Baby refusing feeds and crying

Baby Refusing the Bottle? Try These Tips

If you’re having trouble bottle-feeding your infant, rest assured that you are far from alone. Around 25 percent of parents report feeding-related problems with their child at some point in their development.

If your baby has been breastfeeding, trying to introduce a bottle can also introduce some challenges. Likewise, changes to the formula or breast milk you’re giving them or the bottle you’re using can lead to difficulties even for experienced bottle-fed babies.

The American Academy of Pediatrics recommends delaying the introduction of foods other than breast milk until your baby is around 6 months old, suggesting exclusive breastfeeding before that time. However that’s not always realistic and you may find yourself introducing the bottle at any time during the first year.

Additionally, formula isn’t the only reason to use a bottle. Many breastfeeding parents want to incorporate bottle-feeding of breast milk for flexibility. The breastfeeding advocacy organization La Leche League suggests waiting until your breastfeeding baby is 3 to 4 weeks old before introducing a bottle.

Whenever you begin using bottles, it can be extremely frustrating trying to feed a baby who stubbornly refuses feeds. But with dedication, experimentation, patience, and love, you can eventually acclimate your baby to bottle-feeding.

Since babies can’t communicate clearly, parents and caregivers are left wondering and guessing why their baby refuses bottle-feeding. The following reasons are some of the most common things to look out for if your baby refuses the bottle:

• Your baby was recently weaned and wants to continue breastfeeding.
• Your baby isn’t hungry enough to want feeding.
• Your baby is feeling sick, colicky, or otherwise unwell enough to feed.
• Your baby is being held in an uncomfortable position.
• Your baby doesn’t like the temperature, flavor, or texture of the milk.
• Your baby doesn’t like the texture or feel of the bottle.

Depending on your previous experience with feeding you may be able to figure out the specific reasons why they’re refusing the bottle. Many times, knowing why they refuse can give you better insight into figuring out how to fix the problem.

Some of the most common and effective things you can try to help your baby accept bottle-feeding include:

• Slowly, consistently, and gradually transition from breastfeeding to bottle-feeding.
• Wait until your baby is sufficiently hungry before feeding.
• Try changing the bottle size and shape, the nipple, or other aspects of the bottle to see what your baby responds to.
• Experiment with the temperature of the milk or formula. Breast milk is lukewarm, so make sure the bottle isn’t too warm or cool.
• If your baby is teething, try changing the temperature of the milk (teething babies sometimes prefer cold milk), massaging their gums, or otherwise helping them with the pain of new teeth poking through.
• Hold your baby in a different feeding position and see what they respond to.
• Allow someone else to handle the feeding. This can be especially helpful during a transition from breastfeeding to bottle-feeding.

Before changing the formula you’re using you may want to talk to your pediatrician. There are different types of formula customized to different needs, but too many changes or certain types of formula can cause other challenges.

More tips to try

In addition to the list of possible remedies above, it is important to try to have a calm and consistent approach to bottle-feeding. Sometimes, your own frustrations with bottle-feeding can affect the infant and make it even harder for them to change.

In general, try to follow these behavioral tips for yourself when bottle-feeding a fussy baby:

• Maintain a comforting routine around mealtime.
• Avoid distractions, such as media, music, and toys when bottle-feeding.
• Feed your child at consistent time intervals of 3 to 4 hours.
• Stay calm and consistent. Don’t become angry, anxious, or overly excited with your feeding child.
• Limit mealtimes to 30 minutes.
• Try to avoid frustration during feeds. Consider having another caregiver offer the bottle if you need a break.

While it is normal for babies to sometimes refuse a bottle, there are some instances where chronic refusal to feed can be indicative of an eating disorder or an illness that requires medical attention.

About 1 to 5 percent of very young children have feeding disorder, which is characterized by an inability to consume an adequate amount of food, resulting in malnutrition.

Getting enough food is absolutely essential for a growing baby. If you think your baby is experiencing a feeding disorder making it difficult for them to gain weight, you should see a doctor immediately. Feeding disorders in early childhood are an important health issue.

In the short term, babies with feeding disorders will experience nutritional deficiency and weight loss (or inadequate weight gain), but in the long term, your baby can experience growth deficits, cognitive functioning problems, stunted neurodevelopment, and behavioral or emotional impairment.

Another time to talk to your baby’s doctor is if your baby refuses to eat due to an illness or pain. Call your doctor right away if in addition to refusing the bottle your baby is showing any of the following symptoms:

• fever
• vomiting
• constant crying
• diarrhea
• difficulty breathing

Consult with a doctor to determine whether there are any illnesses or physiological issues you are unaware of that might play a part in your child’s fussy eating.

Feeding difficulties are common problems in infants and toddlers. Don’t be too worried if your baby is struggling with the transition to bottle-feeding.

There are many different approaches you can take to fixing the problem, and if you are nervous or worried about any of your child’s eating habits, contact your doctor immediately.

With consistency, determination, and lots of attention paid to your baby, you can help them overcome their obstacles and anxieties around bottle-feeding.

Bottle Feeding Problems - Why Your Baby Squirms, Appears Uncomfortable – Baby Care Advice

When your baby squirms, appears uncomfortable during a feed, fusses, cries or refuses a bottle, seemingly fights the bottle despite being hungry, it can be challenge to figure out the cause. The timing and type of behavior she exhibits provides vital clues.

Does your baby display troubled behavior in relation to bottle-feeding, such as….

• Refuses a bottle
• Turning away from the bottle.
• Refusing to close her mouth around the nipple.
• Holding nipple in the mouth but not sucking.
• Taking only a small amount and then refusing more.
• Screaming when placed into a feeding position or at the sight of the bottle.
• Milk pouring out of baby's mouth.
• Feeding too quickly.
• Feeding too slowly.
• Falling asleep before the feed is completed.
• Coughing and spluttering when feeding.
• Not consuming as much milk as expected.
• Wanting more milk than expected.
• Throwing up large amounts of milk.

Then there may be steps you can take to remedy the situation and get your baby to calmly and happily take a bottle.  

‘Behavioral’ means baby’s behavior is in response to the circumstances rather than a physical cause. Behavioral reasons are the most common of all reasons for infant feeding problems. There are numerous behavioral reasons for a baby to experience feeding problems and/or display problematic feeding behavior. Common reasons include:

Babies are in an oral stage of develop. Sucking is the primary way babies soothe. They also learn by sucking and mouthing objects. Many babies have a strong desire to suck for reasons that extend beyond hunger, such as tiredness, boredom, discomfort and soothing. There may be times when you mistake your baby’s desire to suck for these reasons as hunger. 

Newborn babies have an active sucking reflex. This means a newborn baby may accept a feed even when she’s not hungry, and she might guzzle down the bottle because she cannot choose to not suck when her sucking reflex is triggered. Once her sucking reflex has disappeared (usually by 3 months of age) she will willingly take only the amount she wants to take. 

If you have mistakenly interpret her fussing or desire to such as hunger and offer her a feed, she might take a little and refuse the rest, or she refuse from the start. If you try to make her drink more than she wants, she will understandably get upset and fuss, cry and pull back from the bottle. 

• See Hungry baby for more reasons why babies often appear
• See Infant reflexes

2. Unrealistic expectations

In around one third of consultations I have had with parents regarding an infant feeding problem, I found that parents were trying to make their baby drink more than he or she needed. In some cases, this was because of errors made their health professionals. They either failed to adjust calculations as baby matured or failed to consider baby as an individual.  As a result, overestimated baby’s milk requirements.

If you think your baby is not drinking enough milk (breast milk or infant formula) you’re naturally going to feel concerned. If your concern translates into trying to pressure her to drink more than she wants or needs (gently or otherwise), you’re going to upset her. So it is very important for your peace of mind and your baby’s enjoyment at feeding times that you have realistic expectations about how much she needs.  

• See How much milk does baby need for standard estimations for age and weight, and reason why a baby might take more or less than recommended.
• Follow your baby's feeding cues. Don't try to make her take more when she indicates she has had enough.

Sleeping and feeding are closely related when it comes to the needs of babies. Both are equally important to a baby's health, growth and development and feelings of wellbeing. You are no doubt aware that if your baby does not feed well she might not sleep well. But are you aware that the opposite is equally true. If she’s not getting enough sleep this has the potential to negatively impact on her feeding. 

Physical fatigue can cause baby to fuss during feeds or falling asleep before the feed is completed. If you have a hungry/tired baby on your hands, tiredness will usually win out.

• Ensure baby gets enough sleep.
• Feed her before she becomes too tired.
• Aim to establish a flexible feeding and sleep routine to minimize the risk of feeding and sleep times clashing.

If your baby is often irritable and not sleeping enough, (see Overtired baby for signs and symptoms) you might find that resolving any underlying sleeping problem will cause feeding difficulties to spontaneously resolve once she receives adequate sleep.

• See our sleep section.
• Download or order a paperback copy of my infant sleep book Your Sleepless Baby: The Rescue Guide. There you will find comprehensive information on the reasons and solutions to various infant sleeping problems.  

Babies over the age of 4 months can easily become distracted while feeding. They are often much more interested in the activities going on around them than they are in feeding.

Feed your baby in a quiet environment away from noise and distractions of other children.

Some feeding problems can be related to what may appear like insignificant details but which can make feeding difficult or uncomfortable for a baby. For example, how you hold your baby will affect her ability to feed from a bottle. If her head is too far forward or too far back or her neck is twisted this can make it difficult for her to suck or swallow.

See How to bottle-fed a baby

A baby can develop an aversion to feeding when past feeding experiences have taught her that feeding is unpleasant, stressful or painful. Typically, baby is diagnosed with reflux and/or milk protein allergy or intolerance to explain her aversive feeding behavior. However, a behavioral feeding aversion (related to feeding management rather than a physical cause) is a far more common cause of infant feeding aversion.

A feeding aversion is the most complex of all infant feeding problems. An effective solution relies heavily on accurate identification of the cause.

See Feeding aversion for more information. Or purchase or download a copy of 'Your Baby's Bottle-Feeding Aversion: Reasons and Solutions'.

It could be the nipple is too long, too short, too fast or too slow.  

The most important piece of feeding equipment is the nipple. The nipple needs to be the right size and speed for your baby's size, age and sucking ability. If the nipple is too long, too short, too fast or too slow for your baby, she may experience feeding difficulties and express her frustration by fuss or crying.

• See Feeding equipment for more information on choosing a feeding nipple.
• Experiment with nipples of different lengths, shapes and speed.

It's possible her feeding difficulties could be due to the nipple ring being screwed on too tight.

In order to maintain a neutral balance in air pressure within the bottle air needs to be able to enter the bottle to replace the void left by the milk the baby is removing. If the bottle is vented, this is achieved via the venting system. However, in the case of a non-vented bottle, the only ways air can enter the bottle are between the nipple ring and the rim of the bottle and through the holes at the end of the nipple. While sucking, a baby will maintain a seal over the holes at the end of the nipple with her tongue and prevent air entry in this way. If the nipple ring is screwed down tightly this also prevents air entry. 

If air is prevented from entering the bottle, this causes a negative pressure to build in the bottle. As the pressure builds, baby need to work harder and harder to extract further milk, until such time and the air pressure is returned to normal. The effort required to suck against the negative pressure can cause a newborn baby to tire and fall asleep before completing the feed. An older baby may simply give up or express her frustration. 

The nipple collapsing (not all will) or stopping to burp baby allows air to enter through the holes and neutralize the pressure. But you don’t want to wait for this to resolve the problem. By then baby is already tiring or getting frustrated. See ‘Collapsing nipple’ for ways to manage this problem.

9. Feeding patterns

Some babies develop a grazing or snacking feeding pattern where they will only drink small amounts of formula at a time and then want to be feed frequently, possibly every hour or two. Although this will not cause any problems for a baby, provided she drinks enough formula in total over a 24 hour period, it can become very tiring for parents to keep up with her constant demands for feeding.

• Try to encourage your baby to take as much milk as possible within 45 minutes. But don't try to make her feed if she doesn't want to. Stop sooner if she does not want to continue. 
• Ensure baby gets plenty of sleep.
• Avoid allowing baby to fall asleep while feeding.
• Support your baby to extend the time between feeds, by offering a little water, a pacifier, a nap, playing with her, or taking her for a walk. Aim to encourage her to wait at least 3 hours from time you started her previous feed, but only if it's reasonable to do so without distressing her. If necessary extend the time between feeds gradually. As your baby gets used to going longer periods between feeds she will gradually take larger amounts at each feed. 

Unless your baby was born prematurely or is very small for her age, developmentally she no longer requires feeding during the night beyond the age 6 months. If nighttime feeding continues past this age its not going to harm her but it could have a negative effect on her appetite and feeding patterns during the day.  

Your baby only needs a certain number of calories in her day (24 hours) to provide for her growth and energy needs. If after the age of 6 months she continues to receive calories from nighttime feeds this will dampen her appetite during the day and she will not need to drink as much formula during daytime feeds. You might find she is content to go for long periods of time between feeds (which is usually what would happen at night). She might fuss or refuse some of her daytime bottles when they are offered simply because she's not hungry at the time. Or she might graze during the day. 

Nighttime feeding will cause your baby no harm, so if you're happy to continue feeding her during the night there's no reason to change a thing. However, it is important that you don't expect her to consume as much milk during the day as she may have otherwise taken if she did not feed at night.  

Many babies will give up night time feedings on their own accord, but others will continue to wake and demand feeds overnight for months and possibly years while parents continue to provide feeds at night. Usually the reason babies continues to demand night feeds beyond the age of 6 months is because they have learned to rely on feeding as a way to fall asleep, or because their internal body clock gets turned around - where the baby has decreased appetite during the day because of the continued night feeds and as a consequence of small feeds during the day the baby wakes hungry during the night. Body clock problems can easily become a cyclical pattern that will continue over the long term unless parents take steps to change the situation. Healthy, thriving babies who continue to demand feedings at night beyond the age of 6 months often require guidance and support from parents to cease feeding at night and turn their body clock around to a normal day-night feeding pattern.  

Aim to cease overnight feeds after 6 months of age. However, before attempting to do this it's important to address any feeding to sleep issues your baby might have. She would need to learn to fall asleep in a different way before you will be able to successfully encourage her to cease night feeds. 

6 months is the recommended age for starting solid foods. Although a small number of babies may benefit from solids prior to this age, it's generally not recommended to start a baby on solid foods before the age of 4 months. An early start on solids has the potential to cause bottle feeding problems because solid foods may decrease the baby's appetite for milk (breast milk or formula).

• If your baby is less than 6 months old, either cease or reduce the amount of solids you offer to see if this helps to improve the situation.
• See our article on starting solids.

If solids are offered prior to bottle feeds, either directly before or mid way between feeds, when it's time for your baby's bottle feed she might be feeling full from the solids, in which case she's probably not going to take much milk from her bottle. 

• For babies 4 - 9 months (when milk is still the most important food) offer solids 15 - 20 minutes after bottle feeds.
• For babies 9 - 12 months (when solids are becoming increasingly more important to a baby's diet) offer solids shortly before or shortly after her bottle, whichever you find works best. Babies at this age are often down to 3 bottles per day plus 3 main meals and 1 or 2 snacks. 

In these early stages of learning to eat solids (4 - 7 months) solids are not needed to add value to a baby's nutritional intake, rather they are offered primarily to provide learning experiences. The baby is exposed to new food proteins that help prime her immune system. She gets to discover new tastes and textures and become accustomed to eating from a spoon. It is at this age that babies are most willing to accept new tastes. So variety rather than quantity is what solids are about. 

Many babies, particularly very young babies, experience difficulty self-regulating their dietary intake. Some babies will continue to eat solid foods for as long their parents keep offering. Some babies will prefer eating solids compared to drinking formula. However, too much solids and not enough milk is not a balance diet for a baby. It may be necessary for parents to limit the amount of solids they offer in order to encourage their baby to have a greater appetite for milk feeds.

See our article on estimating how much milk your baby needs to make sure she's getting enough.

While some breastfed babies willing accept milk from a bottle many will not, at least not straight away.

Difficulty weaning from breast to bottle is rarely resolved by finding the 'right' feeding nipple. (All feeding nipples will feel equally foreign to a breastfed baby. ) Nor does a solution lie in finding a formula with the 'right' taste. All formula will taste strange to a breastfed baby). The difficulty associated with weaning to a bottle most often lies in the fact that bottle-feeding requires a very different sucking action to breastfeeding. While breastfeeding the movement of your baby's tongue milks the breast, where as bottle-feeding requires a sucking action. A baby who has been exclusively breastfed beyond the age of 3 months will often refuse milk from a bottle because it "doesn't feel right" and she doesn't know how to suck from a bottle.

It takes time and practice before a breastfed baby learns how to suck on a bottle. 

• Try offering expressed breast milk in a bottle initially. (Don't be too optimistic and put too much in to start with. It would be a shame to waste it).
• A soft flexible nipple often works better.

NOTE: Many breast fed babies will refuse to accept a bottle while they are still being breastfed at times. They will simply wait until a breastfeed is offered.  For these babies it will be the case of breastfeeding or bottle-feeding, but not both.

• Your Baby's Bottle-feeding Aversion book
• Baby Care Advice consultation
• Rowena Bennett's Online Bottle-Feeding Aversion Program

In my book, ‘Your baby’s Bottle-feeding Aversion’, I have described physical and behavioral reasons for babies to develop an aversion to bottle-feeding. How to identify the cause and the solutions to match. Included are step-by-step instructions on how to regain your baby’s trust and resolve a feeding aversion caused or reinforced by repeated pressure to feed.

While the book was written for bottle-fed babies, many nursing mothers have found that applying the same strategies has also helped them to successfully resolve a breastfeeding aversion.

You might find that reading this book is all you need to do to understand the steps you need to take to resolve your baby’s feeding aversion and get him back to the point of enjoying eating until satisfied. 

If you would like an individualized assessment of all reasons for infant feeding problems, not just feeding aversion, we also provide a consultation service. Baby Care Advice consultants have extensive experience in pinpointing the cause of feeding aversion and other behavioral feeding problems such as those related to equipment and the parent’s feeding practices. (For more on what’s included in a consultation).

By Rowena Bennett, RN, RM, CHN, MHN, IBCLC.

Copyright www.babycareadvice.com 2021. All rights reserved. Permission from the author must be obtained to reproduce all or any part of this article.

Six time-saving modules to help your family enjoy feeding again with Rowena's step-by-step plan. Enjoy additional tools to manage anxiety, troubleshoot any issues, introduce new carers, how to manage illness/teething and much more.

• Module 1: Understanding feeding aversions
• Module 2: Identify the cause
• Module 3: Prepare for success
• Module 4: How to resolve your baby's bottle-feeding aversion
• Module 5: What to expect
• Module 6: Troubleshooting
• BONUS: Guided meditations

8 reasons why a child refuses to eat

Our life is impossible without food. From birth, a child has an instinct for eating. And with age, he does not cease to understand whether he wants to eat or not. Therefore, forcing a child to eat on the part of the parents is wrong. If the child grows and develops normally, then let him eat what he wants and how much he wants. Forcing the baby to eat, you can easily break his natural sense of proportion, and then fight overeating and being overweight. All children are different and it is important to give the child the amount of food that will satisfy his needs. And these needs depend on various factors. If the little one refuses to eat, try to understand the reason for this behavior. nine0003

1. The child is not hungry. Even if a long time has passed since the last meal, it is possible that the child is still full. Parents should take into account the calorie content of food and the energy consumption of the child. If the meal was high in calories, but after that the child watched cartoons and did not run in the yard, then he may not want to eat for a long time. Physical activity encourages the body to expend energy and the child will get hungry faster.
2. The child does not have a daily routine. It is advisable to feed the baby at about the same time. The optimal portion for a child is two of his palms folded together. In addition, it is necessary that the child every day spend time in the fresh air and go to bed on time. If the child has little active pastime, then do not be surprised that he does not eat well. nine0007 3. The child is ill. Lack of appetite may be a symptom of some disease. Many children begin to eat badly when they are teething. Often the child refuses food when he has a fever. Before forcing a child to finish eating porridge, make sure that he is healthy.
4. The child "interrupts" the appetite. Sometimes snacking can cause a child to eat poorly at lunch or dinner. Do not give any cookies or sweets if you plan to sit down at the table soon. nine0007 5. The child does not like a particular dish. The baby may not refuse food in general, but simply milk porridge or borscht. Everyone has their preferences and kids have them too. Consider your child's preferences when planning menus. Accustom the little one to new tastes gradually, in the same way as complementary foods were introduced. Children are reluctant to perceive new tastes, but if given often and a little bit, they get used to it.
6. The child has psychological problems. Children subtly feel the psychological situation in the family. Refusal to eat may be associated with a desire to attract the attention of parents to their person. nine0007 7. The child developed an eating neurosis. If parents force the child to eat regularly, without taking into account his desire, then the baby may develop food neurosis. Such children begin to cry at the sight of a plate, they can run away to another room and become hysterical.
8. All children are different. Do not compare your child with other children. All have their own physical characteristics. If the baby eats little, just make these small portions as healthy and nutritious as possible, but do not force him to eat more than he wants. nine0003

Do not treat the refusal of food as disobedience and whims. Try to understand what the problem is and solve it. Think and analyze your behavior, did you do everything as it should? If you realize what you did wrong, then try to quickly correct your mistakes. Use methods such as fairy tale therapy. Before going to bed, the child will listen with pleasure about his favorite fairy-tale hero, who ate well, so he was strong and courageous. Try to interest the child in the beautiful design of the dish. Ordinary products can become a castle, a car, a cute face - there is room for parental imagination to roam. nine0003

If the child does not eat well: what to do and what not to do

What to do if the child does not want to eat.

- Malyusik, well, one more spoon - and that's it! Last! I ate only two, let's have a little more, here's the most delicious piece for you! - says the average mother, offering a spoon with one hand, playing the accordion with the other, showing the trick with the disappearance of the handkerchief with the third, turning the cutlets over with the fourth, while doing somersaults on one leg.

Sound familiar?

Every dad has an instinct to bring home food, and mom has to feed the baby food. And if he refuses to eat, a signal is triggered - "I'm a bad mother" or "the child is sick."

In this case, the most important thing for a parent to understand is whether the child DOES NOT WANT or CANNOT eat?

If the baby is running around, having fun and looking good, without showing any signs of illness, then most likely he does not want to eat. There can be many reasons:

• A breastfeeding child prefers milk and dairy products, intuitively understanding that he needs calcium, and now milk is healthier for him than soup. nine0051
• The child wants a cookie, not vegetables.
• He's really not hungry. For example, his metabolism is slow, breakfast has not yet been digested, and lunch is already being offered. Or the child was sitting in front of the TV after breakfast and his appetite had not yet had enough time to play out. Compared to the boy next door who was outside all day.
• If a child is not genetically destined to become Uncle Styopa, then he can eat much less than his peer, who has tall parents. nine0051
• Psychological problems. If earlier you accidentally gave your child a bitter cucumber, then he may refuse any green food. Or you yell at the child during the meal, and for him the food is perceived as a trauma.

If your child is lively, but at the same time he has a "bad appetite", then this is not his problem, but yours - the psychological problem of an unsatisfied instinct. If a child jumps, jumps, he has healthy nails, hair, etc., think less about what he lacks. Better think about something nice))

An active child = not a hungry child.

Wait for the natural desire and correctly distribute energy costs - walk more often, send the child to the sports section, or simply say: “If you don’t want to, take a walk, dinner is not earlier than seven and no snacks.” That is, if your child simply does not want to eat, normalize feeding - strictly at a certain time and without snacks. The body will get used to secrete gastric juice strictly according to the schedule.

And one more thing. There are no rules about how much a child should eat. He can eat a kilo (and make you very happy) and 9Send 00 grams to the toilet. Or eat 100 g and learn everything.

But it is much more difficult if the child CANNOT eat.

Causes:

• If you are breastfeeding, you may have “tight breasts”, when it is very difficult for the baby to suck milk.
• A child has a runny nose, and when he eats, he begins to choke.
• Food hot, cold, sour, bitter.
• He has sores in his mouth (for example, from toys), and they hurt when food gets on them. nine0051
• Teeth are cut, gums hurt.
• Bowel problems. The stomach starts to hurt while eating.
• The child simply fell ill (cold, SARS, poisoning, influenza, etc.). If the child is sick, and he is not dystrophic, then you should not force him to eat. The body fights infections better when it's hungry.

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