If I Give My Newborn Baby a Bottle, Will She Refuse the Breast?

Originally published on February 11, 2014; Revised August 27, 2024

Author: Robin Kaplan, M.Ed, IBCLC, FNC

The short answer is “we don’t know”.  There is so much information out there about nipple confusion.  Some will tell you that if anything other than a breast *touches* your baby’s mouth, he’ll never want to breastfeed again. Others will regale you with stories about how their exclusively breastfed baby had bottles! cups! pacifiers! in the first few hours of life and had no problem switching back to breast.  Each baby and situation is different.  It’s never a given that your baby will, or will not, develop nipple confusion if he/she has a bottle before breastfeeding has been successfully established.

ABOUT SDBFC

The San Diego Breastfeeding Center was established in 2009 by Robin Kaplan, International Board Certified Lactation Consultant, Functional Nutritionist, and parent.  Her vision was to create a judgment-free, inclusive support system for families navigating infant feeding challenges. 

SDBFC offers a wide range of one-on-one breastfeeding, infant feeding, and nutrition consultations - as well as classes, support groups, online articles, and social media - making it your one-stop-shop for all things infant feeding!

What is Nipple Confusion?

Bottle nipples and breast nipples have a very different feel to the baby, so sometimes when babies are used to one and they are introduced the other, it can seem confusing.  You can help to prevent this by choosing a bottle nipple with a sloped, wide base rather than a small, thin, long nipple.  This will help the baby to continue to open his/her mouth widely while feeding, which is what we want him/her to do while at the chest/breast.  However - it is often a “flow preference”, rather than nipple confusion, that can cause a baby to have a difficult time switching from bottle to chest/breast.  Even the “slow flow” bottles the nurses use in the hospital flow much faster than the breast, especially during those first few days when milk volume is low.  Plus, even with those “slow flow” bottles, the baby doesn’t have to work very hard to get the milk to flow into his/her mouth.  When the bottle is tipped, the milk often just pours into his/her mouth.  At the chest/breast, the baby has to suck for a while to elicit the “letdown” of milk, and then throughout the feeding is only rewarded when he/she sucks at the breast.  With a bottle, the milk pours into his/her mouth whether he/she’s sucking or not.  These babies are smart!  They learn very quickly that with one form of feeding, they don’t have to work as hard.

How Can I Avoid Flow Preference?

The easiest way to avoid flow preference is to only feed your baby at chest/breast until breastfeeding has been established, baby is back to his/her birth weight, and has gone through his/her first growth spurt that occurs around 2-3 weeks of life.  However, there are many different situations when it may be necessary or appropriate for a baby to fed in an alternative way during those first few weeks of life.  Some of these situations may include: premature babies who haven’t developed the suck, swallow, breath pattern yet; birth complications that force parent and baby to be separated for some period of time; anatomical challenges that prevent the baby from being able to latch on properly (tongue/lip ties); or sometimes parent’s preference - damaged nipples, etc.  If you do feed your baby another way, there are things you can do to avoid the possibility of your baby developing a flow preference, or preferring an alternative feeding method.  If your baby is able to latch comfortably, one option is to supplement at the chest/breast using a tube and syringe, and to either deliver the supplement very slowly and only when baby is actively sucking, or allow the baby to pull the supplement on his/her own.  This helps the baby to continue to associate the breast with food, as well as ensuring baby has to work for the flow.  If you do bottle feed, you can pace the bottle feeding so that it simulates a feeding at the breast - I’ll discuss this in greater detail in the next paragraph.

What if I Need/Want to Give my Brand New Baby a Bottle?

If a baby does receive a bottle, there are some things you can do to help prevent a flow preference from developing.  The most important thing to realize is that there really isn’t a truly “slow flow” nipple, and that most bottles are the same, even the ones that claim to be designed for a nursing baby.  It’s not so much the bottle you choose, but the method you use to feed the baby.  Baby should be fed in a paced manner, so that the length and pace of the feeding mimics a breastfeeding session.  The amazing online breastfeeding resource, KellyMom, has a great article on how to properly bottlefeed a breastfed baby - http://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/.  Another great resource regarding bottle/breastfeeding is www.breastandbottlefeeding.com.  Both sites contain a great amount of information on “nipple confusion” and flow preference and how to avoid them.  

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Ashley’s Success Story

As an IBCLC, I work with a lot of moms trying to get their babies back to breast after being fed via bottle.  I’m always excited to share my own story to give them some hope and let them know that it is possible to transition a baby who is exclusively bottle fed to a baby who exclusively breastfeeds!  My first child was born in New York City, in the fall of 2007.  The hospital I delivered at had two lactation consultants on staff, but the one who was scheduled to work the day my daughter was born was in a car accident and not able to come in. So I fed my baby with an incorrect latch for a day and a half. By the time the lactation consultant arrived on the day we were being discharged, my nipples were cracked and bleeding.  I was in extreme pain and every feeding brought bouts of panic and anxiety with it.  Looking back, I realize that she had a lip tie and that may have been causing the painful latch.  I chose to pump for a few days to allow my nipples to heal, and found that pumping and bottle feeding caused much less stress.  So I exclusively pumped for my daughter for 4 months.  

Exclusive pumping is hard work!  You’re basically doing double feedings - by feeding the pump, then feeding your baby.  Plus with the constant washing of pump parts, I felt like I was chained to the house every three hours so that I could pump to maintain my supply. On the flip side, there were benefits to it as well.  My husband could feed the baby and I was able to get out of the house early on to do things like laundry.  :)  However, I always felt like I was missing out on a HUGE piece of those early months with my baby.  I’d always assumed I’d breastfeed exclusively, and felt like a failure that I wasn’t.  I kept trying periodically, but my baby would often cry at the breast and I would get frustrated easily and give up, assuming it would never happen.  But I kept trying, and finally, at 4.5 months, she was latching regularly and I was able to put away the pump!  She nursed until 14 months old, and I’d never felt such pride or accomplishment about anything before.  I use this story to encourage moms that just because their babies aren’t latching RIGHT NOW, that doesn’t mean that they won’t later.  

If your baby is struggling with bottle feeding or breastfeeding, we are just a consult away!

Don’t let bottle feeding or breastfeeding struggles cause stress for you or your baby!  Our consultants can help identify the root cause(s) of why your baby is struggling going between breast and bottle and can offer suggestions for ways to overcome these challenges!  Book a one-on-one postpartum consultation today

SDBFC is committed to providing high-quality lactation and functional nutrition consultations to parents in San Diego and beyond. Explore our postpartum, prenatal, and functional nutrition consultations, take a breastfeeding class or attend a workshop.

About the Author

Robin Kaplan has been an IBCLC since 2009, the same year that she opened up the San Diego Breastfeeding Center.  Robin was the founding host of the Boob Group podcast and published her first book, Latch: a Handbook for Breastfeeding with Confidence at Every Stage in 2018.  Melding her passions for supporting lactating parents and holistic health, Robin finished her Functional Nutrition Certification in 2023. In her free time, she enjoys hanging out with her two teenage boys, hiking, traveling, weaving, cooking, and searching for the best chai latte.

How Long Does My Breast Milk Stay Fresh?

Breast milk storage guidelines can be incredibly complicated to decipher.  With each pump company and breastfeeding website having its own storage and handling recommendations, how's a mother to know which one to follow?  Plus, throw in whether the baby is full-term, pre-term, healthy, or in the NICU, and we have quite a confusing situation.

After delving into our lactation consultant guidelines for human milk storage, I think I have the definitive list for you….at least for this year!

How long does my breast milk stay fresh?

Here are the recommendations, for a healthy infant, according to the Core Curriculum for Lactation Consultant Practice, 2012:

Room Temperature 72 º:   6 -10 hrs.

Refrigerator:  5-7 days

Insulated cooler with ice pack: < 24 hrs.

Completely thawed in the refrigerator: < 24 hrs.

Freezer compartment in 1-door refrigerator: 2 weeks

Freezer door in 2-door refrigerator (not in door): 3-6 months

Deep freezer: 6-12 months

Here are the recommendations for a hospitalized infant, according to the Core Curriculum for Lactation Consultant Practice, 2012:

Room Temperature 72 º: < 4 hrs.

Refrigerator:  up to 7 days

Insulated cooler with ice pack: < 24 hrs.

Completely thawed in the refrigerator: < 24 hrs.

Previously frozen, brought to room temperature: <4 hrs.

Freezer compartment in 1-door refrigerator: not recommended

Freezer door in 2-door refrigerator (not in door): < 3 months

Deep freezer: < 6 months

How should I store my breast milk?

• Glass or plastic baby bottles

• Clean food storage containers with tight-fitting lids

• Disposable feeding bottle liners and mother’s milk bags

How do I warm my stored breast milk?

• Never use the microwave to warm up breast milk.  Not only does the milk heat unevenly in the microwave (which could cause unintentional burning), but it decreases the anti-infective quality of the milk and reduces its overall health properties (ABM Protocol #8)

• Defrost frozen breast milk in either the refrigerator overnight, by running under warm water, or setting it in a container of warm water. (ABM Protocol #8)

• There have been no studies done to provide recommendations for how long milk can be kept at room temperature after a baby has partially fed from the cup or bottle.  The Academy of Breastfeeding Medicine recommends using the milk within 1-2 hrs after baby finished feeding.  (ABM Protocol #8)  Many lactation consultants and pediatricians recommend using the rest of the milk at the next feeding sessions and then throwing any leftovers away.

Do I need to sterilize my bottles and nipples?

• Bottles, nipples, and pump pieces need to be sterilized before you first use them.

• Once a bottle, nipple, or pump piece has been used, sterilizing is unnecessary.  Instead wash everything in hot, soapy water and then rinse, or throw them in the dishwasher.

Less complicated, right?  

I hope that I was able to clarify a few of those difficult-to-figure-out questions you had. 

Now go.... breastfeed, pump, and give that delicious goodness to your child!  And, definitely check back in a few years to see if anything has changed!

Battling and Resolving Excess Lipase in Breastmilk

While it is unknown how common it is for a mother to have excess lipase in her breast milk, causing it to smell or taste soapy, I come across it often enough that I thought it would be helpful to share how to deal with it, from a mom's perspective.    Christina Williams was gracious enough to write this article, walking us through her journey battling and resolving her issue with excess lipase and her baby who refused to take a bottle, even when she went back to work.  Thank you so much, Christina, for sharing your knowledge and determination!

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In preparation to be a first-time mom, I’d been tearing through books and following countless blogs for months prior to my daughter’s arrival. I was sure I had everything in order and was ready for anything motherhood had to throw at me. I could distinguish common rashes from those that are more worrisome, had memorized the slide deck of normal infant poop, and had figured out the optimal wash routine for my growing collection of cloth diapers. Was I prepared to do the seemingly simple task of giving my new baby a bottle after we established our breastfeeding relationship? The thought hadn’t even crossed my mind.

We struggled for months to get my breastfed daughter to take a bottle. We tried every trick in the book – countless fancy bottles, different people, positions and places, and my husband even devised a few feeding contraptions. Nothing worked. She could see that bottle coming at her and would seal those cute little lips right up until it was out of sight. Everyone tried to be encouraging, “She won’t starve herself,” they would say. Maybe not, but she sure liked to scare me into thinking she would try. When I went back to work she reverse cycled, completely refusing milk during the day but eating almost constantly through the night. Staying up most of the night and working all day is not a recipe for success for a working mom. I was lucky to squeeze in two hours of broken sleep a night.

Then, when my daughter was nearly 5 months old, I tasted some breast milk that had been in the fridge for a few days. It tasted rancid, soapy, and a little metallic. No wonder she had been refusing it! I thawed some milk from my freezer stash – that was terrible, too. That confirmed it; there is excess lipase in my breast milk.

What is lipase, and what is it doing in my breast milk? Lipase is an enzyme that breaks down the fats in your milk to help baby digest it. When lipase occurs in excess, this process happens much more rapidly and can make the milk taste off or sour after a period of time. Milk with excess lipase is safe to drink, but some babies dislike the taste and refuse it. Sometimes this change happens in a matter of hours, but many women find that they have 24 hours or more before the milk fats break down enough to alter the taste. 

I think I have excess lipase. What can I do about it? Fortunately, lipase can be inactivated at high temperatures, and milk can be safely stored in the fridge or freezer. Milk must be scalded before freezing, as lipase is still active even at low temperatures. Unfortunately, many women find out that they have excess lipase after establishing a freezer stash and finding that their baby won’t take any of it. If you find yourself in this situation, consider donating. Many babies will accept this milk, and it is often used in tube fed babies who can’t taste it, anyway. My regional milk bank was thrilled to accept my milk, excess lipase and all.

The first step is to determine at what point your milk starts to taste funny. I tasted my room temperature pumped milk hourly until I noticed a difference. I found that I need to scald at work after each pump session, as I don’t have enough time before it turns to make it home at the end of the day and do it all at once. Once you’ve determined your personal timeline it will help you make a plan for scalding your milk.

What do you recommend as the easiest, most effective method to scalding pumped milk? There are two popular ways to scald – in a pan on the stovetop and using a bottle warmer. Both methods require that the milk reach a specific temperature and then cooled.  Some methods suggest heating to 180° and cooling immediately. Others*** recommend heating to 144.5° and keeping it at this temperature for 1 minute, or heating to 163° for 15 seconds and then cooling. Personally, I prefer the bottle warmer method and heating to 180°. I find it difficult to reliably heat to either of the lower temperatures and maintain those temps for the recommended length of time, so I tend to stick to the 180° method. Plus, having a new baby makes even basic tasks seem complicated, so I opt for the simplest option.

***Per Lawrence & Lawrence, bile salt-stimulated lipase can also be destroyed by heating the milk at 144.5 F (62.5 C) for one minute (p. 205), or at 163 F (72 C) for up to 15 seconds (p. 771).

How do you scald milk in a bottle warmer? What supplies are needed? How long does it take? I scald at work 2 or 3 times per day. It takes me exactly 7 minutes to scald and clean up.

Here are the supplies I use (total investment, around $70):

-Bottle Warmer – Select a bottle warmer that doesn’t have an automatic safety shut off. You need to heat the milk to a high temperature, so having the auto shut off kick in mid-scald isn’t going to get the job done. I prefer warmers that contain the entire bottle versus those that allow half of the bottle to stick out the top.

-Stainless Steel Bottle - I don't like to heat in plastic, especially to such a high temperature, and I found that heating in glass is sketchy. My glass bottles broke in the bottle warmer on too many occasions, plus the hot glass can’t be transferred directly into cold ice water or it will shatter. It must be poured it into another container first before cooling. Too many steps if you ask me! Stainless steel allows you do all the steps without transferring containers.

-Digital Thermometer - You'll need one of these regardless of what scalding method you use.

-Container for Ice – Select a container that is deep enough to submerge your bottle and around 3-4 cups of ice. I use a large, glass measuring cup.

-Ice - I like to bring a huge bag of ice in once a week. I can never remember to pack a bag of ice from my own freezer every day, and this seems to make the whole process a little easier.

Steps:

1. Fill up bottle warmer reservoir, fill the stainless steel bottle with milk, and set the timer for at least 5 minutes. I can usually heat 7-8 ounces in 3-4 minutes. It will take longer to heat if you are using a glass container.

2. Prep your ice bowl with a few cups of ice and cold water. I find it helpful to have this ready before I start heating the milk, as the last few degrees change very quickly and you don't want to over heat. Those last 20 degrees seem to happen in just a few seconds.

3. Start the bottle warmer and stick in your thermometer. As your milk is heating, stir it around a bit with the thermometer so it heats evenly.

4. As soon as you reach 180°, quickly remove from heat and submerge in the ice bath. I let it sit with the lid off for a few minutes while I pack everything else up.

5. After a lot of the steam has escaped and the milk is relatively cool, I put the cap on the bottle and put the container with the bottle inside in the fridge. Usually, I put a paper towel over it if I’m putting in the office fridge. It isn’t necessary to put the ice bath in the fridge, but if I leave it on the counter I will inevitably forget about it until it's too late. The fridge is a nice insurance policy for those Mommy Brain moments.

6. Once completely cooled, transfer the milk into a storage container.

Anything else I need to know? I find that my scalded milk doesn’t always last a full 7 days in the fridge. Your experience may be different, but it’s best to make sure it passes the sniff test after a few days before using. Scalding milk may reduce some of the anti-infective properties and nutritional value of the milk, but not enough for it to be of concern unless baby is getting only scalded milk all the time. Lastly, this all may seem overwhelming, but it is completely do-able, even at work. It took a bit to get in the swing of things, but now it’s just a part of my daily routine.

It took a while to get my daughter to start accepting a bottle, even after I started scalding. After all, we had been conditioning her to think bottles are full of gross milk. It took a few months of patience and persistence, but she now does most of her eating during the day and sleeps at night (well, maybe the sleep part hasn’t been worked out just yet). In true baby fashion, she hates the beautiful, enormous collection of glass bottles I picked out when I was too hormonal to know better. She loves the cheapest, least eco-friendly bottles out there. Typical.

Disclaimer: If you suspect you have an issue with excess lipase, please consult your physician or lactation consultant for advice on how to best manage your situation. I am not a medical professional, just a mom sharing my own experience.

Links to other articles about excess lipase:

Simply Rebekah: Excess Lipase (An Introduction through Becoming a Milk Donor)

Kellymom - My Expressed Milk Doesn't Taste Fresh.  What Can I Do?

La Leche League International - Can Diet Changes Help With Excess Lipase

Have you experienced excess lipase in your breast milk?  

Did it cause difficulties with your baby taking a bottle?

Update on 2012-09-25 16:50 by Robin

Here are the supplies that Christina referenced in the article: 

Munchkin Precision Digital Bottle Warmer 

Pura Stainless Steel Bottle

Norpro Digital Thermometer