What's Going On?

Dear Dr. Honig: I have a baby in my program who refuses a bottle even when he's hungry What's going on?

When a baby is abruptly weaned from being nursed and enrolled in care where he will be bottle-fed, he may not have enough time to adjust to the change. The baby has to adjust to a loss of the skin-to-skin snuggling of nursing, as well as to the feel of a rubber nipple rather than a soft, warm human nipple. These sudden changes might be so bewildering and difficult that they lead to mighty bouts of crying, a vigorous turning away from the offered bottle, and spitting out the nipple of the bottle.

Ease the Transition

Even babies who are not in "other-than-mother" care sometimes put up stiff opposition and exhibit much distress when a mom starts a slow process of weaning from breast to bottle. This process is much more confusing and stressful when so many variables change at once-including a new source of milk, a new taste, and new arms that hold the baby for feeding.

This infant's refusal of the bottle points out how urgent it is for parents and teachers to share information, concerns, and timetables with one another. If a baby is just being weaned from the breast, parents need to tell the teacher! One way to ease the transition is for the mother to express her milk for bottle-feedings during the early days as she is trying to wean her baby. Then, at least, the baby tastes Mom's milk. This gradual introduction of new feeding practices allows babies to take one step at a time as they transition to being bottle-fed.

Cuddle During Feedings

Another possible reason for this baby's reaction is that the parents, unaware of how important holding is during nursing, have habitually left him in a crib with a propped up bottle for feedings. Your tender, careful holding of the baby for bottle-feedings might seem strange and uncomfortable to him. Cuddling during feeding is a deeply important way for babies to gain a sense of intimacy.

Learn Babies' Feeding Styles

If this baby is already bottle-fed at home, the teacher needs to find out how a baby was held for feedings and how patient the mom was with his feeding preferences. Some babies nurse frantically and gulp down milk with terrific intensity until they feel satisfied. Other babies are "snackers" who take some sips, pull away from the nipple, look around a bit, and, at their own pace, latch onto the nipple again. Some parents are impatient and jiggle the nipple when a baby lets go, hoping it will hasten the baby's reconnecting with the nipple.

Be sure to ask the mom of a newly enrolled infant just how she nurses her baby. A baby may have adjusted well to receiving the bottle from Mom and Dad, but find it hard to get used to yet another set of arms holding him.

Try Swaddling

Some babies can quiet themselves, settle down, and attend to nursing better when swaddled securely or while in a darkened room where voices are low. This information could be on a checklist that the parents of a newly enrolled infant fill out for the school.

How to Feed a Baby

* Babies have unique responses to being held, to the scent of a teacher's body, and to being in a certain position on the teacher's lap. Be sure you are comfortably settled into a rocking chair when offering a bottle. After testing and making sure that the milk is just the right temperature for the infant, watch how the baby latches onto the nipple. Which angle of the bottle does she prefer? Does she seem to want to be turned into your body at a different angle while you feed her? Does the baby prefer to "hold hands" with you as she feeds? Does she seem to want to curl her little fist around one of your big fingers for more comfort as she nurses?

* Does the baby feel more relaxed if you first swaddle her in a receiving blanket as she settles into your lap for a feeding? Some young babies are much less upset in the early months if they are cozily swaddled before they are fed. Otherwise, they may feel somewhat unsure and demonstrate the Moro reflex-flailing their arms and then closing their hands together as if they don't feel safely held.

* If a baby is a "snacker," take note that you will need extra patience. Allow more time for this baby to latch onto and then off the bottle, look around, and get back to nursing. Have you noticed whether she is highly distracted by bright lights or noise in the infant room? If so, try to choose a quiet corner, or a place that offers low lighting and quiet so that the baby can focus on sucking rather than on the distracting sounds and sights of the room.