Dr. Greene’s Answer:
When a four year old is still using a bottle to go to sleep there are two patterns that must be overcome. First, she has chosen the bottle as her lovey, or special comfort object, to help her with the transition from a wakeful state to a sleep state. Secondly, this choice has become a deeply ingrained habit. Weaning her from the bottle will require either finding an effective substitute, or using tremendous force to break the patterns.
Your daughter’s insistent urge to grow is a powerful force that can be harnessed to help effect the change. Engage her cooperation. Set a date in the near future, perhaps her fourth birthday, and offer her an exciting opportunity. To celebrate this milestone, she can collect all her bottles, take them to a local store, and trade them in for something that would be thrilling to her (perhaps a small bicycle, a pair of roller-skates, a hamster, or an Easy-Bake Oven — something that will make her feel more grown up). If she excitedly looks forward to the date, she may be able to sacrifice the bottle in order to enter a new phase. Only communicate in a way that builds her security and self-esteem: You are excited about who she is as a 3-year-old; you will be excited about who she becomes as a 4-year-old. You will want to provide extra support around going to sleep, as I will describe in the next paragraph.
If you are not able to enlist her resources directly, weaning the bedtime bottle can be accomplished by substitution. Replace the bottle with a more age-appropriate transition/comfort object. Make the alternative as attractive as possible, while making the bottle less attractive.
This new transition to sleep might include a consistent bedtime ritual, when you spend about 20 minutes together doing the same nighttime activities in the same order. Give her something wonderful to hold as she sleeps. A large stuffed animal (about the same size she is), or a really great doll that she falls in love with, would be a good choice. Put away other stuffed animals or dolls for awhile; she will form a more special bond when she only has one or two. You may also want to make a tape recording of your voice singing to her or telling her stories. Listening to you repeat the same stories or songs night after night will comfort your daughter as she drifts off to sleep. You know your own daughter best. Select comforting measures that will touch her most deeply. Some parents try one of several bitter-tasting products to make the bottle less attractive. You can try adding a drop of ‘bitter apple’ (available in pet stores to teach pets not to chew) or nail-biting solution (to stop children from biting nails) on the nipple or actually in the bottle. A small amount will give the bottle a mildly bitter or musty taste, making it a less important part of the sleep transition. Many children will stop asking for the bottle within one to two weeks.
If neither of these approaches work, you will need to energize the process yourself. Offer milk (or something else to drink) in a cup at the beginning of the bedtime ritual — before reading a story, taking a bath, or brushing her teeth. Reduce the amount she gets in her bottle by 0.5 to 1.0 ounces a day until it is empty, then take the bottle away. Respond to requests for the bottle with hugs.
Weaning is difficult, but if you delay, the bottle will affect the shape of her mouth and teeth. Wean her from the bottle before peer pressure unkindly steps in. Peer pressure will do the job, but only by threatening her self-esteem.