What Is Nipple Confusion? (Plus, Our Expert Advice For Moms)

What is nipple confusion, and how to stop it? We’ll cover all the answers for moms, including expert advice from certified lactation consultant Corky Harvey.

If you’re breastfeeding, you might choose to bottle feed baby your pumped breastmilk for any number of reasons. This opens up a lot more convenience!

For example, it frees you to have your partner, or another caregiver, bottle-feed baby breastmilk while you’re at work (or you’re otherwise away from baby). 

And introducing the bottle also ensures baby is used to the bottle, in case you'd need to supplement your breastfeeding with formula later.

But if bottle feeding breastmilk doesn't seem similar enough to breastfeeding, there’s a risk that your breastfed baby may develop nipple confusion, and only want either the breast or the bottle (not both). 

Fortunately, there are plenty of steps (both proactive and reactive) that you can take to combat this problem.

What is nipple confusion, and how to prevent it? We’ll cover all the answers for moms below, including expert advice from certified lactation consultant Corky Harvey (RN, IBCLC, MS; The Pump Station & Nurtury). 

What is nipple confusion?

Nipple confusion can happen in two ways: 

  • Baby strongly prefers the bottle over the breast
  • Baby will only drink from the breast and won’t take a bottle

The first type of nipple confusion (breast refusal) can occur when your baby starts to have trouble nursing from your breasts after they’ve taken a bottle. They may have trouble latching onto your breast, have difficulty sucking, or may otherwise struggle to get enough milk.  Or, they may simply prefer the bottle over your breast. 

The second type of nipple confusion (bottle refusal) occurs when baby strongly prefers nursing from your breasts, and thus won’t drink from the bottle at all when you offer it. 

Why does nipple confusion happen?

Nipple confusion occurs because the breast and bottle dispense milk in different ways, and feel different --- so much so that baby develops an extremely strong preference for one and rejects the other. 

For example, a bottle might dispense milk more quickly than the breast, and baby might not have to work as hard to suck and remove milk from the bottle (like they must do at the breast). This may lead baby to prefer the “easier” bottle.

A bottle could also cause baby to latch or suck in a way that only works for the bottle (and that isn’t adequate for removing milk from the breast). As a result, baby might give up trying to remove milk from your breasts. 

Alternatively, baby might prefer the comfort and closeness of nursing from your breast – or the feel of the breast compared to the bottle nipple – leading them to reject the bottle. They might also dislike the bottle feeding position you use, because it isn’t as comfortable as breastfeeding. 

In some cases, they might not want to take a bottle when they know you’re nearby, as they wonder why the option they see as “better” (your breast) isn’t being offered.

 11 Tips To Combat Nipple Confusion

Fortunately, there are plenty of ways to help stop nipple confusion, and encourage baby to prefer the breast and bottle equally.

For starters, if you haven't offered the bottle yet, timing the bottle introduction right may make baby more likely to accept it. 

There's no one "perfect" time to introduce it, but introducing the bottle between 3-6  weeks of age --- and after breastfeeding is established ---  makes baby more likely to switch between bottle and breast without issue. 

(Baby could be more likely to reject the bottle if they're 7 weeks or older --- but you can still successfully introduce it after 6 weeks of age.)

And regardless of when you started the bottle, there's plenty more you can do.

The key is to:

  • Make breastfeeding and bottle feeding feel as similar as you can, and...
  • Figure out what baby doesn't like about the breast or bottle feed, if they start to refuse one.

Here’s our list of the top 11 tips for moms – including expert advice from certified lactation consultant Corky Harvey. 

1. Choose the right bottle

As we mentioned above, one key to overcoming nipple confusion (or preventing it in the first place) is to make the breastfeeding and bottle feeding experiences seem as similar as possible.

One way to do this is by choosing a breastfeeding bottle – one designed to closely mimic your breast. 

  • This bottle should have a slower flow to match your own. 
  • It must require baby to put in work to suck the milk out, just like they need to do when breastfeeding. 
  • It should also have a shape and feel that’s similar to your breast, including a breast-like nipple that bends and flexes like your own – and that requires baby to latch on just like they latch onto your breast. 

Check out our previous article for the full details on selecting a bottle, plus our top 5 breastfeeding bottle picks. 

Even if you don't want to select a breastfeeding bottle, choosing a bottle with a slow-flow nipple and anti-colic valve is key.

2. Use the same cues when breastfeeding and bottle-feeding

This insider tip comes from lactation consultant Corky Harvey --- she shared it during our previous breastfeeding Q&A. She advises that using the same “cues,” or routine steps, is another way to make the breastfeeding and bottle feeding experiences similar. Here’s what she recommends:

  • Hold and cuddle baby in the same way you do when breastfeeding. 
    • This includes using the same skin-to-skin contact for breastfeeding and bottle feeding, and making eye contact with baby.
  • Hold a blanket, stuffed animal, or other comfort object during breastfeeding, then hold (or have whoever is offering the bottle hold) that same object during bottle feeding.
  • If you sing a song during breastfeeding, include that same song in your bottle feeding routine.
  • Switch sides when you offer the bottle, just like you switch sides during a nursing session.

If someone else is offering the bottle all or most times, you can also create a “smell” cue so both feeding experiences smell like you. Sleep with a blanket or burp cloth so it smells like you, then have your partner or caregiver wrap it around the bottle when feeding baby.

 

3. Encourage the right latch

Promoting a deep latch on the bottle is essential, so baby doesn't develop a bad latching habit at the breast.

  • Touch or brush against baby's lips with the bottle. 
  • Let baby open the mouth wide to accept the bottle (this is the rooting reflex, which they use to latch onto the breast).

As you offer the bottle, remember --- do not push it. Baby should accept and latch onto the nipple on their own, without being forced. If baby gets too fussy when the bottle is offered, stop and try again later.

4. Balance or rebalance your feeding schedule 

If baby starts to prefer the bottle, try readjusting how many nursing sessions  they have daily relative to bottle feeds.

As Corky Harvey told us before, "Strike a balance between keeping baby familiar with the bottle and maintaining a strong breastfeeding relationship. Offering a bottle approximately 3-4 times a week, and no more than once per day, should maintain this balance." 

Harvey continues,  "If your baby starts to prefer the bottle over the breast, it's best to reduce the number of bottle feedings relative to breastfeeding sessions, or go back to breastfeeding alone until baby breastfeeds normally."

(If you work outside the home, baby should be breastfed as often as possible when you are at home, since they'll be taking bottles at all feeds in your absence).

5. Try paced bottle feeding 

Paced bottle feeding creates a slower bottle feed that gives baby more control over when to start and stop. It also requires baby to put in more effort to access milk from the bottle. So, this bottle feeding experience mimics breastfeeding as closely as possible.

Hear from Christen at Milk Diva Lactation about nipple confusion and paced bottle feeding: 

 During a paced bottle feed, you'll hold baby upright, slowly offer the bottle, and encourage a deep latch. You'll hold the bottle horizontally while tipping it just slightly, so baby will need to work and suck. You'll also encourage baby to take breaks, as well as cue you in to when they are finished.

For a full step-by-step guide to paced bottle feeding, click here.

6. Use different positions

Surprisingly, the most comfortable breastfeeding positions for baby and the most comfortable bottle feeding positions for baby are often different. 

Try these bottle-feeding positions suggested by lactation consultant Corky Harvey:

  • Try holding baby mostly upright, but reclining them a bit.
  • Hold, or have the adult who's feeding baby hold, baby so baby’s back leans on the adult’s chest. This way, baby is free to look around the room.
  • Try seating baby in a stroller or bouncy seat.

(Whichever position you choose, you will need to hold the bottle yourself. NEVER prop a bottle!)

Or, if you're looking for a different breastfeeding position to make baby more comfortable, check out our ultimate guide to breastfeeding positions.

7. Leave the room or house during bottle feeds

Sometimes, baby won't take a bottle when you're around, because they associate you with the comfort of breastfeeding. So, as Harvey recommends, try leaving the room and having someone else offer the bottle. 

If that doesn't work, you might need to leave the house completely for baby to accept the bottle from your partner or another caregiver. If you aren't working outside the home, use this time to run an errand, take a walk,  or even relax in the car.

What if the opposite happens, and baby will only take the bottle from you? Start the bottle feed, then switch to having your partner or caregiver offer the bottle in the middle of the feed. As you continue to do this, leave the room so baby can get used to bottle feeding without you around.

8. Distract your little one during feeds

No matter which way you're feeding baby, a distraction might make them more likely to feed. Try using a mobile or toy, singing or playing music, or gently bouncing or swaying them. You could even walk with them or feed them outside, as suggested by Harvey.

9. Try a new temperature 

Other times, baby's nipple confusion comes down to not liking the bottle's milk temperature. So, don't be afraid to experiment. Often, babies will prefer body temperature milk, because that's the same temperature as when they nurse from the breast. But other babies prefer warmer milk, and others prefer colder milk.

Warming the bottle nipple under warm water may also help. Or, if baby's teething, try chilling the nipple in the fridge just before feeding.

10. Focus on supply if needed

If you've returned to work or are otherwise away from baby for longer, regular periods, your milk supply might drop if you don't take precautions. If this happens, baby might start to prefer the "quicker" bottle over your breast. After all, they've been receiving more bottles anyway.

Remember that you need to pump every time baby gets a bottle, as the emptying of your breasts is what keeps your supply up. Try these tips to increase your supply if needed. And breastfeed as often as you can. You might also consider using a breastfeeding supplementer to encourage baby.

11. Use the "meal-and-snack" method

If baby wants the breast and gets frustrated at the sight of the bottle, give them what they want… sort of.

Offer the breast first, then switch to the bottle for a "snack" if they are still hungry. Or, offer bigger breastfeeding "meals," with smaller bottle feeding "snacks" in between. 

Baby will be less frustrated when you offer their less preferred feeding method when they aren't at their hungriest.

Summing things up for moms

Nipple confusion can be frustrating, but you've got plenty of tips at your disposal. 

Remember to make breastfeeding and bottle feeding feel similar, with the same latch, flow patterns, and cues.

Balance your breastfeeding and bottle-feeding sessions.

When you've figured out what baby doesn't like, switch up your routine.

And remain calm --- don't get frustrated. You've got this!

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