Thursday, December 06, 2007

Help! My baby won't take a bottle!

I hear from a lot of families when Mom is heading back to work. All of a sudden, "D day" is a week away and all of the attempts they've made to get baby to take a bottle just aren't working, and they're getting panicked. I hear all sorts of plans they've come up with if baby really never takes that bottle, from spoon feeding to daytime visits to Mom at work, to letting baby just be hungry all day until Mom gets home, and then letting her eat all night to make up for it. I'm so grateful when families call in help from me so they don't have to do any of those things!

Megan and her family are a great example for how we can help her take a bottle, still be loving to her, and get the job done!

Megan was almost 12 weeks old, and was a champion breastfeeder. Sweet little round cheeks and all. She's also a very smart baby, and knows what she likes. She likes breastfeeding with Mom. And she knows what she doesn't want to do - she doesn't want to take a bottle, or, if she's willing to have it in her mouth, she's certainly not going to suck from it.

Mom and Dad tried so many things:
  • Different nipples on the bottles (almost never makes a difference)
  • Different people feeding Megan
  • Sitting in different positions
  • Warm milk in the bottle
  • Cold milk in the bottle
  • Sippy cups
  • Spoon feeding
  • Getting her really comfortable with having the nipple in her mouth
  • Teaching her to use a pacifier

Megan would have nothing to do with the bottle, except letting the nipple sit in her mouth while she played with it with her tongue. And Mom was only 7 days away from heading back to work. They called me, and asked if I could help. I set aside a whole day if they needed it, and went in. I left 5 1/2 hours later, after Megan had happily taken a bottle once from me, and once from Dad. So, what did we do that worked?

I typically see babies do one of two things when learning to take a bottle.

  1. The Stand Off: Baby refuses and refuses, crying and fussing, falling to sleep from exhaustion and waking from hunger until finally, no more than 8 hours later, they give in and drink hungrily from the bottle.
  2. I walk in, present the bottle, and the baby takes it.

The second option happens about 10% of the time. I think it has something do with having someone new cruising in with the full expectation that it'll just work that easily, and baby says "okay!"

The first option is more along the lines of what Megan did. Mom and Dad had done a great job of getting Megan to accept the nipple of the bottle in her mouth, and let it be there peacefully, so she had no bad thoughts about the bottle. So smart! The problem was that Megan just didn't see the bottle as a source of food. That's what Mom is for!

Mom, Dad and I had decided that today was the day - we'd do an all day stand off if need be to get Megan taking that bottle, so this was what we did:

When I arrived, Megan was sleeping, and we knew she'd be hungry when she woke up. Mom had fed her that morning for her first feeding, but her second feeding had been slept through, so we knew she'd be really raring to go. When she woke up she was hungry right away, so I held her for a minute and said hi, getting acquainted, then presented the bottle, which was plain room temperature breastmilk Mom had pumped that morning and left out on the counter. We only had 2 ounces of that liquid gold in there, so we wouldn't be wasting much if we needed to toss it.

Megan let me put the bottle in her mouth, looking at me and gurgling. She played with it for a moment, then spit it out and looked at me as if to say "okay, we played the put the nipple in my mouth game, now give me to Mom so I can eat!" I gently had been telling her that like Mom had told her, she needed to learn how to use the bottle so that when Mom went back to work and she was home with Dad that she and he could share meals together. When she spit the bottle out, I put it down and let her sit up, connecting with her by talking and cuddling.

She clearly gave another hungry cue, so I cuddled her back on my lap and presented the bottle again. This time she got mad, and started fussing and whining. I told her I understood, and that she needed to do this so she could eat when Mom was at work, and that I knew it wasn't what she wanted. After presenting the bottle a number of times more, giving her a break until she was calm before each time, we stood up and started bouncing and walking around the room. I discovered she loves a certain window looking over the valley, and we stayed there for a while, enjoying the window and eachother.

We tried the bottle again, me being firm with it, putting it up against the top of her palate, yet removing it when she spit at it or turned her head.

Finally so frustrated and tired, she fell asleep on my lap. She woke about 30 minutes later, hungrier than ever. I presented the bottle again, and she was really furious. I got up, and headed back to her window, waiting until she was calm until presenting the bottle over and over again. About 3 hours had passed at this point, Mom had left to take a break anticipating a full day of stand off, and Dad had been there, doing work and observing.

Then, after many yelling fits from Megan and repeated attempts from me, the moment came. She took the bottle and started sucking. I kept holding her, bouncing gently, and crooned to her what a very negotiable baby she was being. She sucked down that 2 ounces so fast, within 30 seconds, it was almost too fast for Dad to see!

We got her more milk as fast as we could, but she had already dropped off to sleep - just enough milk to let her relax. When she woke, we moved to Dad, so he could feed her this time. Mom was home now, and waiting to see if it would work. Again, Megan wasn't happy about it, but she took the bottle from Dad as well. Success!

Here's the steps to helping your own baby learn to take the bottle:

  1. As young as 3-4 weeks, once baby is breastfeeding reliably, start introducing a bottle at least once every other day, no matter what. Stopping even for a week might put you back to square one, and cause the need for the above mentioned "stand off". This is great for you and baby - it covers your bases in case of emergency, or if Mom gets sick and needs to take a medication that transfers with breastfeeding, or if Mom and Dad would like to go on a date!
  2. If baby isn't taking a bottle, do what Megan's Mom did, slowly and gently introducing the bottle so baby is familiarized with it. Just put a tiny bit of milk in, so you don't waste.
  3. Help baby with motivation by offering a bottle instead of the breast when she's hungry, but not starving. Tell her with your words what you're doing and why you're doing it.
  4. Hold the nipple of the bottle to the roof of her palate, to stimulate her suck response.
  5. Acknowledge and respect her turning her head or spitting out the nipple - her way of saying "no".
  6. Wait, wait, wait. Choose a day when you'll have a full day to put towards this, just in case it takes a long time. Make sure you have someone with you for moral and physical support, so you can tag team.
  7. Don't give in and feed baby - no baby will starve themself, but this is one of the first major stand offs in your relationship, so it can be hard to get through.
  8. Get professional support if you need or want to. It's a matter of making it happen once, and there's no hard and fast rule that says it has to be Mom or Dad that makes it work. There might be a little stand off later with each, but it'll be much much less.
  9. Stick to your guns, reminding yourself that this is for the ultimate happiness of the whole family, even if baby disagrees in the moment.
  10. If baby is around 6 months or older, consider doing this with a sippy cup instead of bottle, it might save you from having to wean her off the bottle in the near future.

Good luck!

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