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The First Year

When Baby Refuses

Persistence and Patience Should Convince Him to Take a Bottle

Question:
     Our baby, Nico, is 4 months old. I’m going back to work in two weeks, and we have a problem. On the days that I work, he will be at home with my husband or a sitter. Nico is happy being with both of them, but there’s one big problem. Nico is breastfeeding and is refusing to take a bottle of expressed milk. He took a bottle fine a couple of weeks ago, but we went on vacation and stopped giving it to him. Since then, he’s been really mad when we offer it. I’ve tried being out of the house for a while, but when he gets hungry, he still refuses. As soon as I get home, he nurses and is fine. His dad and I are really stressed out. What can we do?

Answer:
     You’re not the first parents to discover that an older baby is often more set in his ways than a younger one. A determined 4-month-old baby who enjoys breastfeeding can be very resistant to any other method of drinking milk. You were wise to introduce Nico to the bottle when he was younger, but you didn’t know how important it was to keep offering every day so that he continued his enthusiasm. It’s understandable — why offer a bottle when Mom is right there?
     The trick to persuading an older baby to take a bottle is to take your time and to not give up. Don’t expect Nico to change his mind overnight. He won’t starve, but he may wind up wanting to nurse a lot when you get home and at night to make up for what he’s missed. In fact, if you are only away from him a few days a week and nurse him all the rest of the time, he may be able to get by without nursing while you’re gone. Of course, it will certainly be easier on everyone if you can get him to accept a bottle.
     Starting immediately, it’s important to offer Nico a bottle a few times a day, every day, whether or not it is a workday for you. If Dad or the sitter is only trying to bottle feed on the days that you are away, Nico won’t be getting enough consistent practice.
     The first step is to help Nico get used to the feel of an artificial nipple in his mouth. An artificial nipple has a different feel than the warm, soft, mother-scented one he prefers. Don’t worry if he’s reluctant to take any liquid from the bottle at first. You may be able to make the bottle-feeding more appealing offering him water, or even better, “sugar water” made by mixing 4 ounces of water with
1 teaspoon of sugar. This water mixture is less sweet than breast milk and because it is different, it doesn’t remind the baby so much of what he’s missing by not having the breast. This is a temporary measure, so don’t worry that you’ll be getting Nico hooked on sweets.
    When you are offering the bottle, it’s fine if Nico just takes a few sips. It’s better to make the experience pleasant, pause, wait and try again. Once he’s pushing the bottle away, it will be much harder to get him to change his mind.
     If at all possible, the person who offers the practice bottles should be someone other than Mom.  The scent of his mother, or even her presence in the room, will often confuse a baby and anger him about the new source of milk. Besides, it’s very hard for most mothers to resist baby’s protests. With Mom hovering, the person giving the bottle tenses up and the baby feels the tension.
     Here are more suggestions to follow as you’re looking for a strategy with Nico. Try each idea for a few days. Don’t switch the approach every day, but after the third day a method isn’t working, try something else.
     • Try different types of nipples. Make sure that Nico can get milk with a minimum of work. Some nipples have smaller holes and can be frustrating for an older baby. There are hundreds of different shapes — try a couple, but don’t keep trying, since consistency is important, too.
     • Try to hold your Nico in different positions, such as away from your body, facing you or in an infant seat. After he is used to a bottle, you can go back to holding him close while he feeds.
     • Offer the bottle when Nico is hungry, half full or when he doesn’t seem hungry at all. Babies are different in the times when they will be receptive to a new way of feeding. Some babies will take a bottle in the evening after breastfeeding, when a mother’s milk supply is naturally low.
     • Offer the bottle when Nico is awake and alert. If that doesn’t work, wait until he’s sleepy. It’s hard to predict in which state a baby is likely to be less resistant, so try both. Most babies, however, will not calm down and take a bottle once they are furious. It’s better to stop, soothe him and try again a little later. If repeated tries are unsuccessful, end your attempts and try again an hour later. Don’t battle Nico — that will make him angry and more resistant.
     If you find that despite all of your daily efforts Nico is still refusing the bottle, you have a couple of choices. You can offer him breast milk from an eyedropper or a spoon to get him used to taking milk in a different way. Or you can start offering him easy-to-digest “soupy” solids such as rice cereal with lots of milk or jarred fruits or vegetables that are high in water. (The American Academy of Pediatrics currently recommends introducing solid foods between 4 and 6 months of age. Breast milk should still be his primary food source at this time, but need not be the only one. You don’t have to give him large quantities of these foods. He only needs enough to get him through the day.)
     It’s hard enough to leave a baby to go back to work without worrying about his feeding. Fortunately, time is on your side. You may have to do more nursing in the evening and at night than you had planned, but if you keep presenting Nico with a bottle day after day, he will eventually figure out that there is more than one way to get his mom’s milk.

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