Breastfeeding and bottles – does bottle preference really exist?

For years, parents have been warned about “nipple confusion” and “bottle preference”.  I too was guilty of being a health professional who passed on these warnings.

But after years of working as a midwife and lactation consultant, both privately in the community and a tertiary NICU, I now under the truth more clearly:

Newborns do not develop true “preferences” in the first 6–8 weeks.

They use reflexes, not choices, to feed in the early weeks.  They spend weeks developing these reflexes – in fact, the sucking reflex starts at about 10-12 weeks gestation.  As soon as they have hands and a mouth, and can reach those hands to their mouth, they start practicing sucking.  Swallowing also happens as soon as they have an oesophagus – and they practice by swallowing amniotic fluid.

All mammal babies are ‘pre-programmed’ to be able to take milk from their mothers from birth.  That is literally why we are called mammals – mammal = mammary glands (that make milk to feed newborns/young babies).

Practicing these skills for weeks during pregnancy cannot be suddenly undone by just a few bottles, even over days or weeks.

In most cases, if a baby appears to “prefer” a bottle in the first 6-8 weeks after birth, it is almost always because:

• breastfeeding has become difficult due to an underlying issue, and/or

• the parents haven’t received the right support and/or information to help get breastfeeding back on track.

It is not about babies being lazy or choosing the “easy option”.  This is about biology, reflexes, and the environment we’re raising babies in.

So, let’s update the conversation.

Why bottles can appear to disrupt breastfeeding - and why it’s not about preference

Newborns use powerful, automatic reflexes that they have been developing since 10-12 weeks gestation to:

• find the breast

• open their mouth wide

• latch deeply

• coordinate suck–swallow–breathe

These reflexes can help guide breastfeeding beautifully - when there are no other issues that may impact feeding.

And these issues can range from misinformation to oral motor issues.

Bottle feeding on the other hand uses a completely different motor pattern.

A bottle teat does not behave like a breast, no matter what the marketing says.  No bottle is ‘just like the breast’

• The baby must actively find and latch to the breast.

• The breast then changes shape in the baby’s mouth, to mold and fill their mouth.

• Milk flow from the breast requires active vacuum and specific tongue movement to remove milk.

• The flow of milk from the breast can pause when the baby pauses their actions.

• A breast encourages wide mouth opening.

• A baby will feed responsively from the breast.

A bottle teat does none of these things.

• The bottle teat can be pushed into the baby’s mouth before they are ready or want it.

• The latch will probably be shallow (even if it is a wide teat) and it certainly won’t mold and fill the baby’s mouth

• The milk will most likely flow even with very light vacuum (regardless of it being a ‘slow flow’ teat).  And regardless, swallowing creates more vacuum, which creates a bit of negative cycle, rather than a baby ‘choosing’ when to suck.

• The milk flow may not pause when the baby pauses.

• Parents can be led to believe a baby has to finish a certain amount to be full.

When a baby is given bottles frequently in the early weeks, the baby may over time:

• stop opening their mouth wide

• start using a shallow latch

• struggle to transfer milk at the breast

• swallow milk automatically even when full

• feed quickly from the bottle but slowly at the breast – which confuses parents and health professionals alike into thinking that breastfeeding is too much ‘hard work’

If a baby is being bottle fed because breastfeeding is not going to plan, but no one has helped the mother (or parents) by explaining exactly what the issue is and/or how to fix it, it may start to appear that the baby ‘prefers’ the bottle.

This is not a “preference”. This is reflex confusion and ‘understanding how newborns feed’ confusion - not emotional choice.

These issues can be fixable with the right support.

Often parents are told they should avoid bottles in the first 4-8 weeks.  And I agree with this, to a point.

The early weeks are when:

• supply is being established

• reflexes are strongest

• parents are learning how breastfeeding works (although, this should also happen before baby is born)

• babies need to feed frequently

• night feeding is biologically essential

Introducing bottles too early can interfere with milk production and parental confidence.  This is why avoiding bottles early on is ideal when possible.

But sometimes bottles are needed and that can be OK. [I'll insert a little PSA here - it is just good marketing that makes us think that bottle feeding is the only alternative if direct breastfeeding is an issue - click here for an article on alternative methods to bottle feeding.]

A short period of bottle feeding can be OK, as long as support and correct information is given on how to maintain (or increase if needed) mum’s milk production, how often and how much to feed a baby (hint, formula tins give incorrect volumes), and fix any underlying issues that are making direct breastfeeding difficult.

When bottles are maybe needed

Sometimes bottles are necessary:

• baby is not gaining weight, and a temporary feeding plan is put in place

• baby is separated from the mother for medical reasons

In these cases, bottles can be used safely, with the right support and information.

This is where responsive (paced) bottle feeding comes in – click here for a link to an article on what this is and how to do it.

So, is there any time a baby can develop a bottle preference?

Yes - but not it is in the newborn period.

Around 8–12 weeks, many babies “wake up” to the world. They move from being a newborn to an infant, and their feeding behaviour can change:

• they become more alert

• they notice their surroundings

• they may become distracted

• they may feed for shorter periods

• they may go longer between feeds (though not always)

This is also a time when babies become more efficient at breastfeeding. Their growth rate slows slightly compared to the first 12 weeks, and feeding becomes less all‑consuming.

Some parents misinterpret these normal developmental changes as:

• “refusing the breast”

• “not getting enough”

• “not wanting to feed”

This can lead to introducing bottles unnecessarily or the number of bottles offered a day may increase - and this is when true bottle preference can begin.

If breastfeeding has always been a little tricky, babies may:

• get frustrated when milk doesn’t flow as fast as they expect – hormones can change around this time, and if a baby has not been feeding as effectively as needed the milk production can drop (this is not because your body is broken, it is doing exactly what it is meant to do, supply milk in response to the demand)

• start to say ‘no thank you’ to the breast if early issues were never resolved

• find bottle feeding easier because it requires different (and fewer) skills

This isn’t because they “like” bottles more. It’s just that now they can make their ‘opinion’ known, and bottle feeding has become their preference.

On the flip side, some babies who have had a bottle every day may suddenly refuse bottles at 3–6 months. Parents often say: “We gave a bottle every day so they’d get used to it - now they won’t take it at all!”

These babies aren’t being difficult. They simply prefer breastfeeding because it is familiar, regulating, and biologically designed for them.

Babies don’t know the concept of “getting used to something”, or practicing because their mum is going back to work 6 months after birth.  They respond to comfort, familiarity, and physiology.

Conclusion: It’s not about preference - it’s about correct information and support

“Bottle preference” in the early weeks is not a behavioural choice. It is not laziness. It is not manipulation. It is not a baby “liking” one thing more than another.

What looks like bottle preference in the first few weeks is almost always:

• unresolved breastfeeding challenges

• lack of skilled support

• misunderstanding normal newborn behaviour

Babies are born with reflexes designed for breastfeeding. Those reflexes need to be supported, strengthened, and protected.  And unfortunately, most health professionals often do not understand what these reflexes mean and how to use them correctly which in turn means parents are not taught how to understand them and use them to correctly.

Bottles do not ruin breastfeeding.   Misinformation and lack of support can.

If supplementation is needed, we need to ensure there is:

• responsive bottle feeding

• correct volumes

• realistic expectations

• skilled lactation support

• a clear feeding plan (with a set review date)

• and an understanding of newborn biology

A lot of babies can move between breast and bottle without difficulty, and most breastfeeding challenges can be resolved, if support and correct information is sought early (although if you are post 6-8 weeks and reading this and having issues with breastfeeding, it is never too late to have some review your feeding history and maybe give you answers as to why you are in this situation and see what can be done to help resolve them).

I really enjoy supporting breastfeeding and teaching new parents about the amazing skills their newborns have to breastfeed. If you are in Perth and want support please get in touch by either messaging my mobile (0405427998), sending an email (info@cherishedparenting.com.au) or clicking on the menu where it says 'Services'.