How to Get a Breastfed Baby to Take a Bottle: What the Research Shows

Most advice on bottle refusal comes from forums and handed-down tips. Researchers have barely looked at it. A 2023 paper from Liverpool John Moores University says the problem has received “surprisingly little attention,” and we found only a handful of studies that address it directly.

So this guide does two things: it shows you what those few studies measured, including where common advice doesn’t hold up, and it gives you a plan built from AAP, NHS and La Leche League guidance. For the technique of giving the bottle itself, see our step-by-step guide to paced bottle feeding. More pumping guides are in our pumping hub.

What the research on bottle refusal covers

The main source is a 2020 survey from Liverpool John Moores University. Researchers asked 841 UK mothers whose breastfed babies had refused a bottle what happened.

• 61% said their baby was still refusing when they filled in the survey, and 39% said their baby eventually accepted.
• The median age at the first attempt was 8 weeks.
• Among babies who accepted, the median time from first attempt to acceptance was 9 weeks, with a range from hours to about 2 years.
• 27.5% said refusal harmed their breastfeeding experience, while 51.6% reported no impact.

The same team’s follow-up study analyzed 30 interviews and 597 forum posts. Mothers put refusal down to the comfort of breastfeeding, a baby’s expectation of feeding at the breast, temperament, disliking a bottle brand, and starting “too late.” These are parents’ explanations, not measured causes.

Bottle refusal is also the less studied side of a wider debate. A 2015 review from Northeastern University of 14 articles defined nipple confusion as difficulty with, or preference for, one feeding method over another, but its question was whether bottles and pacifiers harm breastfeeding, not why a baby refuses a bottle.

What mothers tried, and how often it worked

These figures come from the 2020 survey, in which 825 mothers answered this question. “Worked” means the mother said it got her baby to accept a bottle.

Method	Mothers who tried it	Of those, said it worked
Partner or family member fed baby	791 (95.8%)	167 (21.1%)
Used a cup	359 (43.5%)	69 (19.2%)
Tried different bottles or nipples	601 (72.8%)	93 (15.4%)
Expressed milk in a bottle	777 (94.1%)	100 (12.8%)
Offered only when baby was hungry	411 (49.8%)	43 (10.4%)
Tried different formula milks	180 (21.8%)	15 (8.3%)
Offered only when baby was not hungry	282 (34.1%)	16 (5.6%)
“Cold turkey” (no breastfeeding until baby accepted)	73 (8.8%)	31 (42.4%)

Our read of this table: don’t treat it as a ranking. Most mothers tried several things at once, nobody was randomly assigned to a method, and mothers whose babies took the bottle right away weren’t surveyed. It does show that no gentle method is a reliable fix.

The 42.4% for cold turkey needs a warning. The study authors raise concern about dehydration in the baby and mastitis or abscess in the mother when breastfeeding stops abruptly. We don’t recommend it. Only 73 mothers tried it, and the survey can’t show how old those babies were or what had already been tried.

Myth check: “You waited too long”

Many parents hear that a bottle must start early, or the window closes. In the 2020 survey, 46.8% of mothers said that in hindsight they would have given, or considered giving, a bottle earlier.

The survey’s own numbers point the other way. Babies who eventually accepted were first offered a bottle later than babies still refusing (median 12 vs 8 weeks), and being older at the first attempt was linked with accepting sooner.

Our read: this doesn’t prove later is better either. The authors caution that babies who accepted immediately weren’t in the sample. Recall went back as far as 5 years. Mothers who tried early may also have stopped sooner, or their babies may still have been young when surveyed, and the data can’t separate these. The fair summary is what the authors say: no study can give an optimum time.

Guidance leans toward waiting a little. La Leche League’s approach is to start pumping for a first bottle once breastfeeding is well established, usually after about four weeks. The NHS says it can take several weeks for you and your baby to feel confident with breastfeeding. The 2015 Northeastern review found emerging evidence that bottles can affect breastfeeding, but said it is hard to tell whether bottles cause the problem or are simply a marker of other difficulties.

Does nipple shape matter?

Less than the packaging suggests, as far as anyone has measured.

• Babies appear able to switch. In a 2010 study at Hospital Universitario Mútua de Terrassa in Spain, researchers compared sucking in 234 mother-baby pairs and ran a crossover trial in 125 mixed-fed pairs. Bottle feeds had 5.9% to 8.7% fewer sucking movements, which the authors called small differences.
• Lab results on special nipples are limited. A University of Western Australia study from 2012 found breastfed babies could feed from an experimental nipple that released milk only under vacuum, with similar tongue movement. They still applied much less vacuum than at the breast (peak -67 vs -122 mm Hg). A study of 20 babies at Showa University in Tokyo found similar jaw and throat movements with another experimental nipple. Neither study tested whether a baby who refuses bottles will accept that nipple.
• Marketing claims are thinly supported. A 2025 Liverpool John Moores investigation of 10 bottle brands marketed in the UK identified 8 advertised breastfeeding-like features and called the evidence behind them “scarce, misleading, and inadequate.” Only one study rated as high quality.
• Comparison trials are rare. The only randomized comparison of two nipple designs with bottle refusal as an outcome that we found is a 2022 preprint, which hasn’t been through peer review, with just 40 mother-baby pairs. Bottle refusal occurred in 23.8% with one design and 10.5% with the other, but breast refusal ran the opposite way (28.6% vs 36.8%). That’s far too small to pick a winner.

Flow may be a more useful thing to think about, though no study has tested it against refusal. A 2019 study from Boston College and Brigham and Women’s Hospital tested 375 nipples of 25 types with a breast pump and found flow rates from 0.86 to 37.61 ml per minute, and said packaging didn’t accurately reflect flow.

By our calculation from those figures, a 3 oz (90 ml) bottle would take about 105 minutes at the slowest rate and under 3 minutes at the fastest. A pump isn’t a baby, so real feeds will differ, but the gap explains why changing nipples can feel like changing the whole experience. Our guide to bottles for breastfed babies covers what to look for when buying.

A plan you can follow

The steps below combine advice from the AAP, La Leche League and the NHS. None has been tested in a trial for bottle refusal, but they are low risk.

1. Choose the helper and the setting. The AAP’s HealthyChildren.org suggests someone else offers it, somewhere other than where you usually nurse. La Leche League suggests you stay close but out of the room, and that the helper could wear or hold clothing you’ve worn so your baby can smell your scent. If a future caregiver can practice, even better.
2. Pick the moment. Offer about 1/2 oz (15 ml) an hour or two after a regular feed, when your baby is alert but not frantic (AAP). The NHS agrees on happy and relaxed, not very hungry.
3. Make it familiar. Drip a little breast milk on your baby’s lips or tongue, then let them explore the nipple rather than pushing it past the gums (AAP). La Leche League adds that running a cold nipple under warm water can make it more acceptable. Try a different position from your usual nursing hold (NHS).
4. Stop early. End the attempt if your baby gets frustrated or after 10 minutes without feeding, and try again the next day (AAP).
5. Change one thing at a time. After a few daily attempts, try another nipple or a cup. Give each device several days (AAP). If your baby takes a pacifier, a similar nipple may help.
6. Check the milk. If it has been frozen or refrigerated and smells soapy, see our guide to high lipase milk. Try freshly expressed milk to rule this out.
7. Build up. Once your baby accepts it, offer an occasional full feed at the time of day you’ll be away (AAP). Pace those feeds and pump when a bottle replaces a feed, so your supply keeps its signal. Our pumping at work guide helps with the schedule.

Plan around your deadline. The NHS suggests starting a few weeks before you go back to work if you’re introducing formula. Our suggestion, based on the 9-week median above: start as soon as breastfeeding feels settled if you have a fixed date, and line up a backup at the same time. Don’t assume two weeks will be enough.

Cups, spoons and other options

A cup is a real alternative, not a failure. The AAP notes a baby may prefer a small medicine cup or sippy cup, even if very young. The NHS says that from 6 months, if your baby can drink milk from a cup, you may not need to introduce a bottle at all, and it recommends open or free-flow cups from around that age.

The research is about newborns who need supplements, so it only partly applies to an older baby refusing a bottle:

Study	Who	Finding
University of Rochester trial, 2003	700 breastfed newborns; 481 received in-hospital supplements	No overall difference in breastfeeding duration between cup and bottle. Possible benefit after cesarean or with more than 2 supplements
Cochrane review, 2016	5 trials, mostly preterm babies	May help breastfeeding up to 6 months in preterm babies. No recommendation possible for term babies
University of Washington review, 2016	28 studies of newborns	Appears safe, but intake may be lower and spillage higher than with a bottle

Cup feeding isn’t always easier. In the 2020 survey, some mothers reported cup refusal too. If you’re using a cup with a young baby, ask an IBCLC or your pediatrician to show you how, and keep your baby upright so they can sip at their own pace.

We found no trials of spoon feeding for a term baby who refuses a bottle. A 1995 paper from a Denver lactation program names cups, spoons and droppers as options for newborn supplements, and the 2020 survey authors suggest spoon, syringe, straw and finger feeding deserve more study as stand-ins. A spoon or syringe may help for a short separation, but ask your pediatrician or an IBCLC what suits your baby’s age.

Match the plan to your situation

This decision guide is our own synthesis of the sources above, not a clinical protocol.

Your situation	Reasonable next step
Under about 4 weeks, breastfeeding still settling, no urgent need	Wait if you can, and focus on latch and supply
Medically advised supplements in the early weeks	Follow your care team. Cup or bottle are both options
Past 4 weeks, no fixed date	One calm attempt a day, with the AAP’s 10-minute limit
Returning to work on a fixed date	Start now, include the future caregiver, and plan a backup
6 months or older	Consider going straight to a cup alongside solid foods
You only wanted an occasional bottle	It’s fine to stop trying, or try again in a few weeks

What the evidence can’t tell you

• How common refusal is. The main survey recruited only mothers who had experienced it, mainly through social media, so nobody knows what share of breastfed babies refuse.
• Whether any method works. We found no trial that randomly assigned refusing babies to a technique.
• Whether results apply to you. About 96% of the survey’s mothers were white and all lived in the UK, and they chose to respond.
• What happens later. Some of the babies counted as refusing may have accepted a bottle after the survey.

Once a baby does take bottles, watch the pace. In a 2010 CDC analysis of 1,250 US infants, 68% of babies fed only by bottle in early infancy emptied the bottle or cup in later infancy, compared with 27% of babies fed only at the breast. This is an association, but it’s a good reason to let your baby decide when a feed is finished.

When to call a doctor or lactation consultant

Call your pediatrician if your baby:

• Refuses feeds in general, or has fewer wet diapers than usual
• Isn’t gaining weight, or seems unusually sleepy or hard to wake
• Chokes, coughs or changes color during feeds, or seems to be in pain
• Has a fever or other signs of illness along with feeding refusal

See an IBCLC if refusal is making you anxious or you have a separation coming up, especially a surgery or treatment. They can check for oral issues and help plan a backup. If your baby is suddenly refusing the breast as well, read about a nursing strike and get help soon, so your supply stays protected.