Nipple Confusion 
a.k.a
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 entirely 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 during breastfeeding promotes 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 commonly occurs during the first few weeks of a baby’s life.


What Causes Nipple confusion?

paced bottle feeding

When a baby breastfeeds, he/she can regulate the amount of milk flowing from the breast, but a bottle flows more rapidly. If the 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 the 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 will allow your baby some time to learn, to breastfeed.


Signs of Nipple Confusion

  • The baby thrusts his/her tongue upward during sucking and pushes the breast out of the mouth.
  • The baby doesn’t open his/her mouth wide enough and therefore only sucks the tip of the nipple, which can cause nipple pain.
  • The baby becomes fussy and irritable because milk does not flow as easily as with a bottle.
  • The mother's milk supply often decreases because her baby does not latch on correctly.
  • The baby may refuse the breast altogether.


How to Prevent Nipple Confusion

  • Avoid bottles the first 6 weeks.
  • Avoid using a pacifier.
  • Use an artificial nipple that flows slowly. Best breast milk bottles discussed here.
  • Never force a baby to breastfeed, gently encourage your baby to accept. Praise 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 them to give your baby 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.
breastfed baby, beautiful breastfed baby, baby, pictures of babies breastfeeding


How to Cope with Nipple Confusion

  • Breastfeed your baby when he/she is calm
  • Mothers 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.
baby with bottle, bottle baby, cute baby
  • 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. 
  • Keep your baby close to your uncovered breast during the night and even the day with a sling if possible. Learn more about Kangaroo mother care here.


When Introducing a Bottle to a Breastfed Baby

What about bottle feeding problems “Bottle confusion"?

  • This refers to when a baby refuses bottle feeding after 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 your baby a bottle that has a slow flowing teat.
  • 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 the mother is thinking of returning to work after a few months.


When should you Introduce a Bottle?





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