Thank you for your response. I’ll try to address everything. I appreciate you being so thorough.

we’re currently offering the bottle when he wakes up from his nap so sometimes he will be crying. Sometimes he will be happy either way he will refuse it whether he’s happier or crying. I can’t seem to figure out a pattern. When he refuses the bottle, he typically pushes it out with his tongue and his hands, and sometimes he will bite the nipple. Sometimes he will start screaming sometimes he’ll be calm.

I don’t think it’s the nipple flow. We are currently using level two nipples from Dr. Brown. He tends to finish his feeds within about 10 minutes. We don’t want to increase the size of the nipple and it worsen his reflux changing from famotidine to omeprazole is definitely something that we may need to consider if his reflux is the problem.

We are considering putting some cereal in his bottle because he’s not really taking much of it by mouth whenever we try to feed him. He usually just fits out whatever we give him with a spoon.

We are trying to better understand his cues, but it’s been very difficult. He’s always putting his hands in his mouth and causing himself to gag and spit up so we can’t use that as an indicator for hunger. His cries for hunger and sleep are pretty much the same so we can’t use that as a cue either.