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Bottle Feeding

Oral feeding in infants is a highly complex process involving multiple nerves and muscles working together to control the incoming liquid without choking or gagging (Marcus & Breton, 2022). The complex process also includes being able to coordinate the suck, swallow, and breathe all at once. If the infant does not have suck-swallow-breathing coordination, breathing is the primary focus, and feeding is no longer of interest and becomes a dangerous thing. If your baby is fussy, coughing, or gagging during bottle feedings, this can be a sign of a feeding problem (Fraker et al., 2007). The first step is to try one different formula, but if the new formula does not work, address the problem to your pediatrician.

  • Signs of poor suck-swallow-breathe coordination (Marcus & Breton, 2022):

    • Unable to breathe during a sucking burst

    • Pulls away from the nipple

    • Appears panicked or frightened

    • Loses liquids at the corners of the mouth

    • Has disorganized tongue movements

    • Shows signs of breathing distress

    • Uses short sucking bursts with frequent pauses

    • Refuses to eat after a few feeds

  • Tips to improve bottle feeds

    • Establish consistency with how you feed your infant

    • Read your infant cues, such as stop feeding when showing signs of distress

    • Provide lots of rest breaks throughout

    • Decrease the liquid flow (there are multiple bottle systems in the market that does this)

    • Feed infant in a side-lying position, helping them breathe easier


Fraker, C., Fishbein, M., Cox, S., Walbert, L. (2007, November 2). Food chaining: The proven

6-step plan to stop picky eating, solve feeding problems, and expand your child’s diet.

Hachette Books.

Marcus, S., & Breton, S. (Eds.). (2022). Infant and child feeding and swallowing: Occupational

therapy assessment and intervention (2nd ed.) AOTA Press.

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