How to Prevent Nipple Confusion in a Breastfed Baby

baby bottlefeeding

In all the hubbub about whether to breastfeed or bottle-feed, one question is often lost: what if you want to do both? Maybe you want to breastfeed in the evenings but have your baby bottle-fed while you pump at the office. Or, maybe you breastfeed but want your baby to take the occasional bottle (like when you're traveling or just plain pooped). All that should matter is what works for moms, but sometimes it's not that easy. Some babies experience what's known as "nipple confusion" or "nipple preference," making it difficult to switch from breast to bottle or vice versa.


"Breastfeeding and bottle-feeding are different and require a newborn to suck in different ways," explains Bridget Boyd, MD, a pediatrician at Loyola University Health System. Breastfeeding, for instance, requires baby to suck pretty hard to get milk; whereas with a bottle it flows with little effort. "When both methods of feeding are used too early, the child may become confused."

But that doesn't mean you have to feed baby from the breast and only the breast. There are things you can do to help your baby avoid nipple confusion and be happy taking both breast and bottle. Try these tips to cultivate a switch hitter at feeding time:

Wait until baby has the hang of breastfeeding. Since it can take a while for a baby to get a hang of breastfeeding, try to avoid introducing bottles (and pacifiers) for the first two to three weeks. That way, your baby can really master nursing from you without distractions, and won't prefer bottle to breast. 

But don't wait too long! Once baby has a good handle on breastfeeding two to three weeks in, try introducing a bottle once a day. "This is especially important if mom will return to work or needs to be away from her baby and a caregiver can provide pumped breast milk in a bottle," says Dr. Boyd. "If the family waits longer -- for example, at the end of a three-month maternity leave -- the baby may refuse to drink from a bottle." In other words, don't let baby get too set in his ways. Try a bottle early on, in small doses, so it doesn't feel so abrupt.

Try a bottle nipple that mimics the breast. Since nipple confusion is caused by differences between bottle and breast, try to minimize those differences by getting a bottle with a "slow flow" nipple -- meaning one that only releases a tiny bit of milk. This way, feeding from a bottle will feel similar to feeding from the breast so the baby doesn't mind switching.

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Make your breast mimic the bottle. Likewise, you can help a nipple confused baby return to the breast by squeezing the breast tissue near the areola to make a "ledge" of breast tissue. "I find nipple confused babies are looking for something firm to latch onto," says Cindy Leclerc, a nurse and lactation consultant. "The point of making the ledge of breast tissue is to give the baby something firm against his tongue." 

Offer the option baby dislikes when his defenses are down. "Try offering the bottle when baby is sleepy or just waking from a nap," says Leclerc. "It will be more difficult if baby is already hungry and upset."

Warm the bottle. Breastfeed babies are used to body temperature milk, so if baby refuses a cold or room temperature bottle, that may be your reason. To warm the bottle, place it under warm tap water for 5 to 10 minutes (not the microwave since that can heat unevenly). Drip the milk on the inside of your forearm to test it before giving it to baby.

Have dad do the honors. Is baby refusing the bottle from you? Well, that's understandable -- your breasts are right there, within reach! "Most breastfed babies will never take a bottle from the mother," says Dr. Boyd. "So dad or another close caregiver will need to train baby to feed from bottle."

Get help. If you're still struggling to get baby to take both bottle and breast, get help from a lactation consultant or La Leche League at 877-4-LA-LECHE.

What's your biggest struggle with breastfeeding or bottle-feeding?


Image via Andresr/shutterstock

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