Nipple Confusion - La Leche League International

The term nipple confusion or nipple preference has been used to describe an infant’s fussiness at breast or frustration when they are having problems switching from a bottle nipple and breast, before breastfeeding is well established. A baby uses a totally different technique to remove milk from the breast than he uses to drink from a bottle. Some babies have difficulty alternating between a bottle and the breast and some do not. There is no way to predict who will have problems breastfeeding after drinking from a bottle. Babies that are born early or babies with a weaker or more uncoordinated suck may be more vulnerable to nipple confusion. Breastfeeding experts disagree to what extent baby’s have difficulty with nipple preference or confusion.

Wait until breastfeeding is well established and feels like part of your daily routine. Many mothers recommend postponing a bottle at least 4 weeks.

If baby needs to be supplemented then consider other alternatives like a feeding cup or a supplemental nursing system.

Inform hospital staff of your wish to not give a pacifier or supplement to baby unless medically indicated.

Holding baby with skin to skin contact may be very helpful at this time.

Paying extra attention to positioning (baby tummy to tummy with you, ear in line with his hips, head tilted slightly back with his nose pointed at your nipple) and latch-on (baby has wide open mouth, is pulled in to mother quickly but gently, more of the areola covered by his mouth on the chin side than on the nose side).

Try praising the baby each time he takes a step in the right direction–an open mouth, tongue down, and good latch-on.

Try to watch baby for hunger cues (sucking fist or fingers, rousing from sleep, fussing but not yet crying) so as to settle into nursing before baby becomes really ravenous or upset.

Sometimes it can be helpful to massage the breast and express some milk first before latching baby on so that he can get an immediate milk reward for his efforts.

If he still frets at the breast, try expressing some milk right into his mouth before trying to latch him on. If you are unable to express milk, even a dribble of water onto your breast into baby’s mouth may help convince him to nurse.

Sometimes it helps overcome nipple preference to consider what is causing the baby’s frustration. If baby is looking for the firmer feel of an artificial nipple on the top of their mouth, then consider trying a nipple shield. Babies might also be more accustomed to the ease of a faster flow. Try using a slow flow nipple and holding it more horizontally. Alternative feeding methods can be used in order to avoid artificial nipples. You can try a spoon, a syringe, or a small soft cup to give supplements if they are still medically indicated.