Expert: Sally Wendkos Olds - 1/11/2007

Question
Hi i have a seven month old daughter, she is still breast feeding. I desperately need to go back to work, but she wont take breast milk from a bottle,cup, or eat solid food yet. I need advice on how to get her to eat when I'm not around any tip will be helpful. Thanks so much, Dawn

Answer
Dear Dawn,

First, congratulations for giving your daughter the best start in life by breastfeeding her!

Your problem with weaning is a common one -- but it can be solved. I am attaching an excerpt from my book (see below). I hope that some of the suggestions will help you.

Good luck!

Sally

Sally Wendkos Olds
Author, THE COMPLETE BOOK OF BREASTFEEDING: Eiger & Olds, 3rd edition 1999, published by Workman Publishing & Bantam Books, and available in most public libraries, bookstores & La Leche League chapters.



INTRODUCING MILK IN A BOTTLE OR CUP
Since the key to your success in combining working and breastfeeding will probably lie in your baby's having at least one or more feedings while you're at work, it's vital that you take special pains to help her like the bottle or cup, even if she doesn't love it. (She'll be saving her love for you.)
  In our society we have generally assumed that babies who are not breastfed need to get their milk in a bottle. But in many countries around the world, babies who cannot be nursed receive all their liquid nourishment in a cup, sometimes right from birth. United Nations agencies do not distribute feeding bottles at all, even to babies who cannot be breastfed.
  Cup feeding has several advantages: there is no danger of nipple confusion; an open cup is easier to keep clean than either a bottle or a sipper cup; you cannot prop a baby alone with a cup the way you can with a bottle; and even premature babies can drink from a cup, since the swallowing reflex appears earlier than the sucking reflex. However, cup feeding may be more time-consuming, and, probably more important, it is an unfamiliar idea to most people -- which may include the person who cares for your baby while you are at work.
  If you can, get your baby used to a cup from an early age, and ask your caregiver to feed her this way. If this will not work for you, however, you do, of course, have access to bottles for the feedings while you are at work.
  By and large, the earlier a baby is given milk in a bottle or cup, the more readily she will take it. Babies confronted with their first bottle at several months of age often refuse it absolutely and will sooner go hungry rather than drink from this strange, hard, unwelcome container so different from their mother's soft, warm breast. This usually happens only for a few feedings, however, until hunger takes over.
  Yet there is a danger in introducing the bottle too early. Although some babies have no trouble taking a daily bottle along with their breast feedings right from birth, other babies who are offered bottles before they have fully mastered the skills of nursing at the breast develop "nipple confusion." They can't make the switch between sucking on the rubber nipple and suckling at the breast, and sometimes develop nursing problems.
  It's important to strike a happy medium. Introducing a cup or bottle after six weeks of age may avoid both these problems. By this age, most babies are competent nursers and yet they're still flexible enough to try something new. Furthermore, the mother's milk supply is well established by now and flows easily enough to keep her baby happy.
  If you must go back to work before this time, of course you'll have to introduce cup or bottle earlier. If at all possible, try to hold off your return to work at least until two months postpartum, both for your sake and your baby's.
  You may decide to introduce the cup or bottle gradually, about a week or two before you plan to go back to work, so that by the time you do go back, your baby is taking one cup or bottle feeding every day, at the same time every day. This time should coincide with at least one of the feedings when you'll be away, so that a pattern will be set. While your baby is nursing from one breast, express or pump from the other breast to keep up your milk supply. Your baby probably will drink less milk from the cup or bottle than she does from the breast, perhaps less than two ounces at a time. This is not a problem.
  Other mothers hold off on introducing a bottle or a cup until they actually return to work. Then it becomes the babysitter's responsibility to work this out, along with other aspects of child care. Meanwhile, the mother remains totally associated with breastfeeding.
  When you or another person (which is often more successful) first introduces milk in a cup or bottle, give it to your baby when he's not terribly hungry -- maybe 45 minutes after a feeding. This way, he'll be more receptive to something new and may be pleasantly surprised to find something good trickling out of it. Also, if you usually sit in a particular chair to nurse, have someone else offer a bottle in some other chair, or some other room.
  Some babies refuse to take a bottle from their own mothers, whose aura they associate with nursing at the breast, or in familiar nursing spots, but they will take a bottle from another person in another location. This someone else might be your baby's father, your caregiver, or any other willing baby feeder. For other suggestions on encouraging your baby to take a bottle, see Box 12-3.
  
  BOX 12-3   OFFERING YOUR BABY THE BOTTLE
  * Have someone else give the cup or bottle, right from the start. This is an ideal way for your baby's father to assume a larger role in his baby's care. The next best feeder is the person who will care for your baby when you go back to work.
  * Introduce the cup or bottle when your baby is not frantically hungry.
  * Some babies have definite preferences for one kind of nipple over another. Others don't care. Try a contoured nipple (like the Nuk or the Kip), but just buy one or two in case your baby doesn't like it. Be sure not to buy nipples especially made for premature infants if your baby is full-term; these nipples are made of thinner rubber, which some vigorous suckers have been known to bite pieces from and swallow.
  * If you can find "blind" nipples, which don't have holes in them, you can make your own hole with a hot pin, to insure that the milk won't come too quickly.
  * To test the flow of milk, hold the bottle upside down. If milk pours out, the nipple opening is too big; if it doesn't squirt out when you squeeze the nipple with your fingers, it's too small. In the first case, there's nothing you can do other than throw the nipple out; in the second, you can make an additional hole or two.

What If Your Baby Refuses the Bottle?
Your baby may absolutely refuse to take any nourishment from a bottle. Some go on "hunger strikes" if they can't have the breast; no matter how ravenous they get or how piteously they cry, they won't give in. Families cope with this in a number of different ways. One of the following may work for you:
  * Nurse as much as possible while you're home, so even if your baby won't take a bottle while you're gone, she'll still be getting a good supply of milk.
  * Brush your baby's mouth with the nipple and let her grasp it herself instead of pushing it forcefully into her mouth.
  * Warm the bottle nipple and the milk to body temperature by running warm water over the nipple and the bottle.
  * Ask someone else to pick up your baby while she's sleeping but almost ready to wake, and feed her milk in a bottle. Do this for a while, and then try it when she's awake.
  * If you have not already offered your baby milk or water from a cup, try offering him water first. Once he takes that readily, he'll probably also take milk this way. You don't need a special cup to do this. Any cup in your house will do, although the infant "sipper" cups with two handles and a lid are the least messy.
  * Feed the milk through a large medicine dropper or a spoon -- rubber-coated or plastic. Sometimes, once the baby has received a couple of ounces of milk this way and is not so desperately hungry, he'll be willing to tolerate the bottle for the rest of the feeding.
  * Experiment with different kinds of milk. One mother discovered that her baby preferred fresh, refrigerated breast milk over thawed frozen milk. If you're feeding formula, try another brand, after consulting with your baby's doctor.
  * Experiment with different feeding positions. Have your caregiver try propping your baby against her raised legs, or holding him facing out, so he can't see her.
  END OF BOX