Understanding and Avoiding Nipple Confusion

October 22, 2014

You may have heard the term “nipple confusion,” but do you know what it really means and, more importantly, how to avoid it? Nipple confusion is a term used to describe many breastfeeding situations, but the most common usage refers to babies that have trouble latching and feeding at the breast after they have received a bottle.

How Nipple Confusion Happens

Both bottle-feeding and breastfeeding are learned skills for your baby. Because most babies do better mastering one thing at a time, it’s best to wait several weeks before offering a bottle to your breastfed baby.

Ultrasound studies verify that babies’ sucking patterns and mouth movements are different when they breastfeed compared to when they bottle-feed. During breastfeeding, babies need to create strong suction to draw out milk from the breast. Breastfeeding infants control the flow of milk and will pause to swallow and breathe. On the other hand, when infants drink from a bottle with a traditional nipple, they receive a more continuous flow of milk which is caused by gravity and the nipple opening.

When babies are exposed to both types of feeding, some will have trouble transitioning from breast to bottle and then back to breast again.

There’s no way of telling in advance which babies will have a problem with nipple confusion, so it’s best to wait to give your baby a bottle of your milk until after breastfeeding is well established (usually about 4 weeks). Full-term infants generally get plenty of milk directly from mom’s breast, and as long as your baby is healthy and gaining weight, there’s really no reason to introduce a bottle at first. Besides, pumping and bottle-feeding create unnecessary, extra work while you’re spending time bonding with your baby and recovering from childbirth.


Going Back to Work + Avoiding Nipple Confusion

Sometimes nipple confusion occurs in an older baby who had been breastfeeding successfully when mom returns to work or school. If mom’s milk supply is lower due to lack of stimulation during separations, the baby may begin to prefer the quick, easy flow of the bottle. The key to reversing this situation is to boost the mom’s milk supply. Mothers also can gently re-focus on the breastfeeding relationship by nursing more often when home with baby and cutting back on the number of optional bottles.

Another type of nipple confusion can happen when a baby refuses to accept a bottle and only wants to feed at the breast. This can be frustrating for moms who are trying to plan for time away from baby. If your baby simply loves to breastfeed but won’t take a bottle, try offering a bottle in a very low-key way by keeping practice sessions playful. Reassure your baby often, and stop trying whenever baby seems stressed. By continuing to offer small tastes from the bottle, baby will soon get the idea that breast milk can come from another container. Some babies will not accept a bottle from mom, but will accept a bottle from a family member or babysitter. Tips for selecting and introducing a bottle to your breastfed baby >>

Note that there are also alternative feeding methods that don’t involve a bottle. For example, some older babies prefer to drink pumped milk from a cup (with or without a straw). They may never need to use a bottle at all.


What to Do if Your Baby is Nipple Confused

Reach out to a Lactation Consultant. Lactation Consultants are trained experts in breastfeeding, latching baby to the breast, healthy bottle-feeding, and solving breastfeeding problems. They can help guide you and help you and your baby continue to enjoy a successful breastfeeding journey. Search for a Lactation Consultant near you >> 

If your baby is experiencing nipple confusion, it might also help to:

  • Increase skin-to-skin contact time.
  • Use a nipple shield to help coax baby to the breast.
  • Use a feeding device such as the Supplemental Nursing System (SNS) to provide increased milk flow, which allows for supplementation at the breast and helps baby learn to breastfeed.
  • Protect and maintain your breast milk supply by increasing breastfeeding or pumping sessions.

To support breastfeeding babies that need to take a bottle, Medela has developed Calma, a research-based feeding system. With Calma, milk flows only when your baby creates a vacuum, which allows your baby to take more time to swallow and breathe, similar to their feeding behavior at the breast. Ultrasound studies of babies feeding with Calma show that they use the same feeding motions used when breastfeeding.

Have you experienced trouble with nipple confusion? Share your story with us in the comments below.

4 thoughts on “Understanding and Avoiding Nipple Confusion

  1. My baby has been breastfed since birth. We waited u til 3-4 weeks to introduce bottle. She took it a bottle twice from dad when i was at the store and she became hungry. Since then, she refuses it most of the time, and either cries and pushes it away or lets it stay in her mouth but she will not suck. It looks like she is confused about what to do with her mouth, but we know she knows how because she will drink it once in a while. I don’t know what to do. We have tried all the techniques, and different nipples. We could try a fee more brands.

    • Hi Kimberly – Have you tried our Calma bottles? Designed exclusively for breast milk feeding, Calma is designed to complement, not replace, the breast as the primary source of breast milk and comfort for baby. It makes baby’s transition from breast to bottle (and vice versa) more natural. Here’s more information about Calma: http://bit.ly/Ltm8zU. We’ve compiled tips and information on the various types of bottles so you can choose what might be best for your little one: http://bit.ly/1rCQNfN. Here’s a helpful article on what to do when baby refuses the bottle: https://www.llli.org/breastfeeding-info/bottles/. We hope this helps!

  2. My baby is 4 months old now n she has been breastfed using a shield since birth. But I started giving formula twice a day n now she does not take breast. She pulls herself away, turns face away n cries. Wat can I do to make her take breast

Leave a Reply

Your email address will not be published. Required fields are marked *

Comment validation by @