When your baby squirms, appears uncomfortable during feed, fusses, cries or refuses a bottle, it can be challenge to figure out the cause. The timing and type of behavior she exhibits provides vital clues. This article discusses potential reasons for troubled feeding behavior.
Does your baby display troubled behavior in relation to bottle-feeding, such as….
Refuses a bottle
Turning away from the bottle.
Refusing to close her mouth around the nipple.
Holding nipple in the mouth but not sucking.
Taking only a small amount and then refusing more.
Screaming when placed into a feeding position or at the sight of the bottle.
Milk pouring out of baby's mouth.
Feeding too quickly.
Feeding too slowly.
Falling asleep before the feed is completed.
Coughing and spluttering when feeding.
Not consuming as much milk as expected.
Wanting more milk than expected.
Throwing up large amounts of milk.
Then there may be steps you can take to remedy the situation.
‘Behavioral’ means baby’s behavior is in response to the circumstances rather than a physical cause. Behavioral reasons are the most common of all reasons for infant feeding problems. There are numerous behavioral reasons for a baby to experience feeding problems and/or display problematic feeding behavior. Common reasons include:
1. Misinterpreting baby's cues as signs of hunger
Does baby at times refuse feeds?
Does she take only a little and not want more?
Babies are in an oral stage of develop. Sucking is the primary way babies soothe. They also learn by sucking and mouthing objects. Many babies have a strong desire to suck for reasons that extend beyond hunger, such as tiredness, boredom, discomfort and soothing. There may be times when you mistake your baby’s desire to suck for these reasons as hunger.
Newborn babies have an active sucking reflex. This means a newborn baby may accept a feed even when she’s not hungry, and she might guzzle down the bottle because she cannot choose to not suck when her sucking reflex is triggered. Once her sucking reflex has disappeared (usually by 3 months of age) she will willingly take only the amount she wants to take.
If you have mistakenly interpret her fussing or desire to such as hunger and offer her a feed, she might take a little and refuse the rest, or she refuse from the start. If you try to make her drink more than she wants, she will understandably get upset and fuss, cry and pull back from the bottle.
WHAT TO DO
See Hungry baby for more reasons why babies often appear
See Infant reflexes
2. Unrealistic expectations
Is baby not drinking as much as you expect?
Is she fussing if you try to get her to finish?
In around one third of consultations I have had with parents regarding an infant feeding problem, I found that parents were trying to make their baby drink more than he or she needed. In some cases, this was because of errors made their health professionals. They either failed to adjust calculations as baby matured or failed to consider baby as an individual. As a result, overestimated baby’s milk requirements.
If you think your baby is not drinking enough milk (breast milk or infant formula) you’re naturally going to feel concerned. If your concern translates into trying to pressure her to drink more than she wants or needs (gently or otherwise), you’re going to upset her. So it is very important for your peace of mind and your baby’s enjoyment at feeding times that you have realistic expectations about how much she needs.
WHAT TO DO
See How much milk does baby need for standard estimations for age and weight, and reason why a baby might take more or less than recommended.
Follow your baby's feeding cues. Don't try to make her take more when she indicates she has had enough.
Is your baby at times too tired to eat effectively?
Does she often fall asleep while feeding?
Sleeping and feeding are closely related when it comes to the needs of babies. Both are equally important to a baby's health, growth and development and feelings of wellbeing. You are no doubt aware that if your baby does not feed well she might not sleep well. But are you aware that the opposite is equally true. If she’s not getting enough sleep this has the potential to negatively impact on her feeding.
Physical fatigue can cause baby to fuss during feeds or falling asleep before the feed is completed. If you have a hungry/tired baby on your hands, tiredness will usually win out.
WHAT TO DO
Ensure baby gets enough sleep.
Feed her before she becomes too tired.
Aim to establish a flexible feeding and sleep routine to minimize the risk of feeding and sleep times clashing.
If your baby is often irritable and not sleeping enough, (see Overtired baby for signs and symptoms) you might find that resolving any underlying sleeping problem will cause feeding difficulties to spontaneously resolve once she receives adequate sleep.
See our sleep section.
Download or order a paperback copy of my infant sleep book Your Sleepless Baby: The Rescue Guide. There you will find comprehensive information on the reasons and solutions to various infant sleeping problems.
Is your baby too busy looking around or trying to play to want to feed?
Is it hard to keep her focused on feeding?
Babies over the age of 4 months can easily become distracted while feeding. They are often much more interested in the activities going on around them than they are in feeding.
WHAT TO DO
Feed your baby in a quiet environment away from noise and distractions of other children.
5. Feeding management
Some feeding problems can be related to what may appear like insignificant details but which can make feeding difficult or uncomfortable for a baby. For example, how you hold your baby will affect her ability to feed from a bottle. If her head is too far forward or too far back or her neck is twisted this can make it difficult for her to suck or swallow.
WHAT TO DO
6. Feeding aversion
Does your baby refuse to feed even when hungry?
Does she scream at the sight of a bottle or when placed into a feeding position?
Have you resorted to trying to feed her while asleep?
A baby can develop an aversion to feeding when past feeding experiences have taught her that feeding is unpleasant, stressful or painful. Typically, baby is diagnosed with reflux and/or milk protein allergy or intolerance to explain her aversive feeding behavior. However, a behavioral feeding aversion (related to feeding management rather than a physical cause) is a far more common cause of infant feeding aversion.
A feeding aversion is the most complex of all infant feeding problems. An effective solution relies heavily on accurate identification of the cause.
WHAT TO DO
See Feeding aversion for more information. Or purchase or download a copy of 'Your Baby's Bottle-Feeding Aversion: Reasons and Solutions'.
7. Feeding equipment
Does your baby gag, cough or splutter during feed?
Does she make clicking sounds while feeding?
It could be the nipple is too long, too short, too fast or too slow.
The most important piece of feeding equipment is the nipple. The nipple needs to be the right size and speed for your baby's size, age and sucking ability. If the nipple is too long, too short, too fast or too slow for your baby, she may experience feeding difficulties and express her frustration by fuss or crying.
WHAT TO DO
See Feeding equipment for more information on choosing a feeding nipple.
Experiment with nipples of different lengths, shapes and speed.
8. The nipple ring is screwed too tight
Does the nipple collapse in your baby’s mouth as she feeds?
Do you find that air rushes into the bottle once the bottle is removed from her mouth?
Its possible her feeding difficulties could be due to the nipple ring being screwed on too tight.
In order to maintain a neutral balance in air pressure within the bottle air needs to be able to enter the bottle to replace the void left by the milk the baby is removing. If the bottle is vented, this is achieved via the venting system. However, in the case of a non-vented bottle, the only ways air can enter the bottle are between the nipple ring and the rim of the bottle and through the holes at the end of the nipple. While sucking, a baby will maintain a seal over the holes at the end of the nipple with her tongue and prevent air entry in this way. If the nipple ring is screwed down tightly this also prevents air entry.
If air is prevented from entering the bottle, this causes a negative pressure to build in the bottle. As the pressure builds, baby need to work harder and harder to extract further milk, until such time and the air pressure is returned to normal. The effort required to suck against the negative pressure can cause a newborn baby to tire and fall asleep before completing the feed. An older baby may simply give up or express her frustration.
WHAT TO DO
The nipple collapsing (not all will) or stopping to burp baby allows air to enter through the holes and neutralize the pressure. But you don’t want to wait for this to resolve the problem. By then baby is already tiring or getting frustrated. See ‘Collapsing nipple’ for ways to manage this problem.
9. Feeding patterns
Is your baby often take only small amounts, refuse more, but then wants to feed again an hour or two later?
Some babies develop a grazing or snacking feeding pattern where they will only drink small amounts of formula at a time and then want to be feed frequently, possibly every hour or two. Although this will not cause any problems for a baby, provided she drinks enough formula in total over a 24 hour period, it can become very tiring for parents to keep up with her constant demands for feeding.
WHAT TO DO
Try to encourage your baby to take as much milk as possible within 45 minutes. But don't try to make her feed if she doesn't want to. Stop sooner if she does not want to continue.
Ensure baby gets plenty of sleep.
Avoid allowing baby to fall asleep while feeding.
Support your baby to extend the time between feeds, by offering a little water, a pacifier, a nap, playing with her, or taking her for a walk. Aim to encourage her to wait at least 3 hours from time you started her previous feed, but only if its reasonable to do so without distressing her. If necessary extend the time between feeds gradually. As your baby gets used to going longer periods between feeds she will gradually take larger amounts at each feed.
10. Excessive night feedings
Is baby feeding more often at night than you would expect?
Unless your baby was born prematurely or is very small for her age, developmentally she no longer requires feeding during the night beyond the age 6 months. If nighttime feeding continues past this age its not going to harm her but it could have a negative effect on her appetite and feeding patterns during the day.
Your baby only needs a certain number of calories in her day (24 hours) to provide for her growth and energy needs. If after the age of 6 months she continues to receive calories from nighttime feeds this will dampen her appetite during the day and she will not need to drink as much formula during daytime feeds. You might find she is content to go for long periods of time between feeds (which is usually what would happen at night). She might fuss or refuse some of her daytime bottles when they are offered simply because she's not hungry at the time. Or she might graze during the day.
Nighttime feeding will cause your baby no harm, so if you're happy to continue feeding her during the night there's no reason to change a thing. However, it is important that you don't expect her to consume as much milk during the day as she may have otherwise taken if she did not feed at night.
Many babies will give up night time feedings on their own accord, but others will continue to wake and demand feeds overnight for months and possibly years while parents continue to provide feeds at night. Usually the reason babies continues to demand night feeds beyond the age of 6 months is because they have learned to rely on feeding as a way to fall asleep, or because their internal body clock gets turned around - where the baby has decreased appetite during the day because of the continued night feeds and as a consequence of small feeds during the day the baby wakes hungry during the night. Body clock problems can easily become a cyclical pattern that will continue over the long term unless parents take steps to change the situation. Healthy, thriving babies who continue to demand feedings at night beyond the age of 6 months often require guidance and support from parents to cease feeding at night and turn their body clock around to a normal day-night feeding pattern.
WHAT TO DO
Aim to cease overnight feeds after 6 months of age. However, before attempting to do this its important to address any feeding to sleep issues your baby might have. She would need to learn to fall asleep in a different way before you will be able to successfully encourage her to cease night feeds.
11. Starting solids early
Have you started giving your baby solids before the age of 4 months?
6 months is the recommended age for starting solid foods. Although a small number of babies may benefit from solids prior to this age, it's generally not recommended to start a baby on solid foods before the age of 4 months. An early start on solids has the potential to cause bottle feeding problems because solid foods may decrease the baby's appetite for milk (breast milk or formula).
WHAT TO DO
If your baby is less than 6 months old, either cease or reduce the amount of solids you offer to see if this helps to improve the situation.
See our article on starting solids.
12. Solids eaten before or between formula feeds
Do you give baby solids between or before bottle feeds?
If solids are offered prior to bottle feeds, either directly before or mid way between feeds, when it's time for your baby's bottle feed she might be feeling full from the solids, in which case she's probably not going to take much milk from her bottle.
WHAT TO DO
For babies 4 - 9 months (when milk is still the most important food) offer solids 15 - 20 minutes after bottle feeds.
For babies 9 - 12 months (when solids are becoming increasingly more important to a baby's diet) offer solids shortly before or shortly after her bottle, whichever you find works best. Babies at this age are often down to 3 bottles per day plus 3 main meals and 1 or 2 snacks.
13. Too much solids
Does your baby love solids so much that she would rather eat solids than drink milk?
In these early stages of learning to eat solids (4 - 7 months) solids are not needed to add value to a baby's nutritional intake, rather they are offered primarily to provide learning experiences. The baby is exposed to new food proteins that help prime her immune system. She gets to discover new tastes and textures and become accustomed to eating from a spoon. It is at this age that babies are most willing to accept new tastes. So variety rather than quantity is what solids are about.
Many babies, particularly very young babies, experience difficulty self-regulating their dietary intake. Some babies will continue to eat solid foods for as long their parents keep offering. Some babies will prefer eating solids compared to drinking formula. However, too much solids and not enough milk is not a balance diet for a baby. It may be necessary for parents to limit the amount of solids they offer in order to encourage their baby to have a greater appetite for milk feeds.
WHAT TO DO
See our article on estimating how much milk your baby needs to make sure she's getting enough.
14. Weaning difficulties
Does your breastfed baby refusing bottle-feeds?
While some breastfed babies willing accept milk from a bottle many will not, at least not straight away.
Difficulty weaning from breast to bottle is rarely resolved by finding the 'right' feeding nipple. (All feeding nipples will feel equally foreign to a breastfed baby.) Nor does a solution lie in finding a formula with the 'right' taste. All formula will taste strange to a breastfed baby). The difficulty associated with weaning to a bottle most often lies in the fact that bottle-feeding requires a very different sucking action to breastfeeding. While breastfeeding the movement of your baby's tongue milks the breast, where as bottle-feeding requires a sucking action. A baby who has been exclusively breastfed beyond the age of 3 months will often refuse milk from a bottle because it "doesn't feel right" and she doesn't know how to suck from a bottle.
It takes time and practice before a breastfed baby learns how to suck on a bottle.
WHAT TO DO
A soft flexible nipple often works better.
NOTE: Many breast fed babies will refuse to accept a bottle while they are still being breastfed at times. They will simply wait until a breastfeed is offered. For these babies it will be the case of breastfeeding or bottle-feeding, but not both.
‘Your Baby's Bottle-Feeding Aversion’ book
In my book, ‘Your baby’s Bottle-feeding Aversion’, I have described physical and behavioral reasons for babies to develop an aversion to bottle-feeding. How to identify the cause and the solutions to match. Included are step-by-step instructions on how to regain your baby’s trust and resolve a feeding aversion caused or reinforced by repeated pressure to feed.
While the book was written for bottle-fed babies, many nursing mothers have found that applying the same strategies has also helped them to successfully resolve a breastfeeding aversion.
You might find that reading this book is all you need to do to understand the steps you need to take to resolve your baby’s feeding aversion and get him back to the point of enjoying eating until satisfied.
Baby Care Advice Consultations
If you would like an individualized assessment of all reasons for infant feeding problems, not just feeding aversion, we also provide a consultation service. Baby Care Advice consultants have extensive experience in pinpointing the cause of feeding aversion and other behavioral feeding problems such as those related to equipment and the parent’s feeding practices. (For more on what’s included in a consultation).
By Rowena Bennett, RN, RM, CHN, MHN, IBCLC.
Copyright www.babycareadvice.com 2021. All rights reserved. Permission from the author must be obtained to reproduce all or any part of this article.
Bottle-Feeding Aversion Program - Coming Soon.