Maybe we shouldn't call this "refusal" because that implies your baby has a choice or is consciously making a choice not to take a bottle. We know that's just not the case with newborns. They don't choose to behave a certain way; they do the best they can with the abilities they have. So instead, let's say When Baby is Struggling to Take a Bottle
Maybe it's back to work, sleep deprivation, or just wanting to get back into your art/yoga/coffee date/therapy/whatever-you-need routine which is making now the right time for baby to take a bottle. When it's not happening it's beyond stressful! I'm hopeful you are getting to this blog post way before the *need* has arrived because that can take some of the pressure off. If, however, you are past the point of choice and are reaching the baby must take a bottle ASAP phase, I can help you, too. Ideally, this would during a one-on-one appointment with me or another skilled and experienced Lactation Consultant (IBCLC). But since we are pretending, you've got a few weeks to make this work, let's make a plan to introduce a bottle for your baby. First, pick a good time to give a bottle. Baby needs to be calm, alert, and showing very early feeding cues. Waiting until baby is upset, fussing, or crying will make it more difficult to bottle feed. Calm baby first, then try some of the tips below which can help set the stage for bottle acceptance:
1. Select the bottle
There are many different nipple shapes and which one is best for your baby can be different based on a lot of factors. We want a nipple which is soft and not too long. The base of the nipple should be moderately wide so baby can create a good seal. Examples of this nipple shape include: Evenflo Balance+, Lansinoh NaturalWave, GentleFlow+, and the Pigeon nipple all have a great shape, texture, and flow rate. Pick the slowest flow rate for these nipples.
2. Hold baby in a comfortable position
Baby will feed best if they feel supported particularly under the bottom and at the shoulders. Many babies feed best slightly reclined. Many parents find it comfortable to sit cross legged and have baby sit in the space between their legs with baby's head and shoulders laying on the caregiver's leg. You can experiment with different positions as long baby feels supported and comfortable, it will make bottle feeding easier. Holding baby flat on their back can make the flow rather fast resulting in sputtering, gagging, and choking.
3. Baby to bottle
Let baby latch onto the bottle rather than trying to put it in their mouth. Rub the nipple lightly on baby's lips and let them lean in and latch when they are ready. Letting baby explore and decide when to latch increases their acceptance. They may grimace and make lots of funny faces as the new textures and taste - this is just fine. Give them time to explore and accept.
4. Angle the bottle
Start the feed with the nipple angled up to the roof of the mouth. The space on the roof of the mouth (palate) causes baby's sucking reflex to start during the first 6ish weeks after birth.
5. Pace the feeding
Once baby is organized and sucking in a rhythm, hold the bottle flat (even with the floor) which allows for milk to flow when baby sucks.
Talk to baby, maintain eye contact, and respond to their cues. If they look stressed, are leaking milk, gagging or anything else that looks uncomfortable tip the bottle down to stop the flow and let baby catch their breath. Talk to your baby. Tell them they are doing so well! They may not understand your words but they know your tone and will be soothed by it. You can sign and hum to your baby, too.
Try having another adult offer the bottle. Maybe dad, grandma, or your best friend has a magic touch.
Use motion like rocking or walking with baby during feeds. A yoga ball bounce is a great favorite! Put baby in a sling and walk around while offering the bottle. Movement is soothing to baby.
Try other positions: snuggle baby close, face them outwards, etc.
Offer the bottle during dream feeding and once that is going well, try it during the day before baby is showing feeding cues.
Ideally, you will introduce a bottle to your baby around 3 weeks if you know you will need to use one long term. I know, I know. You hear that you should wait to introduce a bottle until baby is older but if we wait too long we miss the window of opportunity to take advantage of newborn reflexes and acceptance of new experiences.
It's certainly not impossible with older babies, but the process may take a bit longer and require more techniques to get baby ready for bottle acceptance. So, when possible start around 3 weeks and offer just once a day or every other day. It's a good chance for the nursing parent to get some uninterrupted sleep and for baby's other adults to feed while you rest. <3