Learning about and understanding nipple confusion is an essential topic for all mothers who hope to exclusively breastfeed. Why? Well, introducing an artificial nipple, whether from a bottle or a pacifier, too soon can be detrimental to mom’s supply and baby’s ability to nurse.
Nipple confusion occurs because the muscles and technique used to extract milk from a bottle are very different from nursing at the breast. In some cases, this can actually lead to breast rejection! And using a pacifier too early? It can mask hunger and sucking cues which can cause mom’s supply to tank.
Before N was born, I was fortunate to be involved in a prenatal group facilitated by a lactation consultant. With her help, I was able to learn what nipple confusion was and why it was essential to avoid pacifiers and ideally bottles too for the first 6-8 weeks to promote exclusive breastfeeding.
I want to share all of my knowledge on this topic with you so you can avoid this pitfall! But don’t worry! If you’re already experiencing the issue, I have also included some tips and strategies to get baby back on the boob and build up your supply.
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What’s the deal with nipple confusion and newborns?
First and foremost, fed is best and I would never want the advice in this article to lead to a hungry baby who isn’t gaining, or a mama feeling guilty. However, this advice is essential for those mamas who:
- Are just starting out on their breastfeeding journeys and baby is gaining weight normally
- Are still pregnant, and are looking to learn as much as they can before baby arrives
I urge you to go into nursing with the mindset that all of baby’s feeding should be done at the breast for at least 4 weeks. Ideally, you should even wait until after the 6-week growth spurt occurs.
This is because between 6-8 weeks your supply is starting to finally regulate. You may or may not know that milk supply works on a supply and demand system. This means the more baby is nursing, the more milk your body is making.
What is Nipple Confusion?
Nipple confusion is when a baby learns the feel of an artificial nipple on a bottle and the technique and motions involved with feeding from a bottle. Then, baby is unable to properly or adequately nurse from the breast.
Why does this happen?
This is because the feel of a mother’s nipple is very different from a bottle nipple. The muscles, jaw and tongue motions used for bottle feeding are also very different. Because of the gravitational aspects of bottle feeding, baby receives milk faster and with less effort. Some babies become accustomed to or even prefer this way of feeding. Some babies can become nipple confused after just one bottle which is why it really is best to avoid them completely until 6-8 weeks.
But doesn’t my breastfed baby need to learn how to eat from a bottle?
If you are worried about baby taking a bottle before going back to work, do not think that means a bottle needs to be given sooner any sooner that 6-8 weeks. Baby will not let themselves starve and will take a bottle if they are away from you long enough. There are also lots of tips and tricks to getting your breastfed baby to take a bottle. So rest assured, this will be way less of an obstacle than potentially tanking your supply over bottles given too early.
What if I need to give expressed milk to calm my baby before they’ll latch?
Some lactation consultants will recommend that you give your baby expressed colostrum to help them calm enough to latch. In these instances, there are alternatives to the bottle that should be used. To feed baby expressed milk or colostrum without an artificial nipple, experts recommend using a syringe, cup or spoon.
You can find more information about this in the resource section of this article. But before attempting this on your own, definitely discuss the practice with your pediatrician or a lactation consultant.
Is nipple confusion unique to bottle use too early?
While nipple confusion is mostly unique to bottles because that is what can ultimately lead to breast refection, pacifiers fall into this topic as well. Pacifiers can also wreak havoc on your supply and your hopes to exclusively breastfeed. This is because they mask hunger signs. I will go into this more in the pacifier section below.
Bottles and Nipple Confusion
As I mentioned above, the main reason you want to avoid bottles for as long as possible is because it is a completely different way of extracting milk than nursing at the breast. The beginning weeks of breastfeeding are essential for building up your supply to meet baby’s needs.
Breastfeeding is also a process that needs to be learned by both mother and baby and constant practice is essential. It will take baby time to perfect their latch and ability to feed. Throughout their learning process they are also signaling to your body to keep making more milk which is crucial to milk production.
Why to avoid bottles for the first 6-8 weeks
Muscle memory and milk supply
Above all, you need your baby to create the muscle memory associated with nursing at the breast and ensure you are developing an ample supply. If your goal is to exclusively breastfeed, then you should make it your priority to have every single feeding at the breast inside of this 6-8-week time frame.
Remember, the longer you go without a bottle the better. This time frame is based on the idea that it takes around 8 weeks for your supply to fully establish. Making it beyond the 6-week growth spurt is especially key. That growth spurt is crucial in ramping up your supply.
Doesn’t pumping signal milk production too?
So if milk production works on supply and demand, you may be thinking: Can’t I just pump when baby takes a bottle, it still indicates a need for milk, right? Okay, this is technically true. However, the pump is simply never going to be as effective at signaling milk production or extracting milk from the breast as your baby.
What if I’m going back to work at the 6-8 week mark?
Naturally, this timeline should be adjusted based on your unique life needs and situation. If your situation requires you to go back to work sooner than a typical maternity leave, the absolute shortest time to hold out on a bottle and still have a high likelihood of breastfeeding success is about 4 weeks.
A converse effect of bottle use and pumping too early
The most common worry associated with using a bottle too soon is low supply and nipple confusion. But for some women, introducing a bottle too soon leads to extra pumping sessions that actually signals for too much milk to be made. This results in the terribly frustrating and often painful problem of having an oversupply.
While this might not sound like a problem, believe me that any mother who has had this knows it really is a burden. With an oversupply you become prone to clogged milk ducts which can turn into the terribly painful infection, mastitis.
Fed Is Best
I want to again add the important factor that all of this is dependent on the fact that your baby was full term and is gaining weight adequately per your provider’s approval and opinion. Your baby’s health and ability to thrive should always be put above all else. You should absolutely be supplementing with formula via a bottle should there be any concerns!
Giving breastfeeding your all and any amount of breastmilk whether given to baby directly, from the breast, or by a bottle is an amazing gift. They don’t call it liquid gold for nothing! You should never feel any inadequacy associated with supplementing or bottle feeding if that ends up being what is best for you and your baby.
Bottle Feeding Can Hide Other Nursing Obstacles
In addition to the problem of nipple confusion and an inability to properly and effectively nurse, babies may begin to favor a bottle because of an anatomical irregularity. Your baby might have a tongue or lip tie (or other anatomically present obstacle) that will go undiagnosed because baby might be thought to prefer the bottle for some other reason. This is because babies with tongue or lip ties can still effectively feed from a bottle. A deep, wide latch is not essential for bottle feeding. They can successfully extract milk using only their lips to suck instead of their whole mouth.
What might be some red flags of a tongue tie and warrant a pediatrician or LC check?
- Trouble getting a deep latch
- Baby not gaining weight
- Recurring pain associated with nursing
Remember, nursing should not be painful! If you have any doubts about your baby’s latch do not wait to seek professional in-person help.
Impossible to overfeed at the breast
One of the many benefits associated with exclusively breastfeeding for as long as possible is that it is impossible to overfeed your baby. You can always be sure that baby is getting the perfect amount of milk. You also know that this milk is filled with the exact proportions of nutrients and antibodies your baby needs at a given moment.
Overfeeding with a bottle
On the flip side, bottle feeding can make it very easy to overfeed your baby even if you are bottle feeding expressed milk. This is because even with all the right strategies in place, which I discuss in my article about pace feeding, a bottle is just inherently faster than the boob.
Because of this, baby can ingest more than they mean to before they have a chance to register satiety cues. This is just another reason that holding off on the bottle as long as possible benefits baby. They are given the chance to better learn what “full” feels like and can be more in control of how much they are eating.
Possible increased spit up with bottle feeding
Another problem with overfeeding is that it can cause baby to spit up excess milk and potentially waste your precious pumped milk. By waiting on bottles until baby is a bit more familiar and confident with feeding from the breast, they will be more prepared to pace feed from a bottle effectively. This will prevent waste and overfeeding.
Supplement only when necessary
Sometimes, supplementation is essential to ensure that your baby is hydrated, gaining weight and thriving. For those mamas who need to supplement, don’t be discouraged! Still keep at breastfeeding, any amount of breastmilk is awesome for your baby. I have had friends do turn-arounds from nearly exclusive formula feeding to exclusive breastfeeding with enough determination.
That being said, I am writing to warn against unnecessary supplementation simply to get a break from nursing or having someone else feed baby prior to 6-8 weeks postpartum. This is extremely counterproductive to your milk supply and can cause you to have low supply very quickly.
This is because every time your baby is having a bottle, particularly of formula, it is a missed opportunity for your body to be emptied of milk and therefore stimulated to produce more milk and increase your supply. Even if you pump during this supplemental feeding it is just not the same as having baby nurse from the breast.
A common time that women who exclusively breastfeed might feel the need to offer a supplemental bottle is during a cluster feed. Cluster feeding is when your baby will nurse constantly, or with only 10 to 15 minutes breaks between feedings for up to hours at the time. It is most common in the evening and around growth spurts.
Your breasts may feel soft and baby will act very fussy but this is very normal and doesn’t mean that baby isn’t getting enough. In fact, this type of feeding is crucial in building your supply. Supplementing during a cluster feed can be a big mistake. Don’t let their fussiness shake your confidence that you are not providing enough! So long as you are seeing adequate wet diapers and weight gain, cluster feeding is not a signal that something is wrong.
Make sure your partner understands cluster feeding too
Be sure that your partner or any other person who is around to support you understands cluster feeding and how it works to increase your supply. Having a partner around who is adding to your stress and making you feel guilty for not supplementing is the last thing you need. This type of feeding is exactly why the recommendation is to wait beyond the 6-week growth spurt to introduce bottles. It is a very effective way of establishing and increasing your milk supply to meet baby’s needs.
When and How to Introduce a Bottle
For many moms the option of never using a bottle is simply impossible. And this article isn’t trying to convince you to never use one! Bottle feeding is totally necessary in order for you to return to work, be away from baby for more than an hour, and if nothing else, in cases of emergency when you need to be away from baby for an unplanned length of time. For those reasons, it is smart to understand the basics of bottle feeding the breastfed baby in a way that will promote feeding at the breast when you are with your baby.
Once your baby is 6-8 weeks old, or ideally more like between 8 and 10 weeks, and you are starting to get ready to go back to work, you can begin adding in daily pumping sessions and exposing your baby to the bottle.
For more information about bottle feeding your breastfed baby when the time is right:
- Bottle feeding your breastfed baby with the pace feeding method
- How to start incorporating pumping in your routine
- Pumping and storing basics.
How to Identify Nipple Confusion and How to Fix It
Maybe you didn’t know the possible implications of introducing a bottle too soon,. Maybe it was necessary to your baby’s health and well-being to use a bottle before the recommended time. Whatever the case may be, your baby might already be nipple confused.
You can tell a baby is nipple confused if:
- They are suddenly drawing away from the breast
- They are rejecting the breast completely
- Seem to be bobbing around looking for a different nipple
- Showing preference or more familiarity to the look and feel of an artificial nipple as opposed to the breast.
Some things you can do to undo the nipple confusion and promote feeding at the breast:
- Avoid all artificial nipples (bottles and pacifiers)
- Give medically necessary supplements or expressed milk using a different feeding method such as cups, spoons, or syringes while at the breast.
- Use a syringe or eyedropper at the breast to ensure that baby is instantly getting food when they latch. This will promote a positive experience for baby as they re-adjust to waiting for a letdown.
- Use lots of skin to skin to promote the other positive feelings that breastfeeding provides your baby.
- Try breastfeeding before baby full wakes or when they are particularly calm and happy.
- It is essential to catch your nipple confused baby in the very early stages of hunger cues because a frustrated and very hungry baby will be very difficult to latch and breastfeed.
- If you miss this window use an alternative feeding method (not the bottle) until they are calm.
Above all, see a lactation consultant to get support with your latch and approach “undoing the nipple confusion”. You’ll also want to learn the proper and effective ways to use alternative feeding methods to the bottle (such as cups or spoons) with an expert.
Pacifiers and Nipple Confusion
While Bottles are the main culprit when it comes to nipple confusion, pacifiers can exacerbate the problem. This is because it further confuses and reiterates the feeling of an artificial nipple in the mouth vs. their mother’s nipple. The type of sucking done on a pacifier is also different than the sucking used to nurse effectively. If you’re feeling pain while nursing or have sore nipples it may be due to your baby’s latch which has been influenced by their pacifier use.
The Vicious Pacifier Cycle
- Pacifiers can also delay a feeding by calming baby with a sucking motion, but this just leaves baby hungrier and results in a sort of “missed feeding” which signals to your body to make less milk.
- As your baby’s feeding is delayed, they will wind up hungrier and display more late hunger cues.
- This can lead to an increased instance of the need to use a bottle of expressed milk or formula in order to get baby fed quickly because they are too upset to latch.
- Once again, this is a missed opportunity to signal to the body to produce milk and again works to lower your supply.
By avoiding pacifiers entirely, you will be more aware of baby’s hunger cues and any comfort nursing that they do partake in at the breast can only help your supply. Pacifiers before 3-4 weeks can definitely negatively impact supply. Experts say they are ideally avoided until the 6-8 week window, like bottles.
Soothing Without a Pacifier
I totally understand why it might seem easy to reach for the pacifier to calm a fussy baby. I want to provide you with some ideas of how you can soothe a fussy baby without them. This way you won’t hurt your supply and cause nipple confusion. In the early weeks remember that you cannot create bad habits with your baby! You should do anything that works to get baby calm in order to promote breastfeeding. This early window is essential for establishing supply and should be your only focus.
Baby Wearing to Soothe Baby
Baby wearing can be an extremely effective way to calm a fussy baby, especially when they are brand new because being close to your body and held tight and snug against you will remind them of the womb. Walking around gently with a swaying motion, plus the sound of your heart beat, might instantly do the trick. I loved my Baby K’tan and my Moby Wrap, both make baby wearing easy, comfortable and the cloth option is great for newborn babies.
Use of Motion to Calm Baby
Another idea that I swore by with N until she was over 6 months old was bouncing on a yoga ball. Sometimes it was necessary to swaddle N tightly and bounce with her on a yoga ball to get her calm enough to attempt a latch and nurse if I missed an early hunger cue. This could be substituted with rocking or swaying and accompanying any of these motions with making a “shush-ing” noise can be especially effective. You can also try singing the same lullaby whenever you calm them to create a positive response to a particular song.
Sensory Deprivation to Calm Baby
Sensory deprivation can also be very effective to calming a fussy newborn because over-stimulation is so common and often misunderstood. Bring your baby into a darkened and quiet room. Hold them close to your body, ideally using skin to skin, or with them swaddled so that they can become calm.
Breastfeeding to Soothe Baby
After some time, nursing can be what you use to soothe baby! No need for a pacifier. Nursing anytime baby is fussy is the best practice because you will know that they have been offered food and even while they are comfort nursing they will be getting a small amount of milk which continues to improve your supply.
Other Points Against Pacifier Use
If you are beyond the recommended 6-8 week window with no artificial nipples and feel that your supply is well established for baby, it may be okay to introduce a pacifier. But, at this point there are some other things you may want to know about.
- First and foremost, a pacifier should never be given to prolong the time between feedings or put off a feeding.
- If your baby is still experiencing problems with weight gain at the 8 week mark, you are working to increase your supply, or you are having any other breastfeeding challenges, it is best to continue without any pacifier use.
Some other things to consider in your decision to use a pacifier include:
- Research has found a link between more frequent ear infections and pacifier use.
- Babies who use a pacifier are also more likely to wean sooner because once they are receiving solid food it is the desire to suck that keeps most babies nursing. When this desire to suck is fulfilled by the pacifier and they are filling up on solid foods, they may wean much sooner than the one-year mark.
- Pacifiers can cause teeth misalignment with extensive use.
If your goal is to exclusively breastfeed baby, for any length of time, following the advice in this article really will give you your best shot! Stay determined and make sure that people around you understand why this is important to you. Knowledge will prepare your loved ones to support you in your goals.
As you continue on your breastfeeding journey, our Breastfeeding Handbook might be just the complete yet condensed resource you need. All of the answers to your breastfeeding questions will be at your fingertips for when you can’t make it to the pediatrician or breastfeeding support groups.
What to do when people think feeding the baby is the best way to help?
When people are around a breastfeeding mother, especially if they are not familiar with breastfeeding or how supply works, it appears to them that all mom does is feed the baby. Okay, this is because it kind of is! But, they think the best thing they can do to help is to give the baby a bottle so mom can have a break. Educate them that this is not the case!
And yes, you probably will feel like all you do is nurse the baby, but that is necessary for the time being. Instead, let them know how else they can help you by providing very specific advice and ideas.
Don’t be shy about direct requests for help
People want to help but often feel uncomfortable taking on the dishes, doing laundry or cooking in your kitchen without being explicitly asked. If they came over to meet the baby they will feel more confident offering to do things with the baby, like feeding them. Don’t be shy, give them direct ideas of things they can do in the house for you, I guarantee that they want to help you and will feel good knowing they are doing something that you really needed done.
Make sure your partner is supporting you too!
As for your partner, let them know that their number one job is to help you succeed with breastfeeding. Just like with your visitors, this might require that you be very direct and specific in what you ask for. Have your partner handle grocery shopping and cooking. If you are still expecting I cannot put enough emphasis on how grateful I was that I had stocked my freezer before N was born.
Ask your partner to fill your water bottle, bring you snacks, or even just to sit and keep you company while you spend hours nursing. Let them know that by supporting, helping and encouraging you, the nursing mama, they are doing an amazing thing and being an amazing parent to their new baby.
Keep learning as much as you can and your breastfeeding relationship will flourish!
Believe me mama, I know breastfeeding is hard! But the endless snuggles and tight bond it creates is like no other. Hang in there and the reward of it becoming second nature will feel so sweet. Why not enroll in our free 5-day breastfeeding email course to continue your quest for breastfeeding knowledge? You’ll be so glad you did.
You’ve got this! Please share your tips and experience below, we love to hear from our readers.
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Pacifiers and Breastfed Babies:
Nipple Confusion and Bottles