Feeding aversion therapy baby

Feeding Aversion - Why your baby is refusing bottles, breast or solids – Baby Care Advice

When we imagine what it should look like to feed a baby, we picture a scene of a hungry baby, gently cradled in our arms, who serenely gazes towards us as he contently feeds, peacefully stopping when satisfied. This is in stark contrast to the way in which babies who develop an aversion to feeding or eating behave. The scene is one of a screaming, hungry baby who acts like you're trying to poison him when you offer him a bottle of milk, breastfeed, or solid foods.

An aversion is the avoidance of a thing or situation because it is psychologically linked with an unpleasant, stressful, frightening, or painful experience. Basically, it’s fear that is displayed in anticipation of something bad happening again. A ‘feeding phobia’ and ‘feeding strike’ are other terms that may be used to describe a feeding aversion. 

A feeding aversion refers to a situation where a physically well baby, repeatedly exhibits partial or full feeding refusal despite obvious hunger. A feeding-averse baby has a history that demonstrates he’s capable of feeding but for reasons yet to be identified and corrected, he refuses to feed or eats very little.

Babies as young as 7 weeks of age can develop an aversion to breastfeeding or bottle-feeding. Older babies can become averse to eating solids. Not just certain foods but the experience of eating solids. A baby could become averse to one, two, or all three feeding methods.

A baby might exhibit one or more of the following behaviors:

• Skips feedings or meals without distress.
• Appears hungry but refuses to eat.
• Fusses or cries when a bib is placed around his neck, or when placed into a feeding position, or when the bottle is offered or shown.
• Clamps his mouth shut or cries and turns his head away from the breast, bottle, spoon, or food.
• Takes a few sips or a small portion of the milk or food offered but then pulls away or arches back in a tense manner or cries. (NOTE: Babies back arch to distance themselves. Back arching does not provide evidence of acid reflux.)
• Feeds only while drowsy or asleep.
• Consumes less milk or food than expected.
• Refuses milk but eats solids.
• Displays poor or slow growth. May be diagnosed as 'failure to thrive'.

The type and intensity of behavior vary between babies. At one end of the spectrum, a baby might simply refuse to eat a particular food owing to a bad experience while eating that food. At the other end, a baby might display almost complete food refusal, eating very little, and require a feeding tube to ensure that he receives sufficient nourishment for healthy growth.

Feeding is not something that a baby can avoid entirely. A feeding-averse baby will reluctantly eat enough to survive but not voluntarily eat enough to thrive. Once averse to feeding a baby will try to ignore his hunger cues for as long as possible. Only willingly, but cautiously, eating when ravenous. Then eating quickly in fear of a repeat occurrence of whatever it is causing his fears. Eating just enough to soothe pangs of hunger, but not enough to feel completely satisfied.

A few behaviors displayed by some, but not all, feeding-averse babies require special mention due to the confusion they cause. These include:

- Conflicted feeding behavior.

- Sleep-feeding.

- Accepts water from a bottle. 

Many feeding-averse babies display conflicted feeding behavior - where the baby takes a few sucks, sharply turns away or arches back in a tense manner, possibly cries, quickly returns and wants to suck again, takes a few sucks, turns away or arches back, cries, and returns to feeding and so on. This disjointed feeding behavior is often interpreted by parents and others as an indication that the baby is experiencing pain, especially if he is intermittently crying, but it’s not necessarily due to pain. Babies who have become averse to feeding will behave in this tense or distressed manner regardless of the cause.

Feeding-averse babies often feed better or well when drowsy or during light sleep. When drowsy or asleep, a baby is not fully aware that he is being fed, and therefore he’s not on edge in anticipation of whatever it is that is causing him to fear feeding. In a drowsy or sleepy state, a hungry baby’s guard is down, instincts kick in, and he feeds well. A feeding-averse baby may refuse and fight feedings while awake but could complete a full feed without resistance when drowsy or asleep. (See other reasons for sleep-feeding.)

A small percentage of feeding-averse babies willingly accept water from a bottle but not milk. This causes parents to believe it’s the taste of the milk that baby objects to, which could be the case, but not necessarily so. It can be because the baby associates the taste of the milk with an unpleasant or stressful experience, for example, being pressured to feed.

Parents often pressure their baby to drink milk from a bottle but seldom pressure their baby to take water from the bottle. Babies are smarter than we give them credit for. They learn to link the taste of the milk with being pressured and therefore react as soon as they taste the milk.

A baby could develop an aversion to feeding if an event occurring directly before, after, or while he is feeding triggers negative emotional responses, such as stress, pain, fear, or disgust. Several scenarios could potentially trigger such emotions.  For example: 

If a baby is pressured or forced to feed against his will, this makes for an annoying, frustrating, or stressful experience depending on the feeding strategies parents employ, and how long they persist.

Being repeatedly pressured to feed against their will is without exception THE most common reason for babies to develop an aversion to feeding and then not want to eat. In most cases, it's the original and only cause of a baby's feeding aversion. However, in around 10 percent of cases, it's a secondary cause that develops after the baby's initial feeding refusal due to one or more of the reasons that follow.

Sucking could be painful if a baby has mouth ulcers, and swallowing could be painful if a baby is suffering from esophagitis caused by acid reflux, or milk protein allergy. Chronic constipation or gastroparesis (delayed emptying of the stomach) could also cause a baby to associate eating with discomfort. 

When a baby refuses to feed due to discomfort or pain, the parent might then pressure their baby by employing subtle or obvious forms of pressure to make him eat. This adds to the baby’s distress. The baby now has two reasons to want to avoid feeding – pain and the stress associated with being pressured to eat. It’s often the stress associated with being repeatedly pressured to feed that continues to reinforce the baby’s avoidant feeding behavior long after medications or dietary changes have removed pain from the feeding experience.

Medical procedures involving the baby's face or mouth, like nasal or oral suctioning, insertion of an NG (nasogastric) feeding tube, or intubation can be frightening, painful, and stressful.

Aspirating fluids or choking on solids would make for a frightening experience. A baby could aspirate owing to dysphagia (an uncoordinated sucking-swallowing pattern) or due to moderate or severe laryngomalacia (floppy vocal cords), or because the flow rate from the nipple of a bottle or breast is too fast, or due to poor head or bottle positioning negatively impacting on the baby’s latch, suction, and sucking and swallowing coordination, or when the parent persists in trying to make their baby eat while he is crying in distress.

Being forced to take foul-tasting medicines or milk (which can be the case for hypoallergenic formula or if a mother produces high levels of lipase in her breastmilk) could cause the baby to develop an aversion to feeding. If medications are added into a baby’s milk bottle, which then changes the flavor of the milk, or if given via a nipple-like device this could cause a baby to reject bottle-feeds. Parents often resort to pressure or force to get their baby to swallow something that tastes unpleasant, adding another reason for the baby to want to avoid feeding, or anything else the parent might try to place into his mouth.

Babies affected by a sensory processing disorder may find the sensation of the nipple, or anything else in their mouth, to be abhorrent. They can display aversive behavior to lumps in food or the smell, taste, or feel of certain foods.

The cause of an infant feeding problem could be due to one or a combination of different causes. A feeding aversion can become even more complex when other feeding problems are involved. (See bottle-feeding problems.) 

There are several other possible reasons for individual babies to display aversive behavior towards breastfeeding, bottle-feeding, or eating solid foods. Any situation that results in a baby becoming frightened, stressed or experience pain while feeding has the potential to trigger partial or complete food refusal.

A single occurrence of one of these events doesn't usually trigger an aversion, but it is possible, especially if the experience is traumatic for the baby. It would generally take repeated occurrences while feeding to cause a baby to become averse to feeding. When such episodes are repeated, the baby learns to link the sequence of events and expect a similar occurrence each time he feeds. And so, he tries to avoid feeding to avoid the situation that has caused him fright, stress, or pain in the past. It's at this stage he will react before the event because he knows what's going to happen. And so, he may become distressed as soon as he recognizes he is about to be offered a feed. Or even if he thinks he is about to be fed because of the position he is held.

The distress displayed by many feeding-averse babies can be so intense that it appears like they are suffering from pain. Therefore, pain is typically the first thing blamed by parents, and by health professionals during brief consultations, when other causes for a baby's feeding refusal are not obvious. However, pain is not the only reason for babies to become distressed during feeds.

So how can you tell if pain is the cause of your baby’s troubled feeding behavior?Check how he behaves at times outside of feeding as this will provide clues. For example:

1. If your baby is happy once you stop trying to feed him, pain is unlikely. Pain fades away. It doesn't suddenly cease because the feed has ended. 
2. If your baby is content between feeds, pain is unlikely. Discomfort associated with acid reflux or milk protein allergy or intolerance, constipation or gastroparesis is not restricted to feeding times only. Your baby would display signs of discomfort or distress at other times in addition to feeding times.
3. If your baby predictably feeds well in certain situations, for example during the night or while drowsy or asleep, pain is unlikely to be the cause of his oppositional feeding behavior. Sleep does not numb a baby to the sensation of pain. If it is painful for him to feed during the day or while awake, it’s reasonable to expect it would also be painful for him to feed at night or when sleep-feeding.

NOTE: If your baby displays any unusual signs that might indicate illness or a physical problem, or if you are worried that your baby is suffering from pain, have him examined by a doctor.

Conflicted feeding behavior where baby takes a few sucks, sharply turns away or arches back, cries, quickly returns and wants to suck again, takes a few sucks, turns away or arches back, cries, returns to feeding and so on, is often interpreted by parents and others as pain, but its not necessarily due to pain. Babies who have become averse to feeding will behave in this way regardless of the cause. If your baby is quickly soothed once the feed has ended, it's probably not pain.  

Is pressure the cause? 

Some parents will pressure or force their baby to feed out of loving concern for their baby’s physical wellbeing. They hate doing this but do so because they worry that their baby will fail to gain sufficient weight or become unwell if they don’t make sure he consumes what they believe, or have been told, is an acceptable amount of milk or food.

Many of the feeding strategies that we believe are ‘encouraging’ or ‘supporting’ a baby to eat involve subtle forms of pressure. For example:

• Pushing the nipple into a baby’s mouth against his wishes.
• Preventing him from pushing the nipple out of his mouth with his tongue.
• Following his head with the bottle when he turns or arches back in tense manner.
• Restraining his head to prevent him from turning away.
• Restraining his arms to prevent him from pushing the bottle away.
• Offering repeatedly at a time when he's rejecting or upset.
• Upwards pressure under his chin in a bid to trigger his sucking reflex.
• Gently compressing his cheeks to apply pressure on his buccal pads (cheek pads).
• Jiggling or twisting the bottle to try and make him continue sucking.
• Squeezing milk into his mouth.
• Trying to trick him into accepting the nipple by switching his pacifier for the nipple.

If these things don’t upset your baby - which generally appears to be the case for babies under the age of eight weeks who due to immaturity have limited ability to complain during the feed but can after the feed – such strategies might be causing no harm. However, doing these things in a bid to control how much a baby eats has the potential to make the experience of feeding unpleasant or stressful for the baby. When repeated, a baby can develop an aversion to feeding.

As a result of developing a feeding aversion the baby will fuss or refuse to feed and the parents, not knowing any better, may then feel compelled to force their baby to eat, and by doing so they may be unknowingly reinforcing their baby’s feeding aversion. 

Behavior that is reinforced will continue. Once averse to feeding, the situation spirals downwards as a result of the ‘fear-avoidance-cycle’.

 

The more the parent pressures their baby, the less their baby is willing to eat. The less their baby eats, the more the parent pressures. And around and around it goes. The 'fear-avoidance-cycle' can spiral downwards to complete feeding refusal while awake, poor growth, and possible hospitalization where a feeding tube might be inserted.

Direct and indirect reinforcements

Any pressure, even subtle forms, has the potential to directly reinforce a feeding aversion. However, there are other strategies, for example feeding a baby while sleeping, giving solids to compensate for the loss of calories from milk, providing milk in other ways such as spoon, syringe, or feeding tube, can indirectly reinforce a behavioral feeding aversion by enabling the baby to avoid feeding while awake during the day. All reinforcements – direct and indirect – need to be removed.

Solutions for baby's bottle feeding aversion

 

Medical treatments

 

A feeding-averse baby is often distressed at feeding times (an exception being those who mostly sleep-feed during naps and at night). Pain is typically the first thing blamed, but the least likely cause of aversive feeding behavior displayed by physically well, thriving babies.

If you go to the doctor with a fussy baby who cries and refuses to eat, he or she may tend to explore physical causes before all others. The following treatments are often recommended by medical practitioners in a bid to remedy a baby's fussy or distressed feeding behavior. 

Medications: Acid suppressing medications may be prescribed to treat suspected esophagitis - inflammation of the baby’s feeding tube caused by repeated exposure to refluxed stomach acid. And perhaps prokinetic medication (also called propulsive agents) to treat gastroparesis - delayed emptying of the stomach.

Dietary changes: A hypoallergenic infant formula may be recommended to treat suspected eosinophilic esophagitis - inflammation caused by an allergic reaction to cow’s milk based infant formula or soy infant formula. 

Once the condition causing the baby's discomfort is effectively treated, his troubled feeding behavior will fade and disappear. 

NOTE: A doctor cannot see into a baby’s esophagus and therefore cannot confirm if he is suffering from esophagitis during a routine medical examination. h3 antagonists and proton pump inhibitors used in the treatment of acid reflux are extremely effective in reducing the production of stomach acid. If your baby is still fussing or fighting feeds two weeks after commencing medications, there's a good chance that acid reflux is not responsible for his troubled feeding behavior. Similarly, if your baby's avoidant feeding behavior continues two weeks after switching to a specialized hypoallergenic formula, the reason may be that milk protein allergy is not the cause. This does not imply that your baby is not affected by these conditions, rather that these conditions are unlikely to be the cause of his avoidant feeding behavior.

Band-Aid solutions: If medications and dietary change fail to resolve a baby's aversive feeding behavior, band-aid solutions such as high-calorie feeds, food thickeners, starting solids, sleep-feeding, might be recommended in an attempt to minimize the risk of poor growth caused by an unresolved feeding aversion. However, band-aid solutions are often ineffective in the case of a feeding aversion because they do not address the cause, which is the stimulus that is causing the baby to fear feeding.

If medical treatments fail to resolve your baby's feeding issues, consider the possibility of a misdiagnosis or that there is more than one cause involved. And extend your search to cover other potential causes, in particular behavioral reasons such as being pressured to eat.

Speech therapy

If your baby often chokes or experiences problems with aspiration while feeding, his doctor might refer him to a speech therapist to assess his ability to suck and swallow effectively. This can be helpful if choking episodes are reinforcing the baby's aversive behavior.

However, if your baby feeds well at some feeds for example in a sleepy state or has fed well in the past before developing a feeding aversion, it's unlikely that the source of his fussy feeding behavior or food refusal is due to a sucking or swallowing problem.

Occupational therapy 

If an oral aversion due to a sensory processing disorder is suspected, your doctor might refer your baby to an occupational therapist for an assessment. Encouraging a child with oral aversion occurring due to a sensory processing disorder to feed as normally as possible requires a very long process that may last months or years. 

An oral aversion is wide ranging with the baby not wanting anything near his mouth. A feeding aversion is specific, related to feeding, and requires very different treatment to resolve the problem compared to an oral aversion

NOTE: Some of the feeding strategies recommended to resolve an oral aversion, such as placing rubbery implements into the baby’s mouth to ‘desensitize’ him to the feel of things in his mouth, are counterproductive in the case of a behavioral feeding aversion that developed or is currently reinforced as a result of being pressured to feed. Placing things into a baby’s mouth without his permission will not regain his trust. Hence, the diagnosis must be correct. If your baby is happy to have anything other than the nipple of a bottle or food in his mouth, it’s probably a feeding aversion rather than an oral aversion. 

Behavior approach

A behavioral approach views challenging infant behaviors such as incessant crying, fussy feeding behavior, feeding refusal, and sleeping problems in the context of the care the baby receives. In the case of physically well babies, it’s not assumed that the baby has a physical problem, rather the parent’s childcare practices are examined.

Infant behavior, whether this is desirable or undesirable behavior, is reinforced by the actions parents take or don’t take. To resolve a behavioral problem, and thus change a healthy baby’s behavior from fussy, distressed feeding refusal to enjoying feeding to satisfaction, it’s necessary for the parent to first make appropriate changes to their childcare practices.

The parent’s infant feeding practices are the last suspected cause of a healthy baby's aversive feeding behavior when it should be one of the first. You will know how thoroughly your baby’s healthcare professionals have assessed the possibility of behavioral reasons for his feeding issues by the number of questions asked of you regarding his feeding history. For example, feeding equipment, feeding frequency and duration, milk type, and concentration, feeding pattern, total daily milk intake, his sleeping patterns (sleep has a profound effect on feeding behavior and milk intake) and most important of all, your infant feeding and sleep settling practices. Our Baby Care Advice questionnaire includes 80+ questions to pinpoint the cause.

No questions asked = minimal to no consideration given to behavioral causes.

Misdiagnosis 

Accurate identification of the cause is essential to finding an effective solution. This is not something that can be achieved during a brief consultation with a health professional. And it definitely cannot be achieved without asking the parents multiple questions about their infant feeding practices. An accurate, and thorough diagnosis of the cause, or causes as is often the case, requires a comprehensive understanding of infant development and behavior, and age-appropriate infant feeding practices, as well as an understanding of the reasons and solutions to infant feeding aversion. At Baby Care Advice we allocate 2 hours for feeding problems.

Misdiagnosis occurs when assumptions are made about the cause in the absence of a comprehensive feeding assessment. Failure to accurately identify the stimulus causing and reinforcing the baby's feeding aversion - which can vary for individual babies - is likely to result in an ineffective treatment plan.

Not only will a misdiagnosis fail to address the cause, but many of the strategies recommended based on a misdiagnosis, such as those described as indirect reinforcements, have the potential to reinforce a baby’s aversive feeding behavior.  A baby’s feeding aversion will continue while it’s reinforced. An unresolved breast- or bottle-feeding aversion increases the risk of the baby developing an aversion to eating solids for the same reasons. Feeding issues can persist for weeks, months or years.

How we can solve your baby's bottle feeding refusal and get your baby to happily take a bottle

Few health professionals are familiar with age-appropriate infant feeding practices and/or the process involved in resolving behavioral feeding aversions experienced by normal developing babies and young children. Therefore, they are ill-equipped to guide and support parents to resolve this complex and highly stressful situation.

A baby's avoidant feeding behavior, poor milk intake, and poor growth could be due to one or a combination of the causes already mentioned. However, a feeding aversion can become even more complex if other feeding issues are involved. For example, unsuitable or faulty equipment, poor feeding position, or the parent’s providing an inappropriate response to their baby’s feeding cues.  (See bottle-feeding problems for more.) 

If you suspect that your baby has developed a feeding aversion, there are a couple of ways we can help.

You might choose to see if you can figure things out on your own as a result of being guided by my book 'Your Baby’s Bottle-feeding Aversion’.

You might prefer to have one of our experienced consultants undertake a comprehensive assessment of all causes and provide individualized feeding advice. You also have the option to receive daily email guidance and support as you work towards resolving your baby’s feeding aversion.

You can purchase Rowena's Online Bottle-Feeding Aversion Program - six modules with clear step by step instructions on how to overcome your baby's bottle-feeding aversion. With a 95% success rate using Rowena's Bennett's method.

‘Your Baby's Bottle-Feeding Aversion’ book

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. 

Baby Care Advice Consultations

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).

Rowena's Online Bottle-Feeding Aversion Program 

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.

Join Our Facebook Support Community

Baby Care Advice has facebook support groups in various languages, for those who have purchased either Rowena's 'Your Baby's Bottle-Feeding Aversion' book/ Online program/ consultation. They are made possible by a volunteer group of parents, who offer empathetic, compassionate support and guidance as you work your way through resolving your baby's feeding aversion.

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

Written Sept 2013. Revised July 2021.

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

How to Help Your Baby Overcome a Bottle Aversion — Malina Malkani

Parents respond with nourishment when their babies cry and fuss because of an empty belly. Once their tiny tummies are nice and full, they turn their head away from the bottle or purse their lips closed. At least, that's the feeding experience parents hope for and expect to have!

What does it mean when a baby refuses a bottle even though they're hungry?

A bottle aversion can be confusing and upsetting to parents, but if you’re one of them, you're not alone.

Approximately 20% - 30% of infants and toddlers have feeding-related problems.

A baby or young child's feeding problem can lead to nutrient deficiencies and malnourishment, ultimately affecting their growth and development.

Some babies can resolve it on their own with time. Still, many need support from parents and/or a team of professionals that includes pediatricians, pediatric dietitians, and speech-language pathologists.

Keep reading to find out what a bottle feeding aversion is, what to do about it and when to call the pediatrician.

What is a Feeding Aversion?

Childhood feeding problems range from picky eating to a refusal to eat.

Can a baby really be a picky eater?

Picky eating and bottle aversions both fall under the umbrella of childhood feeding disorders. A feeding disorder is an inability or refusal to eat and drink enough food to meet nutritional needs.

Feeding difficulties tend to fit within three general categories that may be very familiar to some parents: limited intake, selective intake, and the fear of feeding. However, most children have mild feeding problems that don't affect their weight and health, despite being very challenging for parents.

What Causes a Bottle-Feeding Aversion?

As an experienced parent, you probably expect some degree of pickiness with your child. But a baby’s refusal to eat might be unexpected and confusing.

Here are some of the most common reasons a young child refuses to eat even though they might be hungry.

• Sensory aversions and developmental disorders

  Feeding problems affect 70%-89% of children with developmental disabilities. For example, children with Autism Spectrum Disorders commonly have sensory food aversions and refuse to eat because of a food's texture, color, appearance, or smell.

• Premature infants

  Premature babies have a high risk of aspiration while feeding. It's common for preterm infants to have oral feeding difficulties. As a matter of fact, difficulty eating is a huge factor in what delays a baby's discharge from the neonatal intensive care unit (NICU).

• Swallowing difficulties

The first step in digestion is the physical processing of food by the mouth, throat, and tongue. Underdeveloped muscles or tongue-tie affect the baby's ability to move food around their mouth, swallow and suck. A frustrated and uncomfortable baby will reject a bottle if they have difficulty sucking.

• Pain and discomfort

  Babies may develop a learned feeding aversion if they associate pain with eating. A milk protein allergy, choking, or acid reflux are common reasons a bottle-fed baby might experience pain during eating. And, don't forget about ear infections. This common childhood illness makes swallowing very painful.

What About Bottle Aversion in Breastfed Babies?

Pumping keeps a mom's milk supply up and allows a baby to continue breastfeeding even when life gets busy. Using a bottle for breast milk can also give moms a much-needed break during overnight feedings and a chance for others to bond with the baby during feedings.

But, bottle feeding is a different sensory experience than breastfeeding, and babies may prefer one over the other.

Breastfed babies can develop a bottle aversion. Breastfed babies may not like the change in feeding position, the temperature of milk, lack of skin-to-skin contact, and fast flow rate even though the milk tastes the same.

The opposite can also happen.

Bottles allow babies to drink faster and more steadily than breastfeeding. And the difference in the rate and flow of milk can cause nipple confusion. In addition, some babies may take to the faster pace of bottle drinking and reject the breast.

The tips below work for formula-fed or breastfed babies who use a bottle.

What to Do if Your Baby Refuses to Eat From a Bottle

It’s important to individualize treatment for a baby's bottle aversion. Every baby is different, and what works for one child may not be the answer for another. The most effective strategies depend on what is causing the feeding aversion, how old your infant is, and your baby's preferences.

As a result, the best way to use these tips is to apply them one at a time. Then, reassess after a few days before applying a new strategy. (You don't want to overwhelm your baby with too many changes at the same time, and if you try too many strategies at once, you won't know which one worked!)

Keep in mind also that some babies end up showing improvement on their own.

And let your pediatrician know immediately if there are any changes in your baby's weight, growth, or energy level.

1. Don’t force your baby to eat

Nudging a bottle into a baby’s mouth isn’t recommended. As a parent, I understand the temptation to get a child to eat, especially a very young infant that you’re concerned about. But forcing a baby to eat can make a childhood feeding disorder worse. It’s also dangerous. A baby trying to refuse a bottle can choke if they’re forced to drink.

2. Find out why your baby is refusing the bottle

A pediatrician can determine whether there's a medical reason for your baby's bottle aversion. If so, a speech-language pathologist can assess your baby's ability to swallow and suck. Then they'll recommend treatments such as swallow exercises. If your baby has a tongue or lip tie that affects their eating ability, a pediatrician may recommend surgery to correct it.

3. Use paced bottle-feeding techniques

Paced bottle-feeding techniques mimic breastfeeding and allow your baby to drink at a slower rate than traditional bottle feeding.

Responsive feeding can teach you how to recognize and respond to your baby's hunger and fullness signals. Then, when you pick up on your baby's cues, you can respond warmly and promptly with food.

Common signs a baby is hungry include:

• Making sucking sounds

• Chewing and sucking on fingers

• Crying - the key is to learn to differentiate hungry crying from the crying of a sleepy or uncomfortable baby

• Fussing

If your baby shows signs they've had enough, parents should let the baby stop eating. Signs a baby is full include:

• Turning their head away

• Gagging

• Spitting up

• Slowing down or stopping

• Falling asleep

• Starting and stopping

4. Change up the bottle

The type of bottle and/or size of the nipple hole can affect the flow rate. If you practice responsive feeding, you'll recognize when the pace and flow of the milk are working well for the baby.

Every baby eats at a different pace and may need a faster or slower bottle nipple. Babies that are both breast and bottle-fed would do better with a slower pace nipple since that's closer to the pace of breastfeeding.

Generally, babies born around their due date can use a newborn flow rate. In addition, there are special nipples for babies with colic. And there are even bottles designed to give your baby the ability to drink at their own pace. For example, the Infant Self-Pacing (ISP) Feeding Bottle allows your baby to control the flow of formula.

5. Change the feeding position or routine

Change the routine with fun and relaxing activities before it's time for a bottle. For example, a few minutes of playtime together on the mat or a walk can diffuse the anxiety around feeding time for you and your baby! Even changing the order of your baby's daily routine might help break up a pattern of feeding difficulties.

Or your baby's usual position might be uncomfortable. Adjust the feeding position or highchair until your baby is comfortable and content. Babies should be held in a semi-upright position with their heads supported.

6. Change the formula

Not all formulas taste the same, and your baby may enjoy another brand better. Also, some babies prefer different formula temperatures, so you can experience warming the bottle vs. not warming the bottle.

If your baby shows signs of a milk protein allergy or dairy intolerance, try another type of formula.

7. Be patient

Understandably, you might be stressed and frustrated when your baby refuses to eat from a bottle. I get it. But, babies can pick up on the tension and stress, which only worsens feeding fears and anxiety. Try to engage in positive food parenting practices that provide structure and encourage autonomy. Patience and a positive feeding experience are important for you and your baby!

Last Thoughts on Bottle Aversion

Aversions to food textures and certain foods' appearances are common in children.

A temporary aversion to certain foods isn't usually a medical concern as long as your child is growing and doesn't fall off their percentile on the growth chart.

But a bottle-feeding aversion isn't picky eating, and your baby may need the help of a team to move through it.

Talk to your pediatrician if there's a change in your baby's weight. A few ounces of body weight is a lot for a tiny baby to lose. Speech-language pathologists and pediatric dietitians are other specialists that can help guide you through your baby's bottle aversion.

If you’re getting ready to start your baby on solids, download my FREE Baby-Led Feeding Essential Checklist to make sure you have everything you need to get started. You might also want to check out my new online course for parents, based on my best-selling book which will walk you through the whole process of starting solids using a baby-led approach.

Alternatively, if your baby is almost ready to start solids and you’re looking for someone you trust to map out the entire first 12 weeks of your baby’s solid food feeding journey, check out my new Safe & Simple 12 Week Meal Plan! Over 30 recipes, weekly shopping lists, tons of balanced baby meals, a complete plan for top allergen introduction, & lots of guidance (with photos) on how to safely serve each food.

And if you're looking for personalized nutrition support for yourself, your babies and/or your kids, I am currently accepting new clients in my virtual private practice. Looking forward to meeting you online… 

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Although breastfeeding can be a natural element of motherhood practice, patience and a little advance preparation. So, if you decide to breastfeed your baby, be prepared for the fact that you may encounter the often encountered problem of proper breastfeeding. However, do not be upset.


Breast latch is one of the most important things about breastfeeding and can be difficult for new moms, and understandably so; It is essential that the baby properly latch on to the nipple during breastfeeding so that he can get enough breast milk. Proper breast latch is also important because it allows the mother to avoid problems such as blockage of the milk ducts and sore nipples.


Learn more about how to properly care for your breasts in the Quick Guide to Breast Care.


One of the best ways to teach your baby to latch on properly is to find a breastfeeding position that is comfortable for both you and your baby. Here we will discuss different breastfeeding positions as well as other useful tips to help you achieve a proper breastfeeding. If you have any questions or concerns, please contact your doctor or lactation specialist for further support.

Helping your baby latch on properly

Before looking at the different positions for breastfeeding, there are a few things you can do to help your baby: ^[1]

• Create a calm and relaxing environment. Your comfort is key when breastfeeding, so find a position that is comfortable for you to breastfeed. In a chair, or on a bed, or listening to relaxing music, make sure you are calm and relaxed before feeding.
• Skin to skin contact. Breastfeeding is a great opportunity to bond with your baby. Awaken your newborn's natural instincts by holding him, dressed only in a diaper, against your bare chest.
• Let your child take the lead. Gradually you will learn to understand the individual signs of hunger in your child. Usually, children begin to shake and nod their heads in the direction of the mother, toss and turn, lick their lips, stick out their tongue, showing that they are hungry.
• Try not to force things. Help the baby find the breast, but try not to push the nipple into the baby's mouth.

Sensitive nipple protection. If your nipples are sore or cracked, try using soft, ultra-thin nipple guards to relieve sore nipples during feeding and prevent further nipple trauma. Due to the fact that the pads are made of thin silicone, the baby will still feel the warmth and smell of the mother's breast.

Popular breastfeeding positions to help ensure proper breastfeeding


In addition to these beneficial nursing steps, it is important to adopt a position that is comfortable for both you and your baby. Experiment with different positions until you find the one that makes you feel comfortable and helps your baby latch on properly.

Here are some of the most common positions that will help you and your baby get a good latch on during feeding: ^[1]

breastfeeding positions

1. Feeding in a reclining position.

The reclining or leaning back position is ideal for mothers who are breastfeeding for the first time. To try it, simply lean back into a reclining position with pillows under your neck, shoulders, and arms. Once you have established belly-to-belly contact with your baby, let him find the breast while supporting him as much as possible.

2. Feeding in the side lying position.


If you are looking for a feeding position that allows you to feed your baby and rest at the same time, the side lying position may be perfect for you. Lie on your side, leaning on a special roller or pillow. Facing you, the baby will be able to take the breast, which lies on the pillow. You can put a towel or blanket behind your baby to keep him in place while you feed. Also, this position is well suited for mothers who cannot sit after a caesarean section.

3. Feeding in the cross cradle position.

Another great position for getting your baby to latch on properly while breastfeeding is the “cross cradle,” which involves placing a pillow on your lap and placing your baby on the side facing you. During feeding, support the baby's back and head with the arm opposite the breast you are feeding.

4. Feeding in the "soccer ball" or "under the arm" position.

To assume this pose, you need to sit comfortably on a chair (in an armchair), leaning on pillows. Place the child on a pillow on the back so that his legs are under your arm and pointing towards the back of the chair. Supporting the back and shoulders of the baby, hold his head with the same hand, and with the other hand you can support the breast that you feed.

As you experiment with feeding positions, you may notice that your baby may like certain positions more. Once you have found the right position for feeding, look out for the following signs that your baby is latching on well: ^{[2] [3]}


• You do not feel acute pain.
• The baby's mouth is wide open, the baby's lower lip is turned out and the upper lip is in the normal position.
• The lower part of the areola (the areola) is in the baby's mouth.
• Baby's chin touches your breast.

Useful tip if you have flat or inverted nipples

​If you have inverted or flat nipples, you need to help your baby achieve a good latch - grab the nipple along with most of the areola. Here are some helpful tips for breastfeeding mothers with flat or inverted nipples:​

• Help yourself with your fingers: you can try to stretch the nipples by rolling them between your fingers in the center where the hole is located, so they create a slight pressure, and the nipple is pushed out. ​
• If these suggestions do not help, then use a nipple shield when breastfeeding for the first time so that the baby can latch onto the nipple and pull it out over time.
  

It's the journey that counts, not the destination


You are now armed with the knowledge you need to know about the basic nursing positions, as well as tips to help you get a good latch on while breastfeeding.

Remember that breastfeeding gets better with time and practice, so don't be discouraged if you run into obstacles or difficulties along the way, such as a bad latch.

Enjoy this special time with your baby and don't forget to consult your doctor or lactation specialist with any questions or concerns you may have.

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"I'm a terrible mother and I don't love my baby": what is postpartum depression

It happened to me

"I'm a terrible mother and I don't love my baby": what is postpartum depression

Interview:

Anna Laletina

Photo:

Quim Roser

March 3, 2016 12:34

It is believed that the first months of a child's life is a happy period for his parents. The fact that the appearance of a child can cause depression in both mother and father, many do not realize. Afisha talked to women who have experienced postpartum depression and learned from a psychologist how to deal with it.

Anastasia, 27 years old, St. Petersburg

gave birth at 25, first child

The child was very desired, planned. The birth went quickly, with almost no pain. Joyful relatives met me from the maternity hospital. A few days at home with me and my son was my husband, who specially took a few days of vacation.

And it all started when I was left alone, one on one with a child. The baby was very restless and was constantly crying, I didn’t have enough milk, I started feeding him formula, and everything seemed to be more or less normal, but then various bad thoughts came into my head. I just couldn't hear him crying, I wanted to run away, to be alone for a second, so that no one would touch me, so that I could just sit alone. I began to wait for my husband from work, gave him my son, and I myself went for a walk with the dog, looked at people. It was summer, everyone was so joyful and happy, but it seemed to me that my life was over and that I would forever sit within four walls and would never be happy again. This is a terrible state, you cannot just rejoice at your baby, so long-awaited, so beautiful! On a walk with a child, I looked at other women and did not understand why they were happy. Where do they get the strength to smile? I started smoking again.

Husband tried to support. He took care of household chores, rocked his son at night and tried to bring me to my senses when tantrums happened. He never reproached me for my condition, but did not understand what was wrong with me. And I had only one thought: I am a terrible mother and I do not love my child.

My mother knew about my condition, but she was very aggressive towards it, she shamed me. When I started whining that I felt bad, that I couldn’t live like this, and so on, she rudely put me in my place. I felt uncomfortable. I didn’t go to the doctors, which I regret now. I just talked on forums with poor people like me.

About a month later they started to let me go, I started to be distracted by household chores, I chose different routes for walking with the child. In the end, I overcame it by simply pulling myself together. I looked at my son and said to myself: "No one can love this child as much as I do." I found a hobby, my son became calmer, I got a little more time for myself. Remembering that state of mine, I feel shame in front of the child. I don't want this to ever happen again.

Julia, 28 years old, Moscow

gave birth at 25, first child

Before going on maternity leave, I was a corporate account manager in a small company. I worked hard and with pleasure, almost without days off. I had strength, there was no toxicosis, I earned money for childbirth, beds, toys and so on. She went on maternity leave a month before giving birth, only because she was physically unable to move quickly.

After giving birth, I looked at my roommates who were touched by their children, spoke tender words to them, stroked and hugged them, but I could not do this in relation to my own child, I did not know how, did not understand how and why, did not feel this very maternal love, but felt her failure. I thought that the birth of a child is a natural process, which is unconditional happiness, and the maternal instinct in me will immediately wake up, but this did not happen. I became withdrawn, suffered from insomnia, confused the times of day, got irritated. There were thoughts of suicide (neither before nor after that there was no more), outbreaks of aggression. I felt lonely and abandoned, although my husband was there and helped. At night I cried, told him how scared I was that I couldn’t control myself, I didn’t feel any love for either the child or anyone else.

I have a degree in psychology, and when I put it all together - suicidal thoughts, sleep disturbance and apathy - I realized that it was depression. Already on the decline of an acute condition, when the child was eleven months old, she turned to a Gestalt psychologist, although it should have been done earlier. The diagnosis was made as follows: borderline condition. We spent about four sessions with her, and I felt better. Reading literature on developmental psychology also helped, as well as the support of my husband, mother and neighbor: she has a child six months older than mine, she also walked with bruises under her eyes, but she smiled.

I would advise mothers to get enough sleep, think first of all about themselves and their well-being, not try to do everything and be an ideal mother, wife, worker and so on at the same time, accept help and ask for it. I would also advise you to prepare yourself informationally for the birth of a child, read books, articles on the Internet (not forums!), go to courses, and if you notice signs of depression, then go to a proven psychologist.

Sofia, 31 years old, Moscow

gave birth at 30, first child

Nobody officially diagnosed me with postpartum depression, but the suspicion appeared pretty quickly. Even at the maternity hospital, my daughter and I had a problem with feeding: she was constantly sleeping, it was impossible to wake her up and not feed her. When she woke up hungry, she would spit out my milk and fall into hibernation again. Lost weight rapidly.

I certainly didn't expect anything like that. I even took a book with me to finally relax. Instead, I had to rush through articles on "How to Breastfeed," which said the same thing in different words: if things are not going well, then the mother is not trying hard enough. As a result, I rushed about the hospital ward like a pale, roaring, swollen ghost. The joy of motherhood is the last thing I felt. But it was hard to breathe from the responsibility that had fallen on me and the feeling of utter worthlessness.

For the first month I struggled to fucking breastfeed. As a result, I hated the whole world. But it was not only about feeding. My life, which I built brick by brick exactly the way I liked it, suddenly collapsed. Everything went wrong, nothing worked out for me. And I didn't see any prospects. I just wanted to sleep and cry. There was no happiness, no butterflies and unicorns, there were only crosses with which I crossed out days on the calendar, not understanding why.

I am very lucky with my family and friends. They supported me the best they could. My husband would rush home every day after work and melt into our daughter, while I could sit alone. The mother-in-law, with whom we lived at that time (our apartment was mired in repairs), took over the cooking for everyone, including me. Moreover, I had to cook separately, because I had a "menu for a little nursing mother." My 80-year-old grandmother came from the other end of Moscow to take a walk with her great-granddaughter. My friends dragged me out to the cafe and listened to my confused stories about how things were not as radiant as expected.

I couldn't come to my senses for a little over a year. Several things helped me. The support of relatives is really very important, especially the help of a husband. I know that many fathers cannot stay with their babies, and this subsequently makes life very difficult for mothers. I first went out with a friend in a cafe a week after giving birth. Two months after giving birth, I went to work part-time. And a couple of months later, a crisis broke out, the ruble fell, and the husband was left without a job. He decided to take advantage of the break to finish the repairs in our new apartment. And then he decided to stay at home with his daughter. So we switched roles. At first it scared me terribly. Then I began to notice that I was rapidly getting better. In addition, I realized that I can feed my family.

The next step was to accept that my life would never be the same again. Everything turned out to be so complicated and unusual that I clung to the past and tried to forget my problems, returning to that life at least sometimes - for example, during the same trips to the cafe. They supported me - but they also slowed me down. It’s as if I’m a normal person there, but at home I’m in a strange role that doesn’t suit me. And there was no way to combine it all into one image.

Therefore, I turned to a psychologist - a year after giving birth. So late just because I couldn't find the right one. And I didn't know how to search at all. I asked my friends, they gave me names and immediately - sky-high figures for me of their fees. By chance, I found out that in the capital there is a city psychological service that is free for Muscovites. I figured that there seemed to be nothing to lose here, and called. I said that I had "postpartum depression or something like that", and I was referred to a prenatal psychologist. It turned out that Muscovites are entitled to 10 free sessions, and then, after a three-month break, again for ten, and so at least for the rest of their lives.

Three months have passed since then, and I finally found some kind of harmony. I can say that the depression is gone. However, the psychologist did not give me such an official diagnosis, besides, she said that it was none of her business - psychiatrists do this. But if she saw clinical signs in me, she would refer me to them, they are also in the service.

Expert opinion

— Is there such a diagnosis as postpartum depression?

- Yes, according to ICD-10 (International Classification of Diseases) there is such a diagnosis, code - F53.0. Accordingly, postpartum depression is not an invention of pampered mothers, but a serious disease that needs to be treated. According to statistics, postpartum depression of varying severity occurs in 15% of cases.

— When does it become clear that we are talking about postpartum depression and not short-term mood disorder, which is called baby blues in English-language articles on the topic?

- The mood changes depending on what is happening in life. The baby slept well, managed to do something for herself - she felt satisfied. She took it in her arms, pressed it to herself - warmth and tenderness spread over the body. I understood why I was crying - I am pleased with myself. I managed to sleep - I felt rested. They let me go to a girlfriend or to the theater - I experienced pleasure. When a woman is really depressed, she sleeps and does not get enough sleep, rests, but this does not help either. Nothing brings positive emotions. And the most painful thing is that she loses the sense of the meaning of what is happening, she does not feel that at least something brings relief and joy. She takes the child in her arms and does not feel anything. The hardest thing about postpartum depression is that a woman tries, but cannot, feel love for her child. And she is torn apart by guilt and the feeling that she is a bad mother. It's not baby blues at all.

— Can postpartum depression appear not immediately after childbirth, but, say, after a couple of months?

- According to the ICD, postpartum depression begins within six weeks of childbirth. According to medical observations, most often immediately after childbirth. After six weeks, it's just depression.

- Is there any risk group? Is it possible to predict the development of depression in the mother even before the birth of the child and somehow prevent it?

- Anxious-depressive individuals are more prone to depression. Also, postpartum depression is more likely to develop if a woman has a history of depression. Predicting depression before the baby is born is quite difficult. But after the birth of a child, the woman herself needs to be attentive to herself, and her relatives to her, and if something is wrong, consult a specialist as soon as possible.

— How to deal with postpartum depression? Which specialist to contact?

— Depression is treated quite successfully with medication and psychotherapy. In case of mild depression, a psychologist can help. Existential and cognitive-behavioral therapy are very good at helping to cope with depression. Existential therapy helps to find the lost meaning of life, to find access to blocked resources. Cognitive-behavioral teaches you to recognize depressive thoughts in yourself and change them to adequate ones. So, with depression, so-called overgeneralization often occurs. For example, "I am a bad mother." This conclusion is made on the basis of a single episode. For example, the baby caught a cold and got sick. And the woman begins to blame herself excessively, forgetting that she coped with all other worries quite successfully. A psychologist helps to open your eyes to the life situation as a whole and draw plausible conclusions. But if psychological help does not help, then you need to contact a psychotherapist. If a specialist prescribes medication, then the mother will have to stop breastfeeding.

— What are the effects of depression on mother and child?

- It all depends on the severity of the depression. Mild and moderate depression can even go away on its own, but during this time a woman suffers, these few months can be a real nightmare. Severe depression has serious consequences, and it must be treated, it will not go away on its own. As for the child, postpartum depression, as a rule, occurs in the first two and a half months of his life. During this period, the main occupation of the mother is the satisfaction of the physiological needs of the child. A woman with a breakdown (and severe weakness that does not disappear after rest is one of the symptoms of depression) will find it very difficult, if not impossible, to care for a child. And she will not be able to emotionally communicate with the child, which will be expressed in some lag in his psycho-emotional development. In such a situation, it is very important for the family to take on these functions.

— Why are there so many opinions that postpartum depression is a made-up problem? Here are just some examples from the forums: “All these depressions are stupid, I don’t believe in it”, “Depression is the lot of spoiled and infantile girls.” Why is it so hard for people to believe that a woman who has given birth is really depressed and needs help?

- Because someone who has not experienced depression himself cannot understand how hard it is. It's like when a person who has never received an extensive burn, looking at a groaning patient with a burn, says: "Well, think about it, it hurts, you can endure it!" Most of the suffering occurs in the depressed person inside.

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