Learning about and understanding nipple confusion is an essential topic for all mothers who hope to exclusively breastfeed because 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, and this leads to possible breast rejection. A pacifier 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 who helped us understand what nipple confusion was and why it was essential to avoid pacifiers and ideally bottles for as long as possible 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 are 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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Of course, there are medical exceptions and more serious issues can occur, but if you are starting out and baby is gaining weight normally, or if you are learning about breastfeeding 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, and ideally until after the 6-week growth spurt occurs because between 6-8 weeks is when your supply is starting to finally regulate. For more in-depth information about building a supply and what you can do if your supply is already low, read Trina’s article all about Milk Production.
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 and then is unable to properly or adequately nurse from the breast. This is because the feel of a mother’s nipple is very different from a bottle nipple and because the muscles, jaw and tongue motions used are very different. Because of the gravitational aspects of bottle feeding, baby receives milk faster and with less effort and can become accustomed to 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. We will look more in depth about why to avoid bottles below.
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 than this. Baby will not let themselves starve and will take a bottle if they are away from you long enough. You can learn more about this in my article all about bottle feeding the breastfed baby. There are also alternatives to the bottle that should be used if you need to feed baby a bit of expressed milk to help them calm down enough to properly latch and nurse. In these instances, it is best to feed baby expressed milk or colostrum using a syringe, cup or spoon. You can find more information about this in the resource section of this article, but should be discussed with your pediatrician or a lactation consultant to be sure it is done correctly.
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, because they mask hunger signs. I will go into this more in the pacifier section below.
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 it is for baby to nurse 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 supply.
Why to avoid bottles for the first 6-8 weeks
Above all, you need your baby to create the muscle memory associated with bottle feeding and ensure you are developing an ample supply. You may be thinking that you can just pump when baby takes a bottle, it still indicates a need for milk, right? While technically true, the pump is simply never going to be as effective at signaling milk production or extracting milk from the breast as your baby. 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, and making it beyond the 6 week growth spurt is especially key. 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.
While the most common worry associated with using a bottle too soon is low supply and nipple confusion, for some women introducing a bottle too soon leads to extra pumping sessions which 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 because you become prone to clogged milk ducts which can turn into the terribly painful infection, mastitis. To learn more read about how to avoid clogged milk ducts.
Fed Is Best
I want to add the important note 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 and 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 because a wide latch is not essential. They can successfully extract milk using only their lips to suck instead of their whole mouth. If you are having difficulties with baby getting a deep latch and they are not gaining weight, or you are having recurring pain associated with nursing, you should immediately ask your pediatrician and a lactation consultant to evaluate your baby for a tongue tie. Nursing should not be painful. You can read additional information about perfecting the latch in Trina’s article, the first week of breastfeeding your baby. But if you have any doubts about your latch do not wait to seek professional in-person help.
One of the many benefits associated with exclusively breastfeeding for as long as possible is that it is impossible to overfeed your baby and 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.
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.
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, which will prevent waste and overfeeding.
Avoid Unnecessary Supplementation
Sometimes, supplementation is essential to ensuring 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 and 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 and 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. 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 that is not what I’m trying to convince you of. Bottle feeding is 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 this you can read all about bottle feeding your breastfed baby with the pace feeding method and how to start incorporating pumping in your routine. Additionally, you may want to learn some pumping and storing basics.
How to Identify Nipple Confusion and How to Fix It
Maybe you didn’t know the possible negative impacts of introducing a bottle too soon, or 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 getting bottles and are suddenly drawing away from the breast or seem to be bobbing around looking for a different nipple. This is because they may be used to the look and feel of an artificial nipple as opposed to the breast.
Some things you can do to undo the confusion include avoiding 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 to undoing the nipple confusion as well as to learn the proper and effective ways to use alternative feeding methods to the bottle (such as cups or spoons).
Pacifiers and Nipple Confusion
While Bottles are the main culprit when it comes to nipple confusion, pacifiers can exacerbate the problem 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 negative impact supply and should 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, so I want to provide you with some ideas of how you can soothe a fussy baby without it so that you don’t hurt your supply and cause nipple confusion. In the early weeks remember that you cannot create bad habits and 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. You can read more in Trina’s article about breastfeeding in the first week.
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.
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 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.
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 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. Lastly, pacifiers can cause teeth misalignment with extensive use.
If your goal is to exclusively breastfeed baby, for any length of time, it really is essential that this advice be followed. Stay determined and make sure that people around you understand why this is important to you and are going to support you in your goals.
If you are looking to learn more before baby arrives to ensure you are ready to take on breastfeeding and have success, or if you are just starting out and looking to learn more and have support, we have created a free 5-day breastfeeding e-mail course that covers a variety of topics and includes action items to keep you accountable.
If you are looking for a bit more, we also have a breastfeeding handbook that we wrote because there simply aren’t any condensed, thorough and easy to understand breastfeeding resources out there for moms. This handbook will have everything you need to get started and keep breastfeeding your baby with confidence.
People think Feeding the Baby is How They Can 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 and 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 essential and necessary. Instead, let them know how else they can help you by providing very specific advice and ideas. 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.
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.
I really believe that reading, knowing and learning is the best thing you can do to promote breastfeeding success. Spend some time and check out all of our other amazing breastfeeding resources.
If you are still expecting, you will also find some great articles and advice in our expecting section.
Please let me know if you have any questions, comments, or need encouragement to keep with exclusive breastfeeding during the first 6-8 weeks to promote supply and avoid nipple confusion for your baby.
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Pacifiers and Breastfed Babies:
Nipple Confusion and Bottles