PDF Summary:Your Baby's Bottle-feeding Aversion, by Rowena Bennett

When your baby refuses to bottle-feed, mealtimes can become stressful and worrisome. In Your Baby's Bottle-feeding Aversion, Rowena Bennett explains that feeding aversion often develops when babies associate feeding with negative experiences—whether from pressure to eat, physical discomfort, or sensory issues. The most common cause is feeding pressure, which can range from gentle coaxing to force-feeding.

Bennett outlines a structured approach to help your baby overcome bottle-feeding aversion. You'll learn why letting your baby control when and how much they eat is important, how to recognize and respond to your baby's feeding cues, and which practices to avoid during the resolution process. Bennett also provides guidance on tracking progress, managing setbacks, and understanding what successful feeding looks like once the aversion is resolved.

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(Shortform note: In her decades of experience, Satter found that when parents stopped enforcing bottle volumes and instead offered regular, pressure-free feeds, children’s weight gain typically stabilized along an appropriate curve. This suggests that most healthy babies can indeed determine how much to consume.)

Infants and kids can sense the energy in what they eat, which enables them to adjust how much and when they consume food. Infants with normal neurological development are inherently able to manage energy. They can determine the amount of food necessary to help them grow in a healthy way, based on the size and shape determined by their genetics. This is innate, requiring no thought or learning. Bennett adds that attempting to manage a baby's intake can backfire. The most effective way to turn a baby or child off feeding is to make her eat when she's unwilling.

(Shortform note: How do infants and children “sense the energy” in their food? The gut and fat tissue release hormones and send nerve signals to the brain to communicate how much energy the body has recently consumed and how much energy is stored in the body. The brain then adjusts hunger and fullness in response to these signals.)

A Structured Approach: The Five Steps for Achieving Success

Bennett outlines five steps to help parents resolve their baby's bottle-feeding aversion: 1) Ensure your baby is healthy, 2) Plan to succeed, 3) Motivate your baby to feed, 4) Follow your baby's lead, and 5) Support your baby's sleep. To ensure your baby is healthy, take them to a doctor if you have any doubts about their health. To plan to succeed, reduce your workload and responsibilities for a two-week period so you can focus on addressing your baby's feeding difficulties. Make sure you're home for all feedings, and limit the feeders to one or two people. Seek help from others for your other children, housework, or emotional needs.

(Shortform note: This plan may not be feasible for all families. For example, if you work a job that doesn’t offer paid leave, you may not be able to be home for all feedings for a two-week period. Or, if you don’t have family or friends nearby, you may not have anyone to help you with your other children, housework, or emotional needs. If you’re unable to follow this plan as written, consider reaching out to your doctor or a social worker to see if they can help you adapt it to your circumstances.)

To motivate your baby to feed, stop sleep-feeding, stop providing solids or breastfeeding during the daytime, and only give your baby milk from a bottle. To follow your baby's lead, avoid anticipating that your baby will eat, either through direct or indirect means. Respond swiftly and correctly to your child's signals when they show they're interested or uninterested in feeding. To aid your baby's sleep, ensure your baby is getting enough rest.

Restoring Breastfeeding

If your goal is to re-establish breastfeeding, this plan may not be appropriate for you. In The Womanly Art of Breastfeeding, the authors explain that when the goal is to restore or strengthen breastfeeding, the heart of the plan is to put the baby to the breast often, in a relaxed, skin-to-skin, low-pressure way, so that most of the baby’s sucking and swallowing practice happens at the breast rather than on artificial nipples. They explain that every feeding that happens away from the breast is a missed chance for the baby to improve breastfeeding skills and for the parent’s body to get the message to make more milk, so any supplements the baby truly needs are best given in ways and amounts that still leave many opportunities each day for the baby to nurse.

Implementing Resolution & Monitoring Progress

Practical Implementation Strategies

Bennett recommends following the suggested feeding strategies to help your baby overcome their resistance to using a bottle. These involve: - Make sure to address any issues with latching, placement, or breathing beforehand. - Refrain from placing the bottle in your baby’s mouth without their consent. - At the first indication of refusal, promptly take the bottle out of your baby's view. - Don't hold the bottle in front of your baby if they're refusing it. - Offering the bottle just twice per meal (and if your baby consistently rejects the second offer, then offer only once)

(Shortform note: Bennett’s use of the word “consent” here is unusual, but it’s clear that she means you should wait until your baby initiates taking the nipple before you place it in their mouth. This is in line with the responsive feeding approach, which Maureen M. Black and Frances E. Aboud define as “caregiver behaviors that are prompt, emotionally supportive, and contingent on the infant’s signals of hunger and satiety, such that caregivers recognize and interpret the child’s cues and allow the child to initiate, continue, and terminate feeding according to those cues.” In other words, feeding should be your baby’s action, not yours.)

• Avoid forcing, persuading, or tricking your baby into eating or continuing to eat when they want to stop. - Not adding medications that taste bitter to the formula. - Prevent a sleep-feeding link, where your baby depends on feeding to fall asleep. - Discouraging conflicted feeding behavior by taking the bottle away when your baby turns their head. - Steer clear of scenarios that could cause your baby stress. - Provide feedings in a calm setting if your infant shows stress during meals. - Limit how many people bottle-feed your infant, aiming for a single caregiver. - Being at home for the initial three days can help your baby rest, since during this time they may feel hungry but refuse feeding, making sleep challenging. - While adjusting, try to provide all meals at home. - Aim for a consistent morning wake-up time to regulate your infant's internal clock.

(Shortform note: These steps help your baby overcome bottle-feeding aversion by stabilizing their circadian rhythm and stress hormones. When your baby’s sleep-wake cycle is regular, they’re more likely to be alert and calm during feedings. This calm state makes it easier for them to accept the bottle and feel safe while feeding. By keeping feedings at home, limiting caregivers, and having a set morning wake-up, you create a predictable environment that reduces stress and helps your baby feel secure. This security is key to helping them move past their aversion and develop a positive relationship with bottle-feeding.)

Bennett emphasizes that these are guidelines, not hard-and-fast rules, and they aim to ease or make feeding more agreeable for your child as they adjust. You may believe these suggestions are unnecessary or that they might not align with your family's situation. You might discover that modifying these suggestions still results in progress in your baby's feeding aversion. However, if things are not going well, you should reconsider any recommendation that you’re not currently following. While all of these recommendations can help improve the chances of a baby overcoming resistance to bottle feeding, two suggestions are particularly important for progress: discouraging conflicted feeding behavior and a feeding-sleep association.

(Shortform note: Bennett’s guidelines are flexible, but she doesn’t provide a clear way to determine which ones you can adjust and which ones you should keep unchanged. To help you decide, consider this rule: If a guideline doesn’t change your response to your baby’s clear refusal, you can adjust it. If it does, you should keep it unchanged. This approach ensures that your baby receives a consistent message about what happens when they refuse to feed, which is crucial for overcoming their aversion. For example, if you’re considering adjusting the guideline about not feeding your baby while they’re asleep, ask yourself: Would this change how I respond when my baby refuses to feed? If the answer is yes, it’s best to stick with the original guideline.)

The advised actions in these situations are exceptions to the "follow your baby's lead" guideline. Conflicted feeding behavior is characterized by an infant who repeatedly drinks a little, pulls away tensely, returns seeking the bottle, and repeats this pattern. The advice is to take away the bottle when your baby looks away, then pause or stop feeding to avoid encouraging this behavior. If your baby’s conflicted feeding behavior isn’t reinforced, it should diminish early on and be gone by Day 5 or sooner. If, after Day 6, your baby still shows conflicted behavior, this might suggest that this fragmented, tense way of feeding has been encouraged.

(Shortform note: Black and Aboud argue that infants learn to self-regulate through repeated, consistent interactions with caregivers. If you repeatedly end feeds in a way that your baby can’t predict, this could undermine their ability to self-regulate. This could be a problem if your baby’s conflicted feeding behavior doesn’t resolve by Day 5 or 6.)

If you've inadvertently strengthened your baby's conflicted feeding habits and now choose to address this by removing the bottle when they first turn away, anticipate a temporary decrease in their milk consumption. It could also indicate that the time it takes for them to overcome their aversion extends beyond the anticipated two weeks if you didn't start on the first day.

(Shortform note: In Don’t Shoot the Dog, Karen Pryor explains that when a behavior has been reinforced on an intermittent schedule, the learner develops a strong expectation that if it just keeps trying, the reward will eventually come. This means that the behavior becomes remarkably persistent and may actually intensify for a time when reinforcement is first discontinued before it finally weakens and disappears. In the case of your baby, this means that their expectation that renewed resistance will eventually lead back to the bottle is strong, and it will take many instances of that expectation being contradicted before it naturally weakens.)

Parents might also not see progress if they fail to heed the advice to prevent their baby from associating feeding with sleep. Certain parents may not adhere to these recommendations, as their baby can only sleep after feeding, and they wish to prevent upsetting their child by changing this habit. If a baby depends on feeding to sleep, they might appear to be hungry and seek a bottle whenever they feel fatigued. However, if they’re allowed to fall asleep while drinking from a bottle, then you won’t be able to adhere to the "no sleep-feeding" guideline. Feeding while sleepy or drowsy may hinder their progress in overcoming feeding aversion.

(Shortform note: Some experts argue that it’s normal for babies to fall asleep while feeding. James J. McKenna and Lee T. Gettler, anthropologists who study infant sleep, argue that in many cultures, feeding and sleep are closely linked. He explains that in these cultures, mothers and babies often sleep together, and babies feed frequently throughout the night. This pattern, which he calls “breastsleeping,” is considered biologically normal. McKenna and Gettler argue that this close connection between feeding and sleep is part of how humans have evolved. They suggest that trying to separate feeding from sleep might not always be necessary or natural.)

Preventing your baby from linking feeding with sleeping requires more than simply implementing the guideline of not letting them sleep-feed. Stopping your baby from dozing off while using a bottle is meant to alter their reliance on feeding as a sleep aid. With your guidance and support, they can learn to fall asleep differently.

(Shortform note: To help your baby learn to fall asleep without the bottle, create a short, predictable pre-sleep routine that always ends with putting them down drowsy but awake. Over time, these new calming cues will replace the bottle as their signal to fall asleep. Consistency is key—babies need many repetitions to form new sleep associations.)

Evaluating Progress & Addressing Setbacks

Bennett explains that progress in overcoming a bottle-feeding aversion can be inconsistent, with ups and downs. A baby who’s no longer pressured to feed will start to accept the bottle when hungry. However, she may still get upset if offered a bottle before she wants to eat. She may still have mixed reactions to feeding, although this will decrease over time. Progress will be a cycle of advances and minor setbacks. Regression days can happen whenever, especially if your child is tired, hungry, or distressed by things like sickness, getting teeth, or immunizations.

(Shortform note: Bennett’s assertion that it’s normal for a baby’s feeding to regress on days when she’s ill or has just had vaccinations is supported by research on “sickness behavior.” This is a set of behavioral changes that occur when the immune system is activated, such as during an infection or after receiving a vaccine. Dantzer explains that sickness behavior is characterized by reduced food intake, increased sleep, diminished exploratory and social activities, and increased irritability. These changes are mediated by proinflammatory cytokines acting on the brain rather than by direct action of infectious agents themselves. This means that the same immune response that helps fight off illness or respond to a vaccine can also temporarily suppress appetite and increase irritability.)

If the infant is sleepy and hungry, the tiredness often takes over, making them more fussy and causing them to feed poorly. In this case, the situation typically improves the next day. If the baby is upset for other reasons, it might delay progress. As the recollection of pressure recedes, the baby will feel calmer during feedings. Her eagerness to eat will vary with her mood, hunger level, and fatigue. Milk quantities and behavioral scores will vary from meal to meal and from one day to the next, but generally speaking, both the quantity and the openness to feeding will trend in the preferred direction.

(Shortform note: A behavioral score is a numerical rating of how easy or difficult your baby’s behavior was during a feeding. For example, you might rate a feeding as a 10 if your baby was calm, alert, and fed well, or a 1 if she was fussy, refused to eat, and cried throughout the feeding. These scores help you track your baby’s progress and identify patterns in her behavior.)

The baby will be happier between feedings and may sleep better. At some point during the second week, the baby will willingly drink ample amounts throughout the day. She might eat more often than is typical for her age group. There will be a growing number of ratings in the 4 and 5 range. Improvement may take time, and there might be fluctuations in her feeding behavior and consumption. Some days might still regress. If there isn't a general trend of progress as time goes on, you may need to investigate further. If, after two weeks, your child's eating isn't meeting your expectations, it may be necessary to investigate further. It could take several weeks to feel confident your baby won't unexpectedly return to old, avoidant feeding patterns, and for your anxiety to decrease.

Pediatric Feeding Disorder

While Rowena Bennett’s approach may work for many babies, some medical researchers argue that a two-week window of improvement and regression may not be realistic for all infants. In an academic paper, some clinicians argue that the term “pediatric feeding disorder” (PFD) should be used to describe infants who have feeding problems that are more complex than what Bennett describes. PFD is a condition that affects a child’s ability to eat and drink normally. It can be caused by a variety of factors, including medical, nutritional, skill, and psychosocial dysfunction. The authors of the paper argue that PFD is a complex condition that requires a multidisciplinary approach to treatment. They recommend that children with PFD be evaluated by a team of specialists, including a pediatrician, a dietitian, a speech-language pathologist, and a psychologist. They also recommend that children with PFD receive long-term treatment, as it can take time for them to learn how to eat and drink normally.

Bennett recommends monitoring how much milk your baby drinks and how she behaves when eating to evaluate progress. This will assist you in assessing when she no longer dislikes bottle-feeding. Once she's overcome the aversion, your baby will voluntarily drink enough milk for healthy development throughout the day. The quantity may differ from what you've been informed or expected she requires. Healthcare providers occasionally think infants need a greater amount of milk than they actually do, so you might have to modify your expectations. Your baby's eating habits might not align with typical expectations for her age.

(Shortform note: In addition to monitoring your baby's milk intake and behavior, you can also track her growth to determine if she's getting enough milk. Growth charts are a valuable tool for assessing your baby's development. These charts plot your baby's weight, length, and head circumference over time, allowing you to see how she compares to other babies her age. By regularly measuring and recording these parameters, you can identify trends and ensure your baby is growing at a healthy rate. If you notice any significant deviations from her growth curve, it may indicate that she's not getting enough milk or that there are other underlying issues that need to be addressed.)

Her behavioral ratings will largely be fours and fives. It's typical for infants to be fussy and distracted while feeding, which would be rated 4. At times, how she eats may earn a score of 3. Bennett suggests you track your baby’s liquid consumption and excretion, assess how she feeds, and measure her progress against your expectations.

(Shortform note: Bennett’s behavioral ratings are similar to the numerical scores that standardized feeding tools assign to different feeding behaviors. For instance, a score of 3 might indicate that your baby is showing signs of mild discomfort or distraction during feeding, while a score of 4 could suggest more pronounced fussiness or resistance. By assigning these numerical values to specific behaviors, you can more easily track patterns and identify areas that may need attention or intervention.)