By Laura Silvas, RN IBCLC

One challenge many mothers face, along with all the other breastfeeding issues, is nipple confusion. Some professionals argue that there isn't such a thing. Some disagree and highly recommend waiting until breastfeeding is firmly established before introducing a pacifier or bottle nipple. Some mothers swear that introducing another nipple ends your nursing journey prematurely. So what is it, how do we fix/avoid it, and will it happen with your baby?

What is nipple confusion?

Nipple confusion is the term for infants who struggle to switch from breast to bottle or bottle to breast. If a baby is strictly breastfed, introducing a bottle may be a difficult transition because the infant is used to being fed directly from the comfort of the mom's breast.

On the other hand, if an infant is primarily bottle-fed, either through choice, poor latch, or other feeding issues, the transition of introducing breast as a feeding source can be difficult. With bottle-feeding, even "breast friendly" or "slow flow" nipples, your baby does not have to work as hard to pull milk from the nipple as they would from the breast. Also, in the early stages of breastfeeding, if your baby receives a larger volume of milk (formula or breast milk) before your milk comes in, the infant's stomach may stretch. The infant may then show dissatisfaction or fussiness because they will only get small amounts of milk from the breast.

How to avoid nipple confusion

While nipple confusion may never present as an issue for some infants, you may find yourself looking for ways to prevent it from happening. Many mothers must supplement due to low breast milk supply or provide extra calories for their NICU babies. Other mothers have to return to work early postpartum and may decide to breastfeed when they return home and feed their baby pumped milk during the day.

Try the following tips and tricks to prevent and reduce nipple confusion:

• If possible, wait 4-6 weeks before introducing a bottle. This will allow you to correct a good latch without adding in an artificial nipple but also helps to ensure that you have established a good milk supply.

• If you need to supplement or add milk following breastfeeding, try using an oral syringe, spoon, or small medicine cup instead of an artificial nipple. These alternatives may take longer but are more "breast friendly."

• If you need to use a pacifier (I get it, you do what you have to do, mama) or a bottle, opt for an artificial nipple that mimics your nipple shape and size. I.e., if you have short, small nipples, using a long bottle nipple probably isn't the best fit for your baby. Many brands now offer breast-friendly/slow-flow nipples in various shapes and sizes.

• If transitioning from bottle to breast, offer the breast at each feeding. And I do mean every feeding. The more the breast is offered, the more comfortable you and your baby will become. Be patient. It's a learning process; your baby is learning how to pull milk from the breast.

• With bottle feeding, try horizontal feeding. This process allows you to hold the bottle horizontally than in the typical angled style. This ensures that your baby has to work a little harder for the milk, similar to the breast.

• Start slow when introducing a bottle (for example, when returning to work). Have dad, grandma, etc. introduce a bottle once a day starting around the 4-6 week mark.

• Try various nipples. It's a guessing game, but eventually, you will find the right one.

Conclusion

Unfortunately, like most of motherhood, sometimes it's hard to tell why you may struggle to feed your baby. Some babies never have an issue switching back and forth. If they don't, mazel tov! If they do, that's okay too. Persistence is key. Reach out to Leva's Lactation Consultants for help if you suspect your baby may be struggling with nipple confusion.