Nipple Confusion

Nipple Preference

What is nipple confusion?

When breastfed babies are given an artificial nipple to drink from, they might become confused and not know how to drink from the breast. These two feeding methods entail completely different tongue and mouth movements and swallowing skills.

During breastfeeding a baby uses his jaw and lips to pump and grip the nipple and breast for effective breast drainage. The suction needed during breastfeeding actually helps for oral development in babies.

Not all babies will develop nipple confusion, some babies have no problem going back and forth between the bottle and the breast. It also usually only occurs in the first few weeks of a baby’s life.

What Causes Nipple confusion?

When a baby breastfeeds, he/she can regulate the amount of milk flowing from the breast, but a bottle flows more rapidly. If Baby has been exclusively or partially bottle-fed and then expected to breastfeed, he/she might refuse to take the breast. This is sometimes called a "nipple strike”.

A mother might introduce the artificial nipple too early and then Baby might not want to drink from the breast anymore, because drinking from the bottle is so much easier.

The best thing to do is to keep your baby exclusively on the breast before introducing an artificial nipple for the first 6 weeks, this will get your own milk supply established and also give your baby time to learn.

Signs of Nipple Confusion

- Baby thrusts his/her tongue upward during sucking and pushes the breast out of the mouth.

- Baby doesn’t open he's/her mouth wide enough and therefore only sucks the tip of the nipple, which can cause nipple pain.

- Baby becomes fussy and irritable because milk does not flow as easily as with a bottle.

- Moms milk supply often decreases because Baby does not latch on correctly.

Baby refuses the breast completely.

How to Prevent Nipple Confusion

- Avoid bottles the first 6 weeks.

- Avoid using a pacifier.

- Use an artificial nipple that flows slowly.

- Never force a baby to breastfeed, gently encourage your baby to accept. Praise and encourage your baby when he/she succeeds.

- Make it clear to the nurses (even with a special notice on your baby's crib) and doctors at the hospital, that you do not want your baby given a bottle. Sometimes the nurses will feed a baby at night while you sleep, thinking they are helping, but actually doing more harm than good. Keep your baby in your room, so that you can breastfeed on demand.

How to Cope with Nipple Confusion

- Breastfeed your baby when he/she is calm.

Read more about how to calm a baby for breastfeeding.

- Moms that want to breastfeed a nipple confused baby, will need to pump milk a few minutes before feeding their baby, so that their milk ejection reflex is stimulated; this is so that their baby does not have to wait for the milk to start flowing.

- If it is impossible for you to breastfeed your baby within the first few weeks, you can use alternative feeding methods, like syringe and cup feeding or “finger feeding”. This is so that your baby is not introduced too early to an artificial nipple.

- Keep your baby close to you, with skin to skin contact while trying to breastfeed.

- If your baby refuses your breast altogether, remember that you can still pump and continue to feed your baby breast milk. Using a double action, electric pump is best to keep your milk supply up.

Read more about how to choose the best pump for you.

- Keep your baby close to your uncovered breast during the night and even the day with a sling (kangaroo nursing) if possible.

Read more about breastfeeding in a sling.

When Introducing a Bottle to a Breastfed Baby

What about bottle feeding problems “Bottle confusion”?

Baby won't take a bottle?

Sometimes a baby refuses bottle, when he/she has been breastfed exclusively. Getting your baby to take a bottle, may be frustrating; especially when a mother is returning to work.

- Sometimes a baby won't take a bottle because of the heavy flow of an artificial teat. Most times, all you need to do is give Baby a bottle that has a slow flowing teat.

- If your baby won't take bottle fed formula, you can always try pumping your breast milk for at least the first month, to get Baby to accept the bottle. 

- The best thing to do, if you would really like your baby to drink from an artificial nipple, is to introduce it early enough (after 6 weeks) so that your baby can get familiar with both the breast and artificial nipple. This is helpful, if mom is thinking of returning to work after a few months.

Other pages on "breastfeeding problems" in connection with nipple confusion

- Breastfeeding with flat or inverted nipples

- Different nipple variations.

- Using a pacifier.

- Using a nipple shield.

- From breast to bottle.

- Suck problems.

Comotomo baby bottles are designed to closely mimic breastfeeding to reduce bottle rejection and nipple confusion issues...

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latching problems due to big nipple 
Hi, im having problems to latch my bb to my big nipple. Had the same problem w my first child too.. ive tried using cup feeding method but baby gets …

Baby refuses the bottle baby used to take breastfeed the whole day and then 2 bottle feeds at nite since she was she is almost 9 weeks old..since last 20 days …

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I been using the comotomo and my baby refuses the breast.. What can I do. She will be two months real soon.

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Site by BFeeding Mamma, Tracy Behr. Currently studying through Child birth International (CBC, CBD). Also an accomplished author and Mommy of two.

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