How babies who refuse the bottle and only want to breastfeed affect mothers

How babies who refuse the bottle and only want to breastfeed affect mothers


While I was pregnant, I heard about the many challenges of breastfeeding and mentally prepared myself for the difficult journey ahead.

To my surprise, my daughter started nursing right away and my milk supply was good, as she was gaining weight all the time. My husband also bottle-fed her with my expressed breast milk from the first week onwards, and she transitioned seamlessly between breast and bottle.

He started having more difficulty feeding when she was 3 months old. She would eat from a bottle only under certain conditions, for example, while being rejected or held in a certain position. Then my daughter started refusing the bottle and crying whenever it appeared in front of her.

Instead of working shifts, I now had the full burden of feeding as well as putting her down for naps and naps, since she would only sleep after eating. I could no longer leave the house for a meaningful amount of time because she refused to breastfeed outside the house. I was exhausted, I felt trapped, and I began to regret breastfeeding in the first place.

New moms are usually warned against introducing a bottle too early for fear that babies will reject the breast for the faster-flowing bottle. But I hadn’t heard anything about bottle refusal until I experienced it first hand – and it was taking a toll on my mental health.

It turns out my experience was not uncommon.

Clare Maxwell, a midwife and researcher, struggled with her younger son James’ rejection of the bottle.

She offered one at 12 weeks without success, but kept trying, culminating when she had to go back to work at seven months. Maxwell bought more than 10 different brands of bottles, hoping one would stick. She changed the temperature of the milk, asked others to feed him. Nothing worked.

“I immediately started looking for any papers on bottle rejection or any research, but there was nothing,” said Maxwell, a senior lecturer at Midwifery at Liverpool John Moores University in Britain.. “As if he didn’t exist”.

Still, parenting forums were flooded with thousands of posts asking for help with the same problem, so Maxwell set out to investigate.

In 2020, Maxwell and her colleagues published a study on the experiences of 841 mothers whose breastfed infants did not accept the bottle. They published an online questionnaire to several breastfeeding groups based in North West England and had to close it after two weeks due to the overwhelming number of responses. Nearly 30 percent of mothers reported that refusing the bottle made their overall breastfeeding experience worse.

Mothers cited different reasons for introducing the bottle, such as returning to work or simply stopping breastfeeding. Some women had to take exams or driving tests or attend events such as weddings or funerals.

Others had serious health-related conflicts, including the need for cancer treatment, undergoing surgery, or requiring medications that are not safe to take while breastfeeding. Methods to try to overcome bottle rejection have had a low success rate – apart from forcing their baby to “cold drink”, which can lead to dehydration.

During visits to medical professionals, more than 80 percent of mothers reported that they encountered a lack of helpful advice or support.

“Many health professionals just shrugged their shoulders in a way that suggested I should just get on with it,” recalled one respondent.

Another wrote that the only advice she received “was that it is extremely important to be exclusive [breastfeed] and bottles were what bad mothers did. … [They] were more worried about the baby getting nipple confusion and stop feeding.”

Expectant parents are usually warned that exposure to artificial nipples could sabotage breastfeeding and are told not to introduce a bottle before the fourth week. According to data from the World Health Organization “Ten steps to successful breastfeeding” advice, health care providers should “counsel mothers about the use and risks of feeding bottles, pacifiers, and pacifiers.”

But is nipple confusion real? The evidence is sketchy at best.

AND Review work from 2015 in the Journal of Perinatology found 14 studies supporting and refuting nipple confusion. But neither establishes causation—in other words, there is no research that conclusively shows that artificial nipples are the reason some infants reject the breast.

“At the end of the day, I don’t believe in the concept of nipple confusion,” said Emily Zimmerman, a speech pathologist and neuroscientist who co-authored the paper. “Messages [around nipple confusion] it made mothers and caregivers really stressed about adding pacifiers and bottles to their regimen.”

Zimmerman heads Northeastern University Speech and Neurodevelopment Laboratorywhich studies the interrelationship between sucking, feeding and early vocal development of infants.

As part of her research, she uses a dummy pacifier connected to a pressure transducer system to measure response pattern to suck and how it changes in response to different stimuli. With a bottle, milk is released immediately after sucking. With the breast, the baby must first engage in non-nutritive sucking – such as that used with a pacifier – to initiate the mother’s relaxation reflex. Once the milk is flowing, the baby will switch to a different, more nutritious sucking pattern.

“Something that studies in my lab have shown is that healthy babies who are born at term are usually able to suckle any pacifier, bottle, nipple, breast, finger with no problem and go back and forth,” Zimmerman said. “So the child can be adapted and modified.”

She also said that in newborns, sucking begins as a reflex controlled by the brainstem, an area of ​​the brain that regulates many involuntary actions such as breathing and heart rate even in adults.

By the age of about 6 months, sucking has largely become a voluntary action, as a result of greater involvement of the cerebral cortex. This area of ​​the brain plays a role in many higher-order functions, including attention, perception, consciousness, and thinking. Therefore, bottle rejection can occur because some babies simply develop a strong preference for the breast over formula — and now have the means to express that preference.

But Maxwell pointed out that other babies reject the bottle in the first few weeks of life, so there is no one right answer. In her case, her son, James, finally accepted a bottle from Maxwell’s identical twin sister. But for most of the mothers in her study — about 60 percent — nothing worked.

My daughter, now over a year old, also stopped taking a bottle after three months. I almost hired a postpartum doula who supposedly specializes in weaning, but she wanted $3,240 to fix the problem. And when I visited the lactation consultant, she tried to convince me that the inside of my baby’s mouth was not formed properly and suggested that she needs occupational therapy.

Instead, at about 6 months, I decided to give up the bottle and exclusively breastfeed, which as a self-employed mother who works from home, I had the luxury of doing. I slowly increased my intake of solid food.

Would I choose to breastfeed again, knowing what I know now? Probably yes. But with more awareness and education about refusing the bottle during pregnancy, I might be more mentally prepared and feel less alone in my situation.

“I think health professionals avoid talking about it because they don’t know what impact it will have on a mother’s decision to breastfeed,” Maxwell said. “But we deserve to know, so that as mothers we can make such informed decisions ourselves.”

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