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Breast and Bottle Feeding Problems

Image by Lucy Wolski

If you suspect your baby isn't getting enough milk (breast milk or formula), you'll understandably be worried. It may be difficult to determine the cause of your baby's squirming, fussing, cries, or refusal to eat when he or she seems distressed during feeds.

Babies don’t talk, but they do communicate! If your newborn or older infant is struggling to feed, falling asleep quickly, showing stress and refusal behaviors, or discontinuing feeding after only a few sucks or minutes, you have a struggling feeder on your hands!

Babies can't always suck efficiently right away, which is more common in babies born a few weeks early (between 35 and 37 weeks of pregnancy). Even fully developed babies can take a few days or weeks to adjust. For those babies struggling to feed after birth, consulting a skilled feeding therapist can significantly reduce the likelihood of long term feeding difficulties, reduce caregiver stress, and improve outcomes with the infant.

Signs and symptoms 

Not all feeding refusal looks the same. There can be a range of signs that your child is struggling to feed well, including:

  • Turning away from the breast or bottle.

  • Refusing to close her mouth around the nipple.

  • Taking only a small amount and then refusing more.

  • Screaming when placed into a feeding position

  •  Gagging or fussing as the bottle’s nipple nears their mouth

  • Feeding too quickly or too slowly.

  • Not consuming as much milk as expected.

  • Chewing on the bottle’s nipple




Behavioral reasons

A baby's feeding problems may be caused by a variety of behavioral factors such as

  • Breastfed babies with limited exposure to bottles or formula may struggle to feed well from a bottle. Bottle-feeding necessitates a completely different sucking motion than breastfeeding. A baby who has been exclusively breastfed for more than three months will often reject milk from a bottle because it "doesn't feel right" and she doesn't know how to suck from one. There are also times that a baby may refuse formula due to the difference in taste and smell. This is uncommon in infants under the age of 3-4 months.


  • When it comes to a baby's needs, sleeping and feeding are closely tied. Both are vital to a baby's health and growth. If she isn't having enough sleep, it will have an adverse effect on her eating. Physical exhaustion may trigger a tired baby to fall asleep before the feed is finished. 


  • Babies over the age of 4 months can easily become distracted while feeding. They are often much more interested in the activities going on around them than they are in feeding.


  • Your baby's desire to eat from a bottle may be impacted by her positioning during the feeding. It may be difficult for her to suck or swallow if her head is too far forward or back, or if her neck is bent.


  • The nipple is arguably the most important factor in a baby’s feeding success. Your baby's nipple should be the appropriate size and flow rate for his or her size, age, and sucking capacity. Your baby may have feeding problems if the nipple is too long, too short, too fast, or too slow. 


Medical reasons for feeding refusal:


Oftentimes, feeding refusal in infants is caused or influenced by underlying factors which may or may not be impacting other areas of development. As previously stated, many otherwise typically developing infants will experience persistent feeding difficulty. Common medical reasons for feeding refusal include: Poor coordination or endurance for feeding, genetic disorders which may impact feeding abilities, gastrointestinal problems, such as acid reflux, slow motility, or dietary sensitivity. 


Acid Reflux

If a baby is fussy, doesn't want to eat, and spits up a lot, then they very well may have acid reflux. When a baby has reflux, it causes them to feel discomfort or pain when eating. Symptoms that may point to reflux issues include:

  • Arching or stiffening their back when feeding

  • Crying, getting red or watery eyes while feeding

  • Coughing regularly during feedings, or right after them

  • Refusing to drink, or Having poor sucking 

  • Taking a long time to eat or drink


Suck, Swallow, Breathe Coordination and Aspiration

If your baby often chokes while drinking, especially if the nipple you are using flows too quickly and your baby has too much milk in her mouth, this can be a sign of poor coordination of the three reflexes that help infants eat: such, swallow, and breathe. A baby must do all three of these things very rapidly, over and over again, in one single feeding. Some infants who can’t coordinate this task well may cough, choke, disengage during feeding, or fall asleep quickly after they start feeding. Although coughing and choking is a strong clinical indication of an aspiration event (milk being inhaled into the lungs instead of swallowed), it should be noted that most aspiration events in newborns are SILENT, meaning the newborn does not yet have a well integrated coughing reflex, and may not cough in response to milk entering the airway. It is important to always pay attention to every behavior an infant demonstrates during feeding. 


Facial or oral structural differences

A baby's feedings can be affected by the shape or structure of their cheeks, mouth, tongue, or jaw. That’s because these body parts affect how they’re able to latch both to the bottle. For instance, when the roof of the mouth is higher and narrower than the usual flat U-shape, which is known as a "vaulted" palate, extra space is created, making it more difficult for the infant to compress a bottle. Retracted lower jaws can negatively impact the infant’s ability to attain a good latch and extract milk efficiently.


When to seek advice:


If your baby is consistently unable to finish an adequate amount of milk or formula, there may be cause to seek professional advice for modifications and strategies. Oftentimes, when a baby of any age is showing stress or refusal signs regularly, there is something going wrong during the feeding process. When left un-treated, these problems can escalate into significant long term feeding refusal and aversion. A feeding specialist can guide you through the process of identifying the cause of the feeding difficulty and making adjustments so that your baby can be successful and gain adequate weight.   We offer a 15 minute phone consultation to discuss your baby's feeding here.

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