Knock‑Out Bottles: Risks & Safer Infant Sleep Tips

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Getting your baby to sleep can be challenging, especially if they’re going through a period of sleep regression.

Some people have touted knock-out bottles, or KO bottles, to help babies sleep better. Knock-out bottles involve adding extra formula, food, or medicine to baby bottles. But there’s no proven data to verify that they help babies sleep.

Even worse, KO bottles can be harmful in many ways, from being a choking hazard to interfering with your baby’s development.

Learn more about the risks of thickening infant bottles, and discover safe alternatives to knock-out bottles.

What Is a Knock-Out Baby Bottle?

A KO bottle is when you add extra items, such as formula, medicine, or baby cereal, to a bottle. The idea is that thickening the bottle will help your baby sleep better. But no research confirms this helps.

At-home remedies to help babies sleep better are nothing new. But the knock-out bottle trend became more popular in recent years because of social media.

“There have been questions about getting your baby to sleep for years, certainly with the rise of all the homeopathic medicines,” says Pamela Schoemer, MD, director of quality, safety, and outcomes, UPMC Children’s Community Pediatrics. “It’s just now marketed in a different way.

“I feel bad for parents because they get pulled in different directions. You can see where parents would get really confused.”

Are KO Bottles Safe for Infants?

Knock-out bottles aren’t safe for babies. They contain unsafe bottle additives like:

• Baby cereal.
• Extra formula.
• Over-the-counter (OTC) medications and supplements.
• Pureed food.

The Centers for Disease Control and Prevention (CDC) warns parents not to add baby cereal or other foods to bottles. The American Academy of Pediatrics (AAP) also advises against putting baby cereal in bottles.

KO bottles pose many potential baby feeding risks.

They’re a choking hazard

Adding extra formula, baby cereal, or pureed food to bottles can be a choking hazard.

“It’s going to come out of the bottle differently because it’s thicker,” Dr. Schoemer says. “The baby’s going to have to suck harder.”

That creates a choking risk not only for that bottle but also for other bottles.

“Because the next time you don’t make the [knock-out] bottle, it’s going to come out quicker,” she says. “So then, they’re more likely to choke on it that way.”

Getting solid food from a bottle can also interfere with your baby’s natural feeding development.

“We’re not supposed to drink our food — we’re supposed to eat it,” Dr. Schoemer says. “If your baby’s not able to get it off of a spoon, which usually is somewhere closer to between 4 and 6 months old, you may not teach them that skill, either. So, developmentally, that’s a problem, too — they’re not building the right muscles to actually eat, which is a big deal.”

They can lead to an electrolyte imbalance

Baby formula is a delicate recipe. Just as you shouldn’t water down formula, you shouldn’t add more either. Extra formula can lead to an electrolyte imbalance in your baby’s body.

Electrolyte imbalances can cause serious health issues like brain swelling and seizures, Dr. Schoemer says.

They can cause dehydration

Adding extra formula to your baby’s bottle can lead to an imbalance in the amount of liquid they get.

“If you raise that amount of formula, it sounds like that isn’t a big deal,” Dr. Schoemer says. “But it actually can cause babies to get dehydrated.”

They can cause digestive issues

Putting food or extra formula in your baby’s bottle can cause constipation and other digestive issues. According to the AAP, infant cereal in bottles can change your baby’s stool consistency.

They can lead to weight gain

Dr. Schoemer describes baby cereal or solid food added to baby bottles as “empty calories.” Those calories can lead to unnecessary weight gain.

“You’re decreasing your baby’s nutrition,” Dr. Schoemer says.

They interfere with hunger cues

Babies have natural hunger cues that let you know when it’s time to feed them. Adding food or extra formula to bottles can interfere with those hunger cues, Dr. Schoemer says.

“We should all learn to eat based on our hunger cues, not because it’s time to eat,” she says.

They can interfere with your baby’s sleep patterns

Knock-out bottles may make babies sleep longer — but that’s not really a good thing.

Babies don’t have regular sleep patterns. Many babies sleep one to two hours at a time and don’t sleep for longer stretches until they’re 6 months old. Knock-out bottles can disrupt that natural sleep routine.

They can cause medication-related side effects

Adding over-the-counter medications like diphenhydramine (Benadryl®) to baby bottles is risky. The same goes for supplements like melatonin, chamomile, or magnesium. Those products can cause side effects that range from mild to severe.

“They may sleep longer and not wake up,” Dr. Schoemer says. “Or, it may actually depress their breathing reflexes or any other reflex. So, if they spit up, they’re more likely to choke on that spit up; they can’t respond to it in a normal way.”

Other potential complications include irritability and excessive drowsiness, Dr. Schoemer says.

Dietary supplements like melatonin don’t face the same level of regulation from the U.S. Food and Drug Administration (FDA).

“One bottle could have significantly different doses,” Dr. Schoemer says. “So, even though you think something might have worked the last time, it may not work the same the next time.”

How Do I Help My Baby Sleep Longer Safely?

While knock-out bottles are risky, there are simple, safe ways that parents can help their babies sleep.

Here are some tips for infant sleep safety.

Set healthy infant sleep habits

Adults generally sleep better when they follow a healthy sleep routine. Establishing a routine around sleep can work for babies, too.

Dr. Schoemer suggests the following:

• Establish a safe sleep space — Babies’ cribs should include only a flat, firm mattress with a fitted sheet, and they should lie on their back. Avoid having them sleep in carriers, swings, or anywhere other than their crib. Learn more about creating a safe sleep environment and get tips for safe infant sleep from UPMC Children’s Community Pediatrics (CCP).
• Keep the house darker and quieter at night — A quieter, darker space promotes sleep.
• Look out for sleepiness cues — If your baby is yawning, fluttering their eyes, or showing other signs of tiredness, place them in their sleep space. “That starts to set up their expectations that, ‘This is where I sleep,'” Dr. Schoemer says.
• Try ways to relax your baby — Bathing your baby or singing a song can comfort them before bed. “Those external cues tell them we’re getting to nighttime,” Dr. Schoemer says. “Even though they can’t read a clock, they start to pick up on those same cues.”

Swaddling

You can swaddle your baby from birth until they can roll over onto their stomach. Swaddling involves wrapping your baby in cloth, like a lightweight blanket, to soothe them.

You should stop swaddling once your baby can roll. At that time, you can use a sleep sack.

Ask your baby’s pediatrician for swaddling tips.

Let them self-soothe

Parents should help their baby if they’re crying from hunger or a wet diaper. But not every cry from your baby is a sign that you have to go pick them up.

“Babies make lots and lots of noises, so you may think they’re awake because they kind of make a little noise,” Dr. Schoemer says. “Don’t go in and (pick them up). Allow them to self-soothe, allow them to fuss a little bit.”

Ask for support

Many parents struggle with sleep because their babies are struggling with sleep. In those situations, you can always try asking for help.

Your baby’s pediatrician is a good source for tips on how to help your baby sleep better.

And if you need sleep yourself, Dr. Schoemer suggests reaching out to your loved ones for help.

“There are plenty of friends and family, other people that if you need to catch a little bit longer of a nap, they can do that one feeding in between so that the caregiver can get that sleep,” she says.

UPMC Children’s Hospital of Pittsburgh and UPMC Children’s Community Pediatrics provide expert care for children of all ages. For more on the services we provide, visit our websites.