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Leslie Kowalski Leslie Kowalski

Bottle Feeding and Bottle Refusal

Bottle feeding is a skill well worth working on for any baby - in fact it is a red flag for feeding issues if your baby can not take a pacifier or bottle.

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Page updated October 2026

Paced Bottle Feeding helps babies feed better!

We often see babies in reclined positions with the bottle tilted straight down, and people told that the nipple must be full of milk - but this actually causes babies to eat too rapidly, leading to gulping, air intake, tummy upsets and overfeeding.

Let’s compare that to breastfeeding. When a baby is drinking effectively, they go at a natural pace - sometimes drinking more rapidly and other times taking breaks. Each session provides the amount of milk that a baby wants - sometimes a meal, sometimes a snack. Paced bottle feeding mimics many aspects of breastfeeding - allowing baby to drink at their own pace, and get the amount they want. Paced feeding is good for all babies, no matter how they are fed - and for a baby having trouble with breastfeeding, it also supports the flow and mouth position of nursing - ideally aiding latch skills too. Many of the videos below show paced feeding in action.

Use a gently tapered slow flow nipple (related article and instagram post by Rachel O’Brien, IBCLC). Wide nipples that look “like a breast” are more like a breast that is not being nursed! With their curved or nipple-heavy shape, the baby has to pinch their mouth, lips and cheeks to fit around the nipple - more like a shallow latch. Instead look for a bottle nipple that is closer to a cone or triangle - so it fills the baby’s mouth, and they can progressively widen on it to get deeper.

Hold the bottle at a slightly downward angle (closer to horizontal) so the baby can regulate the flow of the liquid themselves. We want them to use their breastfeeding muscles (and promotes their oral/facial development) but not get overtired either. So if you see them pinching their lips and squeezing in their cheeks like they are drinking a milkshake - the flow is too slow for them. If you see leaking, spilling or hear gulping, sputtering, choking - then the flow is too fast. The angle of the bottle will differ for every baby - use the angle that helps them do the work of the feeding, but not one that overtires/fatigues them (not tilted enough) or one that overwhelms them (too tilted).

It is a myth that the nipple needs to be completely filled with milk. Babies actually get air in their tummy if air leaks into their mouth while drinking. If you hear gulping, clicking, air hissing noises - that is more likely causing air ingestion.

Try different feeding positions to find the most comfort (your comfort counts too!) and for your baby to have good “posture” - relaxed body, able to use their hands purposefully, and able to extend their chin a bit away from their chest (think of the angle you hold your chin when drinking a glass of water).

If baby is taking in air, gulping, drinking too slowly (or doing anything else that makes feeding challenging) - see if any of these help:

See which work best for you and your baby - your favorite position may differ from others and that’s fine!

Bottle Refusal

For babies refusing bottles, the answer is rarely about finding the perfect bottle but rather figuring out why bottle feeding is hard for your baby. Usually this issue is related to their oral skills (and if they are having breastfeeding and/or digestive issues - it may be the same root cause).

Work with an IBCLC trained in bottle refusal

As outlined in these fantastic resources - “Bottle Skills for the Bottle Refuser”, a video by Susan Howard, IBCLC, and “What to Do When Your Breastfed Baby Won’t Take a Bottle”, an article by Rachel O’Brien, IBCLC. We want to work with empty bottle nipples to figure out which one(s) fits your baby’s sucking pattern best. Not only might you find the right shape for your baby at this, time, practicing sucking without the milk also makes it easier for the baby to learn what to do with their mouth. Then we can add the milk back and let them go from there.

Because bottle feeding difficulties can sometimes indicate an underlying oral issue these, it’s always important to work on the above ideas. But also we want you to be able to have options!

Explore feeding alternatives

When you want to go out (an appointment, going to work/school, or any reason!) and your baby has not yet taken a bottle = or if they are 5+ months and you want to explore other ideas anyway - let’s look at these ideas:

Here are some examples of products to consider (these are not an endorsement, they are just examples for you to look at so you can have an idea of what’s out there) - Silicone training cup (also shown in a video above), Straw cups (also shown in a video above), this TalkTooks Itsy Cup (multifunctional), The Doidy Cup (comes in many colors if you search around), or cups that limit the flow of liquid such as the Reflo smart cup, this First Years cup, this Munchkin Splash, or cups that have a spout (and many more ideas along these lines). Be careful to use cups that don’t have valves that limit the flow, though because they only encourage cheek-pinching/milkshake drinking sucking.

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