As an IBCLC in private practice, I am sometimes asked for solutions when a breastfed baby refuses to take a bottle after his mother has begun regularly separating for a return to work or school.  This dilemma rouses an emotional response in me, because I experienced it to varying degrees with each of my three children, with tremendous emotional fallout.  I would apologize for the emotions that come through in my response, however, I have come to believe that our feeling side is often neglected in these situations, but it gives rise to the best solutions. I allow my emotions to remain on the surface and I share what my experience and knowledge point to in situations like these.

I feel profoundly sad for any mother and baby dealing with bottle refusal. Both are at the ends of their ropes and there is a circumstance (not always something mother can change) that is preventing them from being together as they were designed to be.  I believe, as La Leche League professes in its philosophy, “In the early years, the baby has an intense need to be with his mother which is as basic as his need for food.”  The stress of this wedge between them and the complications it presents can affect every aspect of their relationship.

My first concern is the mother’s support system. Is there a partner or support person who can focus his or her energies on taking care of mother so she can take care of her baby?  Are there extended family/friends who can bring over meals or come to do some housework on the weekends?  This mother must be supported in practical ways because she’s juggling both her job and her pre-motherhood expectations of how babies should behave.

A common secondary problem that stems from a baby refusing a bottle while separated from his mother is that he will begin to reverse cycle – he’ll spend his entire night, while mother is beside him, consuming the calories he missed while they were separated all day. “This isn’t going to be sustainable,” exhausted mothers tell me.  Of course it isn’t – something has to give, somehow.

Fortunately, baby’s needs evolve with each day. This doesn’t mean babies are “happy to separate,” it only means some aspects of the separation itself are a little more flexible.  Around the middle of the first year, baby will likely be ready for some solids, which lessens the (nutritional) impact of the separations a little bit.  In my case, my babies didn’t take solids until around 7 months, but when they did, I allowed solids to be fed by the babysitter and I only breastfed my babies.  This meant I didn’t feed a solid meal, usually, until closer to 12 months of age!  They would take one or two feedings of solids, but not daily.  When I was with my babies, we only breastfed.  This didn’t make them averse to solid food later, and didn’t complicate the “teaching them how to eat” business. I saw the solids as a stopgap to the problem of their bottle refusal.  This is one very strong reason why I try to encourage mothers, if it is at all possible, to delay their return to work/school for as long as possible.  Even making it to the 6-month mark opens options for dealing with the complications that regular separation can present.  If mother has to leave sooner, we can encourage her that, even if he never takes that bottle, her baby’s dependence upon her as sole source of nutrition does wane in time.

The situation that the baby is in also matters, especially when he is expressing his needs in a manner that makes it impossible for the caregiver to feed him.  A daycare center with lots of babies is often ill-equipped to handle such a situation.  My specifications that my babies never cry alone (I knew they would cry but I wanted them to be held or worn when they cried, never left alone) and be fed on demand were too much for a regular daycare.  I needed to find a creative solution, one that allowed my babies to be cared for by one person who didn’t have her hands too full to keep them engaged in a loving way, even as she could not substitute for me. I was fortunate that I was able to brainstorm and implement options that worked for us, and I recognize that other mothers might have to think even further outside the box to find ways to meet, or at least find a compromise toward, their babies’ needs.

I understand and remember how desperate a mother’s need for a prescribed solution to matters like these can be.  We want “Solution B” to  “Problem A”, and we are managing so many things we never expected to have to manage. But, in refusing the bottle, baby is clearly expressing some needs and we just can’t verify what those needs are … or, if we can, maybe we are too hardened or saddened by the realities of what our culture imposes on new mothers to acknowledge and address those exact needs.  The family’s response to these needs will be mirrored later in the child’s life, when how he eats isn’t the issue, but another situation will arise and the parents will be forced to either apply a “prescribed fix” to the situation or think flexibly about how to meet the needs of this child in a manner that respects them as bona fide NEEDS and preserves the family’s sanity.  The solutions will not always meet mother-in-law’s approval or be found in the parenting magazines or on the TV shows about babies, but they will be organic, fluid manifestations of how mothers and their babies adapt to threatening situations.

Here are some practical considerations for when a baby won’t take a bottle, or if he is otherwise expressing his discomfort with separating from his mother:

• Can the mother stretch her maternity leave at all, in any way, so that she has even one more week with her baby?
• Is the baby rejecting the bottle because the expressed milk doesn’t taste very good?  Some mothers have too much lipase, which begins breaking down her milk while it is stored, leaving the milk smelling and tasting “off.”  Some babies don’t mind this, but others seem to be very sensitive to it.  Try feeding milk expressed within a few minutes immediately and see if baby resists.
• Can daycare be closer to where mom works so separation time isn’t as long and maybe they can nurse at lunchtime?
• Can baby be brought to the mother at all?
• Is she breastfeeding at the caregiver’s location on drop-off and at pick-up, lessening the number of feeds during their separation?  This will be especially helpful when solids are introduced, perhaps even covering the entire day.
•  Is mom sharing sleep with her baby?  Napping together on weekends and days off?  Sleeping in on weekends while someone else wears the baby and does some housework in the early morning hours, bringing him to nurse as needed?
• Can she work out a flex-schedule so that she’s working one fewer day a week, perhaps with a caregiver bringing baby to her at the end of the workday so they can nurse, then she puts in a few extra hours to enable the 3-day weekend?  Or a day off on Wednesday?  It never hurts to ask these things, and they’re not forever — just a few months until the baby’s needs evolve a bit.

Maybe the mom isn’t going to sleep much at night, maybe instead she will sleep after nursing the baby at home, wake for a few hours after dad/partner has given baby his bath, washed bottles and pump parts and prepared everything for the next day (I think babies love to be worn and talked to when someone is preparing their bottles and pump parts!), sleep again after the next nursing session, and cobble together 5 or 6 hours on work-nights.  No, not sustainable long-term, but also not necessary long-term … just necessary TODAY.  I realize these aren’t solutions that fit into the norms of our culture, but if they permit a family to balance its responsibilities in the context of meeting the real needs of their baby, isn’t that what matters?

Just after my youngest entered toddlerhood, I was asked to review Balancing Breast and Bottle (click on the title to see the companion website) by Amy Peterson and Mindy Harmer — it offers a comprehensive anatomical perspective on why some babies resist bottles, and practical tips for how to help them learn to.  This information would have helped me tremendously had it been available when my firstborn worked so hard to learn to breastfeed from my one-flat and one-inverted nipples, then demonstrated absolute frustration when I stuck every long-nippled bottle teat in her face starting at 6 weeks and finally giving up at 4 months.  It wasn’t gonna happen.  The book shows very clearly how to choose a bottle teat that more closely approximates the mother’s nipple and works with the baby’s anatomy.  It might be worth a try if they aren’t already too worked up and stressed out about the whole process.

I was back to work at 12 weeks, and through more tears and agony than I care to recall, I had to figure out how to keep my baby thriving and keep myself alive.  I switched babysitters so she was a 2-minute drive from my workplace.  We spent my lunch hour together, nursing at the beginning and at the end.  Whenever it was practical, I brought my baby with me to work and we just nursed when I could do that. On days I could go home at lunchtime, we napped together, then when Daddy came home, I finished my workday tasks.  Sometimes, I did my work after dark — she would sleep from 9-11:30 or so and I’d finish my projects and correspondence then.  I would rather have been sleeping, but my baby had needs of me and my job had expectations I had to meet, as well.  Breastfeeding wasn’t my problem.  Motherhood wasn’t my problem.  Otherhood was. I had to manipulate everything else so the breastfeeding and the mothering got done. I felt like a freak and wondered if I was setting my children and my family up for permanent misfit status … but I prioritized what was important to us and let the rest fall into order as it would.  Today, other than a still-messy house, we look like a regular family. 🙂

As in many situations, mothers have to define their own success.  We need to assess our situations for the “soft” walls — the ones that will give — so we can find the balance in our lives. What do I value?  How do I make my decisions, and with whose input?  Have I had 15 minutes since my baby was born to assess what his arrival has done to my value system?  Our solutions and situations won’t be the same, there will be no “right” or “standard” answer.  We all have to find our own way.  If a mother has all of the information she needs to make an informed choice, we have saved her from the Guilt-Monster.  She may regret later that her situation wasn’t different, but she will make her decisions based on what she has and what she can do, which is all any of us can expect of ourselves.  I can remember feeling downright ostracized by women who had no idea about my situation, women who raised their eyebrows at me and said “my family made a choice” as if I was making the “wrong” one.  I believe every mother wants to do what is best for her baby, but we are so bombarded by cultural messages of what is important, we lose touch with our instincts and our innate sense of what we can do.  As an IBCLC, when a mother welcomes me into her life, I do my best to offer her all of the information I have that pertains to her situation, and to remind her that sometimes, the best solutions are the ones that she comes up with herself.