Study: Breastfed babies refusing the bottle

Published in June 2020.
Maxwell C, Fleming KM, Fleming V, Porcellato L. Matern Child Nutr. 2020;16:e13047.
‘Bottle refusal is when a breastfed baby initially or continuously refuses to accept a bottle containing either expressed breastmilk or infant formula.
Little is known about bottle refusal in breastfed babies; however, an informal review of global online forums and social media suggested large numbers of mothers experiencing the scenario.
The study aimed to explore UK mothers’ experiences of bottle refusal by their breastfed baby in order to provide understanding of the scenario and enhance support for mothers experiencing it. A 22-point online questionnaire was developed and completed by 841 UK mothers. Findings suggest that mothers introduced a bottle to their breastfed baby due to physical, psychological and socio-cultural factors. Advice and support for mothers experiencing bottle refusal was not always helpful, and 27% of mothers reported bottle refusal as having a negative impact on their breastfeeding experience. When compared with eventual bottle acceptance, bottle refusal was significantly associated with previous experience of bottle refusal, how frequently mothers intended to feed their baby by bottle and babies being younger at the first attempt to introduce a bottle.
The study provides a unique insight into the complexities of bottle refusal by breastfed babies and the impact it can have upon mothers’ breastfeeding experiences. It generates knowledge and understanding that can help to inform practice and policies. In addition, a ‘normalising’ of the scenario could enable mothers, and those supporting them, to view and manage it more positively.’

Key messages

  • There is no one definitive reason why a breastfed baby refuses to bottle feed
  • The psychological benefits of breastfeeding appear to underpin refusal for some babies.
  • Biologically, babies expect to breastfeed; bottle feeding is not a normal concept for them.
  • A breastfed baby’s individual personality/temperament may underpin their bottle refusal.
  • Mothers explain refusal as their baby ‘disliking’ certain bottle brands and being introduced to a bottle ‘too late’.

A note from Suzy:

Having worked successfully on bottle refusal issues with many families over many years, I know just how utterly frustrating it can be! Mothers have felt trapped by the constant breastfeeding.  Fathers have felt helpless and left out because, let’s face it, feeding is an important bonding moment between parent and baby.
If you are stressed by constant refusals and it just doesn’t feel right to keep insisting then please, please stop because it is very likely your baby is feeling exactly the same way. Take a break for a minimum of at least two weeks.  Call me, I can carry out a full analysis because sometimes finding the cause can make a huge difference to how, or when, you offer the bottle. You can opt for a virtual consultation with effective information before you try again. Alternatively, I will work with you in your home showing you an intuitive and respectful technique that has worked for so many of my clients. My aim is for you to understand what to do and why. You will feel empowered around positive feeding in general and your baby learns to really enjoy bottle feeding.