Central Mississippi Down Syndrome Society


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Central Mississippi Down Syndrome Society

667 US-51 Suite C
Ridgeland, MS 39157
601-385-DOWN (3696)

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Bottle Feeding

Bottle-Feeding Your Baby

Most babies with Down syndrome grow properly and do just fine in the eating department. But some young babies with Down syndrome have a harder time sucking efficiently, due to their low muscle tone. Their mouths may be less “alert” or ready for feeding, and the extra effort they have to put out to eat gives them less endurance for getting through the whole meal.

Babies with Down syndrome and their parents usually find a few tricks that make feedings easier for everybody.

Breastfed babies with low muscle tone can lose interest while waiting for the milk to let-down. Some babies with Down syndrome find it harder to latch on to the breast or bottle nipple and maintain a good hold throughout the meal. These babies take many more breaks and end up eating less per feeding than you would expect for the amount of time spent. Swallowing excess air is common because the baby has a less efficient hold on the nipple.

Despite these concerns, babies with Down syndrome and their parents usually find a few tricks that make feedings easier for everybody. Below are some of the techniques that often work.

What Can Be Done?

Babies with low tone may need help using the muscle strength and control they have. They often prefer to be fed in a way that requires the least effort, rather than using their muscle control. To help encourage muscle strength, you need to “wake them up” or alert them before and during each feeding. Here are a few wake-up strategies; contact your baby’s doctor to review the appropriateness of these activities for your child.


Start the feeding when your baby is most awake or alert.

See if playing with your baby just before feeding helps increase attention for the meal. Play gentle tickle games with fingers, toys, or kissing around the face and neck. While supporting your baby’s head, dance with your baby so head and upper body control is stimulated. Bounce your baby gently in your lap. Of course, the dancing and bouncing should be done only if your baby can handle that much stimulation and has the head control necessary to participate without getting hurt.

Some parents find that a cool or tepid bath wakes up their baby before feedings. Others find that a brisk towel rub helps.

After waking up your baby’s body, focus the alerting on the face and mouth area. A cool washcloth on the face or gentle tapping around face and mouth may increase readiness for the bottle.

Some parents find that gently tickling or stretching the muscles around the lips and cheeks helps wake up the mouth. You can use fingers and washcloths.


Feed your baby in as upright a position as possible. The more your baby is up against gravity, the more active the muscles become. In addition, babies with Down syndrome seem to be more prone to ear infections. Upright feedings decrease the chance of liquid backing up in the ear canals, reducing the risk of infection.

Be sure that your baby is being fed in a chin tuck position. This position, with the head not too far back and not too far forward, seems to set up the neck and mouth muscles for the strongest sucking response. Try to rest your baby’s head – not neck – on your arm when holding during feedings, which automatically tucks the chin slightly. This position also can be achieved with pillows or arm rests.

An angled bottle, available commercially, may be used to keep the baby’s head at this angle until the end of the feeding. With a regular bottle, children must tip their heads back to get the last few drops. An angled bottle solves this problem. Cool the liquid.

Temperature may affect the efficiency and speed of your baby’s sucking and swallowing. After checking with your doctor, consider starting the baby at room-temperature formula and gradually chilling the formula until your baby can handle it straight from the refrigerator. This can increase not only the baby’s interest in sucking but also the amount that is sucked during the meal.

Cheek and Tongue Involvement

Some babies need to be reminded to suck during the meal by having a little attention drawn to their tongues. To increase tongue involvement, try tapping the nipple on the tongue or pressing up and down on the tongue regularly throughout the meal. This may serve to wake up the tongue, but should be discontinued or decreased if it disrupts the meal too much. Cheeks can be tickled, squeezed slightly, or tapped to keep them active during a feeding.

Ask for Help

Babies with Down syndrome have all the basic skills necessary for taking a breast or bottle. The suggestions in this article are intended to increase babies’ efficiency and control, so they can progress to more difficult food textures and consistencies.

Some babies with Down syndrome have further medical complications that interfere with good sucking or good nutritional intake. These conditions may require extra assistance. Ask your pediatrician, feeding specialist, or developmental team if you have questions or need more help. If you do not have a team in place, please see our list of suggested professionals.