Why won't my breastfed baby take a bottle?
There are several reasons why parents decide they want or need their breastfed baby to consume milk from a bottle. When or if that decision is made, many parents find they are caught off guard by their baby’s refusal to bottle-feed. They might try several different strategies to “encourage” their baby to accept. However, without a clear understanding of the reason for their baby’s refusal, they may be unknowingly making what is often a stressful situation even worse.
An effective solution to your baby’s bottle-feeding refusal depends on the reason or reasons for his refusal. In this article I describe the most common reasons for breastfed babies to refuse to feed from a bottle.
Why some breastfed babies are more or less willing to feed from a bottle
Babies are creatures of habit. They learn through repetition. Through past feeding experiences, babies learn what to expect when they are fed. Like the rest of us, babies develop preferences in regard to the taste of the food and the way they like things done. Some babies are more accepting and others more cautious of change because of their temperament type (inborn personality traits).
Recognizing these characteristics may make it easier for you to understand why your baby might behave as he does when you make changes to what he has learned to expect at feeding times.
Causes of bottle refusal
Common reasons for physically well, typically developing breastfed babies to refuse to feed from a bottle include:
- Baby doesn’t know how to feed from a bottle.
- Baby objects to the taste of infant formula or stored breast milk.
- Baby has no incentive to want to bottle-feed.
- Baby prefers to breastfeed.
- Baby has learned to depend on breastfeeding to fall asleep.
- Baby has developed an aversion to bottle-feeding.
- Baby prefers to be bottle-fed by one parent only.
Of course, there are other potential reasons for bottle refusal, such as loss of appetite due to illness or sucking problems. It will be obvious to you if your baby is unwell. If he has a history of successful breastfeeding, you can rule out a sucking problem.
1. Baby doesn’t know how to bottle-feed
One of the most common of all reasons for breastfed babies to refuse to feed from a bottle is simply because they don’t know how.
The oro-motor actions required to successfully breastfeed are different from those required to bottle-feed. An active sucking reflex enables a baby to feed from both breast and bottle in the early weeks following birth. However, it is only through repetition that he “learns” to feed either way, or both. Once his sucking reflex has disappeared (between three and four months of age), whether he “knows how” to breastfeed or bottle-feed depends on prior learning.
If you want to encourage a breastfed baby to learn to feed from a bottle with minimum risk to successful breastfeeding, it’s all about the timing. Introducing a breastfed baby to bottle-feeding too soon (before the age of four weeks) can make it harder for him to learn to breastfeed. Too late (after eight weeks of age) can result in bottle refusal.
It's not sufficient to randomly offer your baby milk from a bottle and expect that he has learned how to bottle-feed or that he will be willing to bottle-feed after his sucking reflex has disappeared. He will require opportunities to practice feeding from a bottle (at least once a day or every other day) before he learns the skills required to effectively feed from a bottle.
Most breastfed babies who have limited or no bottle-feeding experience before the age of three months will be confused by the feel of a silicone nipple in their mouth, which is nothing like their mother’s nipple despite what the manufacturers of nipples claim. In addition to not knowing how to suck from a bottle, they may not identify a silicone nipple or bottle as being a means to satisfy their hunger. Hence, a baby lacking sufficient bottle-feeding experience might simply play with the nipple without sucking if he is not hungry or reject and become upset if he is.
It is possible for babies to learn to bottle-feed after their sucking reflex has disappeared, but it’s not easy.
2. Baby objects to the taste of formula or stored breast milk
A breastfed baby could know how to bottle-feed but refuse some or all bottle-feeds because he is confused by the unfamiliar taste of baby formula or stored breast milk, or because he finds the taste to be unpleasant or repulsive.
Freshly pumped breast milk typically has a pleasant, sweet taste. However, the taste of breast milk can change…
- when refrigerated or frozen. How different stored breast milk will taste from freshly pumped breast milk depends on how long the milk has been stored.
- by the effects of lipase. Breast milk contains lipase, a digestive enzyme that breaks down the fat. The longer the milk is stored, the more lipase activity it will have. High levels of lipase can cause breast milk to have a soapy or sour taste. Many but not all babies will be accepting of the taste. (See XX for what to do it your baby objects to the taste.)
- Regular baby formula has a pleasant taste but it does not taste the same as breast milk. Your baby could reject a bottle containing baby formula because the taste is unfamiliar.
- Most hypoallergenic formulas have an unpleasant, bitter taste which babies in general will initially object to. There is a stark contrast in taste between hypoallergenic formula and breast milk. If a hypoallergenic formula is the only milk the baby receives, most babies will come around to accepting it—provided their parent doesn’t try to force them to drink it.
Anything you add to your baby’s milk has the potential to alter the taste. For example.
- Fortifying breast milk. Sometimes parents are advised to add a regular formula or hypoallergenic formula powder into breast milk to increase the calorie and nutrient content.
- Vitamins or medications. This is not advisable because it may not only change the taste of the milk, but it also encourages parents to pressure their baby to finish the bottle so that he receives the full dosage.
- Food thickeners won’t necessarily change the taste in a noticeable way, but they change the viscosity (thickness) of the milk. Anything a baby finds unfamiliar can be met with frustration and rejection.
Some parents switch between milk when offering a bottle-feed—for example one bottle may contain breast milk but the next contains baby formula. A baby could refuse some feeds but not others depending on whether he prefers or rejects the taste. Alternatively, he could reject all bottle-feeds, even those containing his preferred milk, because he thinks it’s going to taste bad.
3. Baby has no incentive to want to bottle-feed
Hunger is the primary motivator for a baby to want to eat. If your baby’s nutritional needs are met through breastfeeding, he may have no incentive to want to bottle-feed and hence refuse. However, he might accept the breast even when he’s not hungry (and comfort sucks rather than actively feed) because the familiarity of breastfeeding provides a sense of comfort and security.
4. Baby prefers to breastfeed
When breastfeeding is successful, it is a pleasurable experience for the baby and mother.
If given the option, a breastfed baby will generally choose to breastfeed rather than bottle-feed. More so if past bottle-feeding experiences have been unpleasant, frustrating or stressful.
In many instances, while attempt to get their baby to accept milk from a bottle, parents will offer their baby a bottle-feed when he displays signs of hunger. And if met with refusal, then offer a breastfeed. When repeated, the baby learns that after rejecting the bottle, he will be offered a breastfeed.
5. Baby has learned to depend on breastfeeding to fall asleep
A sleep association refers to the conditions, props or activities the baby learns to psychologically link with the act of falling asleep. A breastfeeding-sleep association means the baby has learned to rely on breastfeeding in order to fall asleep.
There are a couple of reasons why a breastfeeding-sleep association might unknowingly discourage a baby from feeding from a bottle.
- If his nutritional needs are met when breastfeeding to sleep, he may not get the opportunity to be hungry enough to want to bottle-feed.
- If he is offered a bottle-feed when tired and ready to sleep (a time that he will be wanting and expecting to breastfeed) he will likely become frustrated, upset and refuse because he wants to fall asleep but does not associate bottle-feeding with the act of falling asleep.
(See our article entitled Breastfeeding to sleep for more.)
6. Baby has developed a bottle-feeding aversion
A feeding aversion is a fear of feeding. There are several potential reasons for why babies become averse to bottle-feeding (and/or breastfeeding). The most common cause is the stress caused by being pressured or forced to feed. (See our article on feeding aversions for causes and behaviors displayed by feeding-averse babies.)
A bottle-feeding aversion could be the original reason for a baby’s bottle-feeding refusal or it could become an additional reason on top of one or more of the reasons for bottle refusal already mentioned.
7. Baby prefers to be bottle-fed by one parent only
Sometimes the baby will accept bottle-feeds offered by his mother but rejects when other caregivers offer, or the other way around.
The baby may accept bottle-feed from one parent (usually the primary caregiver, which is generally the mother) because of the emotional connection he has built with that parent as a result of past pleasurable feeding experiences.
Alternatively, a baby may reject bottle-feeds offered by his mother because he associates her with breastfeeding and is confused by her offer to bottle-feed him. If combined with a breastfeeding preference, he may become frustrated or upset by her attempts to give him milk from a bottle rather than breastfeed as she would normally do. Another reason for rejection when offered a bottle-feed by one parent or caregiver can be because the baby has learned they will pressure or force him to feed.
The solution could be simple or complex
As you can see there are several potential reasons why a breastfed baby might to refuse milk from a bottle. The solution could be as simple as providing consistency with the milk offered, or as complex as teaching a baby how to bottle-feed or require the parent to make changes in their feeding practices to resolve their baby’s aversion to bottle-feeding.
To be effective the solution must address the cause or causes of your baby’s refusal. This can be complicated by multiple individual factors, such as...
- The reason you want your baby to accept bottle-feeds. Sometimes, this is because of the stress caused by an unrecognized and therefore unresolved breastfeeding aversion, or because of low milk supply, poor growth, or because the mother is returning to work, or simply to allow for others to feed baby while mom has a brief break, perhaps to sleep or simply to enjoy a few hours doing something else.
- Whether your goal is for your baby to bottle-feed partially or fully. If partial, how often?
- The urgency of the situation. For example, is it essential for your baby to bottle feed in the near or distant future?
- The type and taste of milk you plan to offer your baby from a bottle. For example, whether your baby will receive breast milk only, and whether this will be freshly pumped or milk that has be refrigerated or frozen, or a regular or hypoallergenic baby formula, or a combination of breast milk and baby formula.
- Your baby’s age, state of health and growth and his/her prior bottle-feeding experience, feeding expectations, and whether or not he/she has learned to depend on breastfeeding as a way to fall asleep.
- The suitability of the bottle-feeding equipment for your baby’s latch and sucking abilities.
- Yours and any other caregiver’s responsiveness to your baby’s feeding cues when bottle-feeding him. (One or more caregivers could unknowingly be overlooking, misinterpreting baby’s feeding cues, which would make for an unpleasant or stressful experience for your baby, and consequently cause or reinforce a bottle-feeding aversion.)
Unfortunately, it is not possible to cover all potential combinations in a single website article.
However, it is possible for one of Baby Care Advice consultants to thoroughly assess and consider all variables that apply in your baby’s circumstances and develop an individualize plan to effectively solve the problem of bottle refusal and achieve your goal.
Written by Rowena Bennett, RN, MHN, CHN, IBCLC.
Published Baby Care Advice website.
© Copyright 2023. All rights reserved.
How we can help
Baby Care Advice provides an opportunity for parents world-wide to receive individualized feeding advice specifically to address their baby’s and family unique circumstances.
Whether your goal is to harmoniously combine breast- and bottle-feeding or to switch your baby completely over to bottle-feedings, through a booked consultation, one of our consultants can help you to develop an effective plan. If you would like daily email support as you resolve this troubling situation, it can be arranged. See bottle-feeding consultation for more information on how we can help.