflux? Do they have torticollis (tight neck muscle)? What’s their gag reflex like?
Gathering these clues can help determine next steps. For example, tummy time builds a strong neck, which builds feeding skills, resulting in better bottle feeding.
If you’d like your baby to take a bottle, Howard says the prime time to introduce one is between four to six weeks of age. A baby’s sucking reflex will fade and oral facial growth increases at around four months.
If your baby’s sucking reflex needs support, Howard recommends building these skills before introducing milk in a bottle. These include:
- pronged teether toys (these hit the high palate)
- “O-ball” teethers (these exercise the tongue when baby mouths the toy)
- “mushroom” teethers (these exercise sucking skills)
- let baby play with an empty teat
When it’s time to give your baby a bottle, Howard offers these tips:
- Bottle should come from someone baby trusts, namely the breastfeeding parent.
- Pick a good “shoulderless teat.” (Lansinoh is one example) and stick with it. (Bottles with “shoulders” have a tendency to encourage baby’s tongue to slide down after the initial latch).
- Begin with a fed and rested baby. Try early in the day.
- Hold baby in an upright, supported way.
- Let baby see, touch and feel the teat.
- Touch the nipple to baby’s nose first and WAIT for them to open their mouth.
- Allow baby as much time as they need. Aim teat for the hard palate.
- Maintain eye contact and praise efforts.
- Respect your baby and never force feed.
This may take multiple tries, over many days. When your baby does successfully take the bottle, follow Paced bottle feeding. It allows baby to be in control, much like when breastfeeding. Take a look at this video explanation.
There isn’t just one way to feed your baby. But having all the information you need will help you find the one that fits.