Must I drink that formula again? Karabeth Newswanger with mother Loretta at Symposium 2002
On the MSUD eGroup, two questions are asked more often than any other question. How do I get my child to take the required amount of formula? How and when do I get my child to make the switch from a bottle to cup? Since these are problems for so many parents, it seemed a good idea to address them in this issue of the Newsletter. To do so, I summarized the responses the parents and grandparents on the eGroup gave to these questions. I owe a debt of gratitude to Mr. Phil Murry, a grandfather who helped comb the MSUD eGroup archives for messages pertinent to the topics.

These ideas were not taken from a book, but from the experiences of those who have dealt directly with the problems. The methods were found to be successful for families - though, admittedly, not without some struggles. I think every parent would agree that no two children are alike. Each parent needs to experiment and find the method with which they feel the most comfortable and that achieves the desired result.

How can I get my child to drink the formula?

  1. Pray for patience. Don't expect the battle to be won overnight.
  2. Be firm and consistent.
  3. Try to determine if the child is sick, really doesn't like the formula, or has seized on formula refusal as a way to assert their independence and push your buttons. This may help you decide what method will work best for you.
  4. Use hunger as an ally. Offer the child the formula first before you give them anything else to eat or drink.
  5. Make it the child's choice. Say something like, "You can choose to drink now and then go play, or you can choose to sit here and drink later!"
  6. Distract the child by letting them watch a favorite TV program or video while they drink. Read a book to them at formula time. Let them turn the page as soon as they drink a few swallows.
  7. Some parents use the opposite approach. If the child does not continue to drink the formula, the video is stopped, the TV gets turned off, or the book gets closed until they cooperate.
  8. Make a chart. When the child cooperates by drinking the formula in a set period of time, give them a reward such as stars or stickers.
  9. Since it frequently seems to be the smell of the formula that children find offensive, have them drink it from a sippy cup or a closed container of some kind with a straw. This eliminates much of the odor.
  10. Drinking from a straw also provides the advantage of the formula going straight to the back of the mouth and missing a lot of the taste buds. You might try one of those fancy curlecue plastic reusable straws just for fun. (Make sure you rinse it out immediately after using.)
  11. Take the child to the store and have them select a special cup to use only for formula drinking.
  12. Depending on the formula you use, try different flavorings or sweeten with corn syrup. Parents reported using Strawberry or Chocolate Quick and Hershey's Chocolate Syrup. Others tried mixing the formula with Gatorade, Kool-Aid, orange juice or making a shake with frozen lemonade. [Check the leucine and/or protein values and adjust the diet if necessary.] One parent reported that Ross has six different flavorings for their formulas.
  13. Use ice in the formula. Drinking it very cold may help cover the taste. [Be aware of the possibility of choking on ice, particularly with young children.]
  14. Dilute the formula as this will minimize the strong taste.
  15. Call in reinforcements. Sometimes an older sibling whom the child tries to imitate can get the child to drink when parental attempts have failed.
  16. Divide the day's formula into five or six even amounts and give these servings on a strict schedule.
  17. Since a sleeping child is in a more relaxed state, some parents set an alarm to get up in the middle of the night and give the child what they missed during the day. The battles of the day are forgotten, and the relaxed, sleepy child drinks without realizing what they are doing. Also when a sippy cup is left near the sleeping child, the child will sometimes drink it on his own during the night. [Do not allow formula to set too long without refrigeration.]
  18. Mix some of the powdered formula or the liquid formula into the child's food: for example, in a baby's pureed food, in an older child's applesauce, orange juice or in puddings, etc. [Caution: don't add too much at a time or your child may reject the food and become suspicious of all foods.]
  19. If your child definitely does not like their formula, talk to your doctor and/or nutritionist about changing formulas. There is a selection of wonderful formulas available. Check under Dietary Resources on the MSUD website. Do some research and contact the companies for nutritional information. Then share the information with your doctor and/or nutritionist who may not be aware of the formula options. Ask your nutritionist to obtain samples to try before you buy a case of a new product.
  20. Never, ever, allow anyone (this includes grandmas and grandpas) to make disparaging remarks about the formula in front of the child. Adopting a "poor you" attitude will make a child, even one who has been drinking his formula quite nicely, wonder - if grandma thinks this stuff isn't very good, why am I drinking it? Try not to even allow yourself to feel negative about it. This formula is your child's key to life and health; be grateful that it is available. Attitudes, even unspoken ones, transmit very easily to children.
  21. When all has failed, the battle has been prolonged, and family life is suffering, some parents - after careful consultation with the doctor and nutritionist - have chosen to use a G-tube (gastrotomy tube) for feeding the formula directly into the belly. This requires minor surgery to insert the tube and ongoing care of the site. The tube requires changing at intervals, but the formula can be given this way for very long periods of time. [See the following article by Gabriele Patterson on this topic.]

We all know that, especially when a child is sick, adequate formula intake is paramount to keeping them out of the hospital and avoiding the complications of MSUD; and yet that is the time when even a compliant child may refuse it altogether.

In addition to the above suggestions, here are a few that may help with the sick child.

  • Reward the child for taking some formula, maybe with a favorite food or drink.
  • Use a syringe. One person made a game of it by putting food coloring in different syringes to make different colors of formula. Then the child could see "the magic color" on his tongue.
  • Partially freeze the formula and make it into a slush. This is particularly good to do when there is severe sore throat.
  • Set an oven timer for a half hour or whatever schedule you want. Give the child just one ounce of formula. (Easy to give with a medicine cup). Repeat and gradually increase the amount of formula and the time between drinks. [This one works especially well in cases of upset stomach to avoid vomiting.]
  • Make the formula more concentrated so they have a smaller volume to drink (ask your doctor or nutritionist about this first).
  • If all else fails, and the child is getting sicker or is in danger of dehydration, etc., it may be advisable to check with your doctor about the possibility of using an NG-tube (nasogastric tube).

The NG-tube is not the same as a G-tube. The NG-tube is inserted through the nose and goes down the throat into the stomach. The formula is then given through the tube. Some clinics teach parents how to insert and change an NG-tube themselves, particularly if the child is frequently ill. It should not be left in for long periods of time like a G-tube. It is a temporary solution to tide you over during a critical time. Be aware of possible serious side effects from the overuse of an NG-tube.

How and when do I get my child to make the switch from a bottle to a cup?
The term bottle used in this section refers to the bottle used to feed babies unless otherwise stated.

This can be a very emotional issue for parents, particularly in the United States. There seems to be more pressure to wean children from the bottle (or breast) much earlier than in other parts of the world. The pressure may come from other people (well-meaning relatives and friends), who point out that the child across the street has been off the bottle since he was nine months old. Why is your child still hanging on to the bottle at his age? Or the pressure may be internal because the mother feels that she is not a good mother since her child isn't weaned from the bottle yet. Sometimes the pressure may come from the doctor who is concerned about the future dental health of the child.

Parents may also have deep concerns about switching their child with MSUD to a cup. They fear the child will no longer drink the amount of formula required or will totally reject the formula. Some mothers reported that their children will drink anything from a cup except their formula.
  • Take a long hard look at your child and your situation and decide if the time is right for your child to be weaned. Do not allow yourself to be pressured into something that you do not feel your child is ready for.
  • Again, pray for patience. Don't expect the battle to be won overnight.
  • If this is your first child, get some advice from other parents in your circle of friends as to how they weaned their non-MSUD children. Read a couple of books about it. If you have already been through this with another child, just try to remember what you did right at that time.
  • Review all the suggestions given in the first part of this article for getting your child to drink his formula. Many of them can be adapted for this situation as well.
  • Be firm and consistent. As one mother put it, "Stick to your guns . . . I think a lot had to do with who was boss! I finally won the fight."
  • If your child's formula consumption drops for a day or two, no permanent harm will be done. [Caution: just make sure calorie consumption stays up.]
  • If the child can understand this approach, try talking to them about how only babies drink from a bottle, and how they have grown up now. Make a big ceremony of throwing away (or packing away) the bottles and throwing away the nipples. This might be followed by allowing them some kind of "big boy" or "big girl" treat as part of the celebration.
  • Remember, the bottle is a closed container and reduces the smell of the formula. Since smell is a large part of taste, and the smell of the formula may discourage drinking, make the switch by using a closed container, such as a sippy cup or sports bottle, to eliminate much of the smell.
  • One person had great praise for a sippy cup called Avent which has soft removable spouts in different textures of rubber - a cross between a bottle nipple and a spout. By starting with the softest one, eventually the transition can be made. It does not spill and can be used by the child if they are lying down. [Note: we are not pushing the use of any particular product, just reporting on the experience of someone who has used it successfully.]
  • Use peer pressure to help you. Encourage the child to be around other children who do not drink from a baby bottle and point this out to them. Their peers may also be quick to make the point themselves.
  • Do not get stressed out by this situation. Several parents wrote in to "confess" that their children had resisted being weaned from the bottle for years, and yet, finally, the day had come. For them, getting the formula in is the most important thing, not how it goes in. Several persons stated that there had been no apparent harm to their children's teeth as a result of their prolonged time on the bottle. [Note: good oral hygiene probably becomes extra important if your child stays on the bottle for a prolonged time.]

The bottom line is, as one mother reported - she has never seen a job application with the question, "when were you off the bottle?"

NOTE: If anyone sent in a suggestion to the eGroup relative to either of these topics and did not find it included here, please forgive the oversight. Currently there are well over 2000 archived messages on our site. Although there are subject lines, the subject line doesn't always match the content. I did my best to search out all the pertinent messages, but may, inadvertently, have missed some. I apologize if I have missed yours.