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Thread: Not refusing bottle, more like not understanding how to suck

  1. #1
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    Default Not refusing bottle, more like not understanding how to suck

    I've read and followed all the LLL and KellyMom materials regarding introducing a bottle and bottle refusal but it seems like now my 14 week old daughter isn't necessarily refusing the bottle per se but, rather, just doesn't get it -- she'll happily play with the bottle, bring the nipple to her mouth, chew on it, but getting her to actually suck on it is really hit or miss (mainly miss). So when she's hungry (and not wanting to play) she has a complete meltdown given she usually won't take the bottle for it's intended purpose. We've tried various nipple types, all slowest flow, but it doesn't seem to matter so have been sticking with the Kiinde nipples since I use their storage system and the few times she drank a bit it was with the Kiinde nipple (both medium and fast flow -- both of which don't drip when held up-side-down so slower flow than other brands newborn nipples). Anything faster just chokes her and I don't want to damage our breastfeeding success.

    I've started back at work and this is a major source of stress. My husband his trying his best (he has paternity leave for the next two weeks), then she starts daycare and needs to be able to take a bottle. Luckily it's a very small, experienced home daycare and she's the only infant and while the woman who will be taking care of her isn't terribly worried, I'm so sad about how my girl melts down when hungry and I'm not around.

    Any ideas as to how to get her to actually drink from the bottle? I'm open to any suggestions. Many thanks in advance.

  2. #2
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    Default Re: Not refusing bottle, more like not understanding how to

    Care givers could forget bottles entirely and try cup feeding.

    It sounds like you have tried a few different bottles/nipples? What about how baby and bottle is positioned, have you played around with that? Paced feeding is the feeding method that is currently recommended to avoid breastfeeding issues, and it can be done with any type of bottle or nipple. Paced feeding gives baby more control, and thus leads to a more calm feeding experience. Have you been trying that? It is not hard to do but it does take some practice once you know the basics.

    I am not a big believer in the idea that a bottle that does not drip when held upside down means the bottle is less likely to cause breastfeeding issues. These sound like nipples that would be very hard to get milk out of, and that would be very frustrating to baby. The way to prevent overfeeding or overly fast flow from the bottle (these are the suspected root of breast refusal) is to help baby control the flow and the amount of the feeding, and that is what paced feeding does.

    On the other hand, if your husband is doing paced feeding correctly, but baby is not "getting it" and getting upset, then I would suggest first, try a nipple that is easier to get milk out of and second, to adjust the paced feeding position to help baby get more milk.

    Also, baby should usually be fed on cue, small amounts at a time. If baby is disoriented with you not there and not cueing normally or with normal frequency, offering milk when baby is calm, well before hunger sets in, may help.

    Few babies are thrilled with accepting milk from a bottle over the lovely experience of nursing. So this being a difficult adjustment is entirely normal.

    More:

    Paced feeding explanation and description: http://www.llli.org/docs/00000000000...astfedbaby.pdf
    Video: https://www.youtube.com/watch?v=UH4T70OSzGs and https://www.youtube.com/watch?v=ykdFuEOIdeE ignore comments except top one from baby's mom!

    Cup feeding explanation and description: http://www.foleycup.com/aboutus.html (You do not need a Foley cup feeder. Cup feeding can be done with any small clean cup)
    Video: https://www.youtube.com/watch?v=R95FUa7_s84
    Last edited by @llli*maddieb; July 17th, 2015 at 08:41 PM.

  3. #3
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    Default Re: Not refusing bottle, more like not understanding how to

    Thanks for the reply! We had tried a few nipples but just got a bunch more yesterday -- she loved playing (again, not the point but it's better than melting down when it's in her face) with the Tommee Tippee nipple so we are hoping that may be the one. We have watched tons of videos and read up on paced feeding and have every plan to do it once she, well, actually starts sucking/feeding from the bottle. Until then, we are still following paced feeding technique just without her ever "suck, suck, swallowing"...

    I am not a big believer in the idea that a bottle that does not drip when held upside down means the bottle is less likely to cause breastfeeding issues. These sound like nipples that would be very hard to get milk out of, and that would be very frustrating to baby. The way to prevent overfeeding or overly fast flow from the bottle (these are the suspected root of breast refusal) is to help baby control the flow and the amount of the feeding, and that is what paced feeding does.
    This is really helpful as I do think the no-drip ones were causing her frustration.

    Also, baby should usually be fed on cue, small amounts at a time. If baby is disoriented with you not there and not cueing normally or with normal frequency, offering milk when baby is calm, well before hunger sets in, may help.
    I breastfeed on demand and we certainly want to bottle feed on cue -- you are right, though, her cues have completely gone out the window (even with breastfeeding sometimes as she's been very distracted with the world lately) which of course makes things hard. So my husband has been having the bottle around when she's calm and that's when she plays with it. Yesterday she was very happy with this but then it was obvious she was getting hungry and wanted to move on from the "play thing"/bottle and get on the breast and got increasingly upset. She never moved to actually feeding from the bottle (didn't meltdown which is an improvement but just wouldn't feed) and I came home about 10 mins later and fed her (I was out of the house to help things). I do think this is progress though (other nipples she would just flat out reject/not be happy around) so I'm hoping after more time she will get it?

  4. #4
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    Default Re: Not refusing bottle, more like not understanding how to

    I'm hoping after more time she will get it?
    Usually this is what happens when a baby is refusing bottles. Your problem is a little different, so it is hard to say! But again I would suggest in that case, there are alternatives. Not only open cup but sippy cups have been used to give baby milk when mom is not home.

    If you have the resources, I do wonder if it might make sense to see a lactation consultant to make sure there is not some physical barrier to your baby sucking on the bottle.

  5. #5
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    Default Re: Not refusing bottle, more like not understanding how to

    I've seen a lactation consultant (and continue to be in touch with her) and she says everything looks fine (we did have tongue-tie that was corrected at 4 weeks but since then she said all looks good) and she's calling it bottle refusal. Hm.

    One additional question based on this morning's attempt: from various resources we've heard not to continue to give the bottle when she's melting down or super hungry (to avoid negative associations) but at this point it seems like if she's not really hungry she's not going to try to actually feed from the bottle...so should we try to power through a "super hungry meltdown" until she takes it (the baby in one of your videos is crying as well)? We know of people for whom this was the only way over the hump but because we were told otherwise are hesitant. But then again we were told this (not to give the bottle when she's upset) when she was younger. I'm at a complete loss among a see of conflicting advice...it's very frustrating and getting so depressing.

    Any specific cups/sippy cups recommended?

  6. #6
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    Default Re: Not refusing bottle, more like not understanding how to

    First, I would suggest treat all advice including mine as suggestions that may or may not work in your situation! Just as there is never one single perfect way to nurse a baby, there is never a single perfect way to feed a baby supplements. Sometimes you have to throw out everything you heard and just go with your gut as well.

    As far as giving baby the bottle when baby is crying, I think it again depends on the situation- If baby is crying from hunger, then the only thing that makes sense is to get some food into baby right away somehow. Maybe a little instant reward will help (milk dribbled on babies lips/tongue?)

    Also when I suggest offering bottle to baby before baby is hungry, that is not meant to preclude feeding baby when baby is upset. It is an idea for helping baby be more effective with the bottle in general, and my working theory is that offering when baby is calm is a way to help babies nurse better so it theoretically will also help a baby bottle feed better. But if things have reached a critical stage and baby is crying with hunger, of course it makes sense to as gently as possible, get some food into baby. It need not be a ton of food.

    For cup feeding any small cup is fine, and for a sippy cup I would suggest use one that the milk comes pretty easily out of, not one of those complicated ones where baby has to suck like a hoover to get anything. Just as with the open cup, have caregiver control the flow with how the cup/baby are positioned

    and she's calling it bottle refusal. Hm.
    after seeing what actually happens with the bottle, or based on your description?

  7. #7
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    Default Re: Not refusing bottle, more like not understanding how to

    Thanks so much! I'd love to be able to trust my gut but at this point I have such FTM dizziness/self-doubt that I have no idea what to think!
    Your working theory makes complete sense to me.

    I've been emailing with the LC -- I asked if she'd look/see what happens but she said "Bottle reluctance/refusal is so common I think it's the norm for breastfeeding infants. You've described it perfectly...That's the typical response - smiling happily and chewing on the nipple as some folk used to do with a cigar, rolling it around. She's acting that way because she does not want the bottle..." Meanwhile my daughter played more (laughing even) with the bottle again this afternoon, given before she was hungry and just in a great mood (but never sucked). So the LC shot down needing to see it, basically.

    My husband gave 1/8 oz in a medicine cup (kind of like a plastic shot glass w/ ml/oz markings) and she took it well. So perhaps there's hope for that. That said, when I also asked our LC about cup feeding she wrote: "At 3 months it can be hard for a baby to take enough by cup as they have a tongue-thrust action until around 5 months (which is why solids are not handled at all well before this)."

    We'll see how bottle and/or cup goes when she's actually really hungry. My hope is, along with your theory, that since getting these chances to play and become familiar with it, she won't be so freaked out if given when she's hungry...and will hopefully, ultimately suck/swallow.

  8. #8
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    Default Re: Not refusing bottle, more like not understanding how to

    Yikes, sorry for the double post!

  9. #9
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    Default Re: Not refusing bottle, more like not understanding how to

    Well again I guess it is whatever works for YOUR baby. As you can see in the cup video I posted, that particular LC had no reservations about feeding a 6 month old with a cup. It can take some patience from the caregiver to cup feed, for sure. But the same could be said of paced bottle feeding.

    As far as what and what is not bottle refusal, I guess this is something that is entirely in the eye of the beholder. It makes sense that if baby is not very hungry, she won't take anything and will just play.

    And I do agree familiarity is the way to go. Also, some babies just do not eat all that much when away from mom, and make up for it when mom is home.

  10. #10
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    Default Re: Not refusing bottle, more like not understanding how to

    As you can see in the cup video I posted, that particular LC had no reservations about feeding a 6 month old with a cup.
    My LC said before 5 months it's not recommended (the video has a 6 month old)...but if it's not dangerous, it may be our route as she excitedly took 1.5 ounces from the cup yesterday evening from my husband when I had to be at work for a bit (after that she started to meltdown but we think that had more to it being close to bedtime and wanting comfort more than food). She was certainly hungry when he gave it to her and flat out refused the bottle (he offered it before the cup), while happily took the cup. So as long as it's not dangerous or harmful to the breastfeeding relationship we worked so hard for, it may be that cup feeding is for us.

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