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How can I break my kids of the bottle-in-bed habit?
Q: My 3-year-old still insists on taking a bottle to bed. His 2-year-old sister takes one to bed, too, which is a habit more than anything. I’m expecting my third child and want to get both of my older two off the bottle at night. How do I do that? My 3-year-old hugs the empty bottle in his sleep and cries out for it if he’s scared. It’s just too easy to give in to his screams.
Lana Memphis
A: Lana, having three children under age 4 is a lot of work! When you and your children’s sleep are at stake, it often seems easier to just give them bottles in bed. But helping your 2- and 3-year-old give up the bottle habit will be much better for their health in the end.

The American Academy of Pediatrics recommends that children stop the bottle and switch to a cup by 1 year of age. Even for bottle-fed babies under 1, experts advise against putting them to bed with a bottle. There are some important health reasons for this:
  • Tooth decay: Children put to bed with bottles of milk or juice are more likely to develop tooth decay. This is because the natural sugars in milk and juice can cause cavities when left on the teeth for long periods of time, like at night.

  • Ear infections: Children put to bed with bottles are more likely to get ear infections. When a child takes a bottle lying down, the fluid from the bottle—and whatever germs it carries from the child’s mouth—can flow into the child’s Eustachian tubes at the back of his throat, leading to the middle ear, and causing an ear infection.

  • Choking: Our bodies are not made to swallow lying down. Babies who are put to bed with bottles could choke on the liquid.
It sounds like the bottle has become an important part of your children’s bedtime routine. To break them of this habit, make sure you have other healthy routines and rituals that can comfort them. For example, a consistent routine of bath, pyjamas, a book on the lap and a cuddle in bed can be very comforting and signal to the children that it’s bedtime and they are safe, secure and ready to sleep. It can also be comforting for them to go to sleep holding a special blanket or a stuffed animal instead of the bottle.

Since the bottle has been a comfort for your children at night, they might find it difficult to give it up. You can decide whether you think it’ll be easiest to take the bottles away gradually over time or all at once. But remember to be firm and follow through on your plan. If you can put up with some fussing for a few nights, you can trust that they will sleep without the bottle very soon. Here are some tips:
  • To take the bottles away gradually: Over the course of a week, add more and more water and less milk or juice to their bottles. Once they’re drinking just water, they’re likely to find the bottle less comforting and it’ll be easier for them to give it up.

  • To take the bottles away all at once: Prepare your children for this event by explaining to them that you are so proud of them because they are a big girl/boy now and that they’ll be a big sister/brother for the baby. Part of being a big kid is being able to do so many fun, grown-up things that babies can’t do—like going down the slide at the park, playing with certain toys, watching special videos and drinking milk from a cup. The other part of being a big kid is stopping doing things that babies do, like using a bottle. Set a date for the big celebration when they’ll show they’re big kids by packing up the bottles to give to the baby. You can acknowledge that it might be a little hard to give up the bottle, but you’ll help them. Give them lots of praise and consider giving them stickers or another special reward, such as a stuffed animal, for giving up the bottle.
Also, since you are expecting a baby any day now, this is a perfect opportunity to prevent this problem from occurring again. Consider breastfeeding rather than bottle-feeding. It has lots of health benefits for you and your baby, and it also reduces the chance that the bottle will become a problem later on. No matter how you choose to feed your new baby, try to develop a nighttime ritual that helps your baby learn to fall asleep without a bottle.

Karen Sokal-Gutierrez M.D., M.P.H. Pediatrician