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Ask Dr. Karp is a monthly Q & A series with world-renowned pediatrician Harvey Karp. Each month, he'll join us on the our site Blog to answer questions from our fans.
Q. My almost 3-month-old gets only breast milk. At the beginning of this month he would take a bottle of breast milk, but lately he won't have anything to do with a bottle, even if the milk is freshly expressed. For two weeks I've tried everything from letting someone else feed him to holding him in different positions, walking around, and everything in between! I've stuck with the same brand of nipple, and I even wait five to ten minutes to nurse him after he refuses the bottle. Next week I return to school, and my husband will be staying with our son for three hours at a time. I'm at my wits' end. If you have any suggestions, I would be forever grateful!
Dr. Karp: Your little guy's resistance is frustrating, but it's actually pretty common. The "stripping" sucking that babies do on a breast is very different from "chomping" sucking that they do on a bottle. Most babies can go back and forth between breast and bottle without any problem, but some get into big-time difficulties.
The most common problem doctors see is when the parents offer too many bottles, too soon. Having bottles during the first couple of weeks of breastfeeding can confuse a baby, and many will flatly refuse to take the breast. (The stripping sucking takes more work than the biting on the rubber nipple that gets the milk flowing.) That's why it's recommended that moms avoid all bottles until breastfeeding has gone well for two weeks.
The next most common problem is the one you're having, and it happens when you wait too long to offer a bottle. Many parents offer a bottle once or twice, and when their baby does well with it, they don't offer the next bottle for another few weeks. They make the very reasonable – but wrong – assumption that if their baby takes a bottle easily a couple of times she will always do fine with one. But most babies require a bottle every day or two to keep up their practice. (But beware! More than a bottle a day can totally undermine the nursing.) And, if too much time goes by without any bottles, some babies (like yours) just dig in their heels and refuse.
Fortunately, you may still be able to get your baby taking bottles. Interestingly, waiting until a baby is ravenously hungry – the strategy most people suggest – almost never works. Hungry babies are even more persnickety about what is in their mouth.
Instead, I recommend you try the following little "bait and switch" technique:
Three-quarters of the way through a nursing – when your little guy's sucking has slowed and his body has melted into a relaxed little bundle in your warm arms – gently ease the breast out of his mouth and slip in a bottle of warm breast milk. To encourage him, squeeze the nipple a little to get a few drops of the sweet milk to come out. If he resists, put the breast back in and try again in a couple of minutes.
Once he does suck a little, you can help make it go even better by using this "reverse psychology" from the Happiest Baby routine: Pull back slightly on the bottle every time he gives it a little suck. This makes most babies suck a little harder as if to say, "Hey, that's mine! Don't take it away!"
You may have to offer the bottle of warm milk over and over for several days, but don't give up! You have a 50 to 70 percent chance that this will work to get him back to taking a bottle once a day.
If all else fails you can feed him with a spoon or eyedropper. It's slow, but effective.
Photo: Lunchbox Photography, Flickr
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