When a child is healthy and gaining enough weight, feeding difficulties are unlikely to be due to a medical problem. There are many reasons why a baby may develop bottle feeding difficulties. Most are easily corrected with minor changes to feeding management. More complex feeding problems are often the result of a combination of different causes and therefore may require a number of different strategies to bring about a resolution.

1. Feeding nipple

   The most important piece of feeding equipment is the nipple. The nipple needs to be the right size and speed for your baby's size and age. If the nipple is too long, too short, too fast or too slow for your baby, then she may experience feeding difficulties as a result

2. The nipple ring attached too tightly!

   Air needs to enter the bottle to replace the milk your baby has taken in order to balance the pressure in the bottle. Air enters the bottle either between the nipple ring and bottle OR through the holes in the end of the nipple. Feeding difficulties can develop if air cannot enter the bottle e.g. if the nipple ring is screwed on too tight and your baby also maintains a seal over the holes of the nipple with her tongue.

   You will know this could be causing more work for your baby if ...

   • You can't see any (or not many) bubbles replacing the milk when she feeds.
   • If the nipple collapses in her mouth.
   • If you notice lots of bubbles rush into the bottle once you remove the nipple from her mouth.

   If you deliberately want to slow her feeding down, then tightening the nipple ring will assist you to achieve this. If your baby has a strong suck, it can be helpful to start feeding with the nipple ring tightened, thereby using the pressure to slow her down. If she slows too much, loosen the nipple ring to make the feed easier for her. (as air can then enter the bottle between the nipple ring and bottle and maintain an even pressure throughout the feed).

3. Feeding patterns

   Some babies develop a feeding pattern where they will only drink small amounts of formula at a time but want to be fed very frequently, possibly every hour or two. Although this will not cause any problems for your baby, provided she drinks enough formula in total over a 24 hour period, this can become very tiring for you to keep up with her constant demands for feeding.

   To improve this habit u can do following:

   • Try to encourage your baby to take as much milk as possible within 45 minutes. Stop feeding after that time.
   • Help your baby to wait a while before feeding again. Aim to encourage her to wait at least 3 hours from time you started her previous feed. As she gets used to going longer between feeds she will gradually take more milk.

4. Misinterpreting baby's cues as signs of hunger

   Babies are born with reflexes, such as the rooting reflex and sucking reflex, which help them to feed instinctively. (A reflex is an automatic or involuntary response.)

   Often these reflexes are misinterpreted as signs of hunger and a formula may be offered. If your baby was not actually hungry, she may take only a small amount and refuse the rest.

5. Tiredness

   For babies, sleeping and feeding are closely connected. It's almost impossible to deal with one and not the other. If a child doesn't feed well, she won't sleep well. However, tiredness can be the cause fussy, unsettled feeding behavior or falling asleep before the feed is completed.

   To deal with any feeding problem, first ask yourself - "Is my baby getting enough sleep?" If the answer is "No", look for ways to improve her sleep pattern. Often feeding difficulties improve automatically, simply because sleep has improved.

6. Early introduction of solids

   6 months is now the recommended age for starting solid foods, for both bottle and breast fed babies. Although a small number of babies may benefit from solids prior to this age, it's not recommended that babies start solids before the age of 4 months. An early start on solids can potentially cause feeding problems because solid foods may decrease a child appetite for milk (breast or formula).

7. Milk or food allergies

   Children can develop an aversion to a food that causes them discomfort, this includes milk. Does your child have any symptoms that could indicate a milk allergy such as wheeze, recurrent cough, eczema, diarrhea, blood in stools, failure to gain weight?

   See a doctor if your child has any unusual symptoms.

8. Gastro-esophageal reflux (GER)

   Babies with GER may develop feeding difficulties because they begin to associate feeding with the discomfort of heartburn. Reflux is a treatable condition, if managed correctly it should not cause your baby considerable distress. If feeding difficulties continue after treatment, it may be that reflux is not the ONLY reason for your baby's feeding difficulties.

9. Teething

   While teething, a baby may fuss with feeding or fail to drink as much formula as normal. Feeding difficulties related to teething generally don't last longer than a couple of days.

10. Distractibility

    Babies over the age of 3 months can easily become distracted during feeding. They are often much more interested in the activities going on around them than they are in feeding.

    Feed your baby in a quiet environment away from noise and distractions of other children.