Nipple Confusion

What is it?

Babies are born knowing how to suck, but they use different techniques to get milk from a breast and a bottle. In general, breastfeeding requires more vigorous mouth and tongue motions, and greater muscle coordination than bottle feeding. Your baby uses 40 facial muscles to nurse effectively and only four to suck on a bottle. If you offer bottle nipples or even pacifiers to your newborn, he can forget how to nurse properly. This confusion can lead to diminished or discontinued nursing. Nipple confusion is generally not a problem after the early weeks, once your baby is nursing well.


What causes it?

Breast nipples are soft and flexible. Your baby must open his mouth wide to latch on and engage a host of muscles. Artificial nipples, on the other hand, are pre-formed and fairly rigid, so they require little effort from a baby and can even be coaxed into a closed mouth. (Many nipple shields also require a different sucking action.)

As a result, a newborn who uses artificial nipples may try to feed from the breast using the same jaw and mouth motions he used to suck on his bottle or pacifier — which are not usually strong enough to draw milk from the breast. He will quickly become frustrated and may fuss, cry, or refuse to nurse.

The baby won't get much milk or feel satisfied, and if this happens in the first few weeks after birth, it may be difficult for him to learn to breastfeed effectively. Nipple confusion can also lead to the more serious problems of nursing strike (when a baby refuses to nurse), sore nipples, breast engorgement, or a slow-down in weight gain.

What can I do?

Avoid artificial nipples and pacifiers until breastfeeding is well established, especially if your baby is having trouble learning to latch on or suck correctly, or you're concerned about your milk supply.

That doesn't mean pacifiers and bottles are always a no-no. If your baby is nursing well, the occasional suck on a pacifier can calm your little one when you're unable to nurse immediately or soothe him when your arms, breasts, and patience are strained.

Sometimes an unexpected illness or other circumstance will make it impossible for you to breastfeed and someone else will have to step in. To reduce the chance of creating nipple confusion, consider "finger feeding" with a supplemental nursing system. These systems allow a caregiver to feed your baby expressed breast milk through a tiny tube taped to his or her little finger. As strange as it sounds, sucking on a finger is much more similar to breastfeeding than bottle-feeding is.

If your baby is already experiencing nipple confusion, you may be in for a rough few days. But you can get through this together. Continue to offer the breast at every feeding, avoiding pacifiers and bottles until things have smoothed out again. Offer your baby your breast before he is fussy or overly hungry. Change your nursing position to find something more comfortable, and try to relax. If the problem is getting worse or you think your baby isn't getting enough milk, call your healthcare provider or a lactation consultant for additional help.

Will it affect my baby?

Yes, if it continues too long. Nipple confusion can lead to a decrease in nursing or ineffective sucking at the breast, which in turn may diminish your milk supply. That can interfere with the long-term success of breastfeeding. Nipple confusion can also cause you to cut feedings short and offer your baby a bottle, depriving him of the high-calorie, high-fat hindmilk (the milk produced at the end of feedings) so important for growth.

Can I still nurse?

Definitely. Although dealing with nipple confusion can be challenging, it is certainly beatable. Offering your baby your breast at every feeding is the first step in correcting the problem.





photo from http://flickr.com/photos/19077164@N00/45557437/