Bottle refusal is very common, especially in breastfed babies. Feeding from a bottle uses different mouth and tongue movements, and many babies expect the breast when the breastfeeding parent is close by. What usually helps is patience and changing one thing at a time: who offers the bottle, when, how your baby is held, the teat, and the milk temperature. Never force the teat in or pour milk into your baby's mouth.
Most of the time a baby refusing the bottle is learning, not ill. But a baby who has stopped feeding altogether, seems unwell, or has far fewer wet nappies needs medical help, and some signs need an ambulance. This guide covers the common causes, what to try first, alternatives to a bottle, and exactly when to get help.
Why do babies refuse the bottle?
The Australian Breastfeeding Association's guide to helping your baby take expressed milk and La Leche League's guide to feeding breast milk other than at the breast describe several common reasons:
- It's a new skill. A bottle feels different, and breastfed babies may need to learn new mouth and tongue movements.
- They expect the breast. If the breastfeeding parent is offering the bottle, or is nearby, your baby may hold out for the breast.
- The flow is wrong. Teats vary in shape, size and flow. Too fast can overwhelm a baby; too slow can frustrate an older one.
- Temperature or feel. A cold teat or milk at an unfamiliar temperature can put some babies off.
- Timing. A baby who is already very hungry or upset is less likely to try something new.
- Feeling unwell or teething. A baby who suddenly refuses a bottle they used to take may be unwell. La Leche League notes a chilled teat can help a teething baby.
It isn't a sign you've done anything wrong. The Australian Breastfeeding Association says many babies need time, patience and practice.
What should you try first?
Change one thing at a time and give each change a few calm attempts.
Who offers the bottle
Have someone else offer it, ideally with the breastfeeding parent out of sight or out of the house. The CDC's bottle-feeding guide says a breastfed baby may take a bottle more readily from someone other than the parent who breastfeeds. La Leche League suggests an experienced, confident person who knows your baby well.
Timing
Offer the bottle at early feeding cues, before your baby is very upset. The Australian Breastfeeding Association suggests trying just after waking, when drowsy, or between feeds when they're less hungry. La Leche League suggests a relaxed, playful moment and, if a session goes badly, waiting a while before trying again.
Position and movement
- Hold your baby more upright, perhaps sitting facing you.
- Try facing outwards on the carer's lap, a position that doesn't look like breastfeeding.
- Some babies prefer their usual breastfeeding hold, skin to skin.
- Rocking, swaying or walking while feeding can help.
- Wrapping the bottle in clothing that smells of the breastfeeding parent helps some babies.
Teat and bottle
Try different teats: shape, length, width and flow vary between brands. The Australian Breastfeeding Association says younger babies often prefer a slower flow and older babies may be happy with a faster one. Let your baby draw the teat in rather than pushing it, and use paced bottle feeding so they control the flow.
Milk and teat temperature
La Leche League suggests trying lukewarm, room-temperature or cold milk. Warming the teat under warm (not hot) water can help if it feels cold, and a chilled teat may suit a teething baby.
| If your baby… | Try this first |
|---|---|
| Cries as soon as they see the bottle | Another person offers it, breastfeeding parent out of sight |
| Mouths the teat but won't suck | Different teat shape, or warm the teat |
| Sucks, then splutters and pulls away | Slower teat; keep the bottle more horizontal |
| Takes a little, then refuses | Pause, change position, offer again calmly |
| Only refuses when very hungry | Offer earlier, at the first feeding cues |
Should you keep trying if your baby screams?
No. Stop, comfort your baby and try again later. La Leche League says not to pour milk into a baby's mouth, and the NHS notes in its introduction to mixed feeding that it may take a while for a baby to get used to a new way of feeding. Short, calm attempts are kinder to you both.
If you're preparing for a return to work, start practising a few weeks ahead so nobody is under time pressure. See returning to work.
What can you use instead of a bottle?
The Australian Breastfeeding Association and La Leche League list alternatives:
- A small open cup. Even young babies can sip from a small cup held to the lips, with someone experienced showing you how.
- A spoon or oral syringe for small amounts.
- A supply line at the breast if you're giving top-ups.
- A straw or sipper cup for older babies.
- Expressed milk in food for babies over 6 months.
Hold your baby upright and supervise every feed, whatever you use. La Leche League notes babies older than 6 months may not need a bottle at all; see cups and moving on from bottles.
La Leche League says a healthy, well-grown baby can manage without milk for several hours if necessary. That isn't a reason to stop offering. Keep offering small amounts during the day, breastfeed often when you're together, and watch the wet nappies closely.
When should you get help for bottle refusal?
These signs come from the NHS guide to spotting a seriously ill baby, which also lists a baby who isn't feeding as a sign of serious illness. The RCH dehydration fact sheet treats sunken eyes as severe dehydration that needs hospital care fast, so we put a sunken soft spot in the same tier.
Get urgent advice the same day (your GP or a health advice line (Pregnancy, Birth and Baby on 1800 882 436 in Australia, NHS 111 in the UK, your pediatrician's after-hours line in the US)) if your baby:
- is refusing all milk, from both bottle and breast
- has fewer wet nappies than usual or dark yellow wee
- has few or no tears when crying
- seems unusually irritable, or keeps vomiting
The NHS dehydration page lists fewer wet nappies and few tears as reasons for an urgent appointment. It lists a sunken soft spot and drowsiness there too, but we use the stricter your local emergency number (000 in Australia, 999 in the UK, 911 in the US) tier for those. See dehydration signs for more.
Talk to your GP, child-health nurse or a lactation consultant soon if your baby is well but refusal goes on for more than a few days of trying, is affecting their weight gain, or if feeds seem painful or your baby coughs and splutters at every feed. For breastfeeding support, contact a breastfeeding helpline (the Australian Breastfeeding Association on 1800 686 268 in Australia, the National Breastfeeding Helpline on 0300 100 0212 in the UK).
What's worth noting while you work on it?
Write down who offered the bottle, the time, the teat and milk temperature, and how much was taken (if any). Add wet nappies for the day. After a few days, the notes usually show which changes helped, and they give your GP or child-health nurse a clear picture if you need advice.
