Care Plan for Bottle Refusal by a Breastfed Infant

Many parents go back to work or school before their new baby is able to fully self-feed, so
providing milk (whether expressed or formula) with a bottle is a regular fact of life. Occasionally,
babies refuse to drink from the offered bottle, leading to stress and frustration for the family.
Babies may cry, turn away or spit out the bottle, dribble the milk out of the mouth and refuse to
swallow, go to sleep, or refuse to eat while their parents are away. There are techniques to
resolve and overcome bottle refusal, depending on the cause.

Suggestions
● “Soapy” smell: sometimes babies don’t like the taste of excess lipase enzyme in the
milk. Follow treatment for high lipase milk.
● Paced bottlefeeding: feeding baby with a bottle in a cradle or reclined position can cause
the milk to flow too fast and choke baby. Instead, tilt baby upright and hold the bottle
horizontal, so the baby is in control of the flow of milk rather than gravity.
● Nipple shape: if baby is used to a certain shape of pacifier but refuses bottles, try finding
a bottle with the nipple of a similar shape to their favorite pacifier.
● Flow rate: milk coming out of the nipple too slow or too fast can cause baby to choke or
get frustrated. Flow speed is not standardized between bottle brands. Try the slowest
flow nipples for that bottle brand, to see which one baby accepts most easily.
● Age of introduction: start practicing with a little bit of milk in a bottle between 6 weeks
and 10 weeks. Babies older than 3 months are expert breastfeeders and may be harder
to persuade to try!
● Time of day: offer bottle when baby is sleepy or tired but not too hungry.
● Another caregiver: some babies may not want the bottle from the lactating parent but
would accept it from another person. It may also help for them to wear a piece of
clothing with the lactating parent’s scent.
● Get baby checked for oral restrictions or asymmetries: sometimes the baby is hungry
and willing to drink from a bottle, but anatomical issues limit their ability to manage the
process.

Alternative Solutions
● Reverse cycling: baby wakes more frequently at night to feed at the breast, making up
for missed feedings during the day.
● Cup, spoon or sippy cup: try a different type of container to deliver the milk.
● Breaktime feedings: Have someone bring baby to you to breastfeed on work breaks or
lunch hour.
● Be patient and calm! Babies can learn to accept a bottle -- it just may take a little time.

Additional Resources
● “Bottle Refusal” article by IABLE, Bottle Refusal - The Institute for Breastfeeding and
Lactation Education (IABLE)
● “Bottles and Other Tools” article by LLLI, https://www.llli.org/breastfeeding-info/bottles/