Nipple Confusion

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 baby’s life.

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

Some moms might introduce the artificial nipple too early and then baby doesn’t want to drink from the breast anymore because drinking from the bottle is so much easier. The best thing to do is to keep 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 get baby skilled at breastfeeding.

Signs of nipple confusion

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

- Baby doesn’t open he's 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 baby to breastfeed, gently encourage baby to eccept. Praise and encourage baby when he succeeds.

- Make it clear to the nurses (even with a special notice on 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 baby in your room so that you can breastfeed on demand.

How to cope with nipple confusion

- Breastfeed baby when baby is calm. Read more on how to calm a baby for breastfeeding.

- Moms that want to breastfeed a nipple confused baby will need to pump their breast milk a few minutes before feeding baby so that their milk ejection reflex is stimulated so that baby doesn’t have to wait for the milk to start flowing.

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

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

- Keep your baby close to your uncovered breast during the night and even the day with a sling (kangaroo nursing) if possible. Read more on breastfeeding in a sling "baby wearing"

What about bottle feeding problems when introducing bottle to breastfed baby “Bottle confusion”?

Baby won't take bottle?

Sometimes baby refuses bottle when he has been breastfed exclusively. Getting baby to take a bottle can also be a very frustrating thing as many moms find they are stuck with this dilemma when they need to return to work.

- Sometimes 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 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. Here is a page on helping moms who are pumping and working

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

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

- Breastfeeding with flat or inverted nipples

- Using a pacifier and breastfeeding

- Using a nipple shield

- From breast to bottle

- Suck problems

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