Nipple Confusion Research Paper

You may have heard the term “nipple confusion,” but do you know what it really means and, more importantly, how to avoid it? Nipple confusion is a term used to describe many breastfeeding situations, but the most common usage refers to babies that have trouble latching and feeding at the breast after they have received a bottle.

How Nipple Confusion Happens

Both bottle-feeding and breastfeeding are learned skills for your baby. Because most babies do better mastering one thing at a time, it’s best to wait several weeks before offering a bottle to your breastfed baby.

Ultrasound studies verify that babies’ sucking patterns and mouth movements are different when they breastfeed compared to when they bottle-feed. During breastfeeding, babies need to create strong suction to draw out milk from the breast. Breastfeeding infants control the flow of milk and will pause to swallow and breathe. On the other hand, when infants drink from a bottle with a traditional nipple, they receive a more continuous flow of milk which is caused by gravity and the nipple opening.

When babies are exposed to both types of feeding, some will have trouble transitioning from breast to bottle and then back to breast again.

There’s no way of telling in advance which babies will have a problem with nipple confusion, so it’s best to wait to give your baby a bottle of your milk until after breastfeeding is well established (usually about 4 weeks). Full-term infants generally get plenty of milk directly from mom’s breast, and as long as your baby is healthy and gaining weight, there’s really no reason to introduce a bottle at first. Besides, pumping and bottle-feeding create unnecessary, extra work while you’re spending time bonding with your baby and recovering from childbirth.

 

Going Back to Work + Avoiding Nipple Confusion

Sometimes nipple confusion occurs in an older baby who had been breastfeeding successfully when mom returns to work or school. If mom’s milk supply is lower due to lack of stimulation during separations, the baby may begin to prefer the quick, easy flow of the bottle. The key to reversing this situation is to boost the mom’s milk supply. Mothers also can gently re-focus on the breastfeeding relationship by nursing more often when home with baby and cutting back on the number of optional bottles.

Another type of nipple confusion can happen when a baby refuses to accept a bottle and only wants to feed at the breast. This can be frustrating for moms who are trying to plan for time away from baby. If your baby simply loves to breastfeed but won’t take a bottle, try offering a bottle in a very low-key way by keeping practice sessions playful. Reassure your baby often, and stop trying whenever baby seems stressed. By continuing to offer small tastes from the bottle, baby will soon get the idea that breast milk can come from another container. Some babies will not accept a bottle from mom, but will accept a bottle from a family member or babysitter. Tips for selecting and introducing a bottle to your breastfed baby >>

Note that there are also alternative feeding methods that don’t involve a bottle. For example, some older babies prefer to drink pumped milk from a cup (with or without a straw). They may never need to use a bottle at all.

 

What to Do if Your Baby is Nipple Confused

Reach out to a Lactation Consultant. Lactation Consultants are trained experts in breastfeeding, latching baby to the breast, healthy bottle-feeding, and solving breastfeeding problems. They can help guide you and help you and your baby continue to enjoy a successful breastfeeding journey. Search for a Lactation Consultant near you >> 

If your baby is experiencing nipple confusion, it might also help to:

  • Increase skin-to-skin contact time.
  • Use a nipple shield to help coax baby to the breast.
  • Use a feeding device such as the Supplemental Nursing System (SNS) to provide increased milk flow, which allows for supplementation at the breast and helps baby learn to breastfeed.
  • Protect and maintain your breast milk supply by increasing breastfeeding or pumping sessions.

To support breastfeeding babies that need to take a bottle, Medela has developed Calma, a research-based feeding system. With Calma, milk flows only when your baby creates a vacuum, which allows your baby to take more time to swallow and breathe, similar to their feeding behavior at the breast. Ultrasound studies of babies feeding with Calma show that they use the same feeding motions used when breastfeeding.

Have you experienced trouble with nipple confusion? Share your story with us in the comments below.

Healthy babies are born with a vital survival skill—the instinct to breastfeed. Interfering with this instinct in the early days and weeks of a baby’s life can lead to problems. Many a mother has noticed a change in her baby’s sucking patterns after introducing a bottle or dummy. Her baby may struggle and cry, find it difficult to latch on, or simply nurse ineffectively at the breast. These changes in sucking patterns and breast refusal are often referred to as nipple confusion.

If your baby has developed problems latching on, your concern now is how to get him back to the breast. Luckily, it is still possible to encourage him to breastfeed successfully again.

Dealing with engorgement
Try reverse pressure softening
Maintaining milk production
Coping with distress
Nursing strike?
Avoiding nipple confusion
If a supplement is needed
Returning to work
Helping a baby to nurse
Breast compressions may also help
A firmer feel
A deeper latch may be needed

Dealing with engorgement

If your baby is not latching on effectively you may experience engorgement, which makes it harder for him to latch on and breastfeed. Gently hand express a little milk before feeding to soften the areola. If you choose to use a breast pump, set it to minimum suction.

Try reverse pressure softening

  • Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola. The pressure moves fluids away from the nipple area, making it easier for a baby to latch on well.
  • You can also press with the sides of your fingers. Place your thumb on one side of the nipple and two fingers on the other side where your baby’s lips will be.

Maintaining milk production

Express your milk if your baby is not breastfeeding well. Express as often as your baby would normally nurse to maintain your milk production. This will also provide milk for your baby until he returns to breastfeeding.

Coping with distress

It can be hard if the very activity that soothes a baby—nursing—is a source of frustration or distress. You may feel that there’s nothing you can do to help or wonder whether your little one will ever nurse well again. However, with the right encouragement, most babies do breastfeed happily again. In the meantime offer lots of carrying and close contact.

To calm your baby, you can:

  • Sing or talk calmly.
  • Hold him against your shoulder or in a sling if he doesn’t like to be held in a nursing position.
  • Keep the environment peaceful.
  • Take a walk outside or a relaxing warm bath together.  Keeping calm yourself
  • Deal with the challenge one feed at a time.
  • Reduce outside commitments and do minimal household chores to give yourself time to concentrate on your baby.
  • Make yourself comfortable as you try to breastfeed.
  • Express milk to feed to your baby and to maintain milk production. The hormone oxytocin, which you produce when you do this, can be calming.
  • Use relaxation techniques such as massages, relaxing music, warm baths, subdued lighting and the breathing exercises taught for labour.
  • Enlist your partner’s support. He has the important role of taking care of you both.

Nursing strike?

When an older baby or toddler suddenly refuses to breastfeed it is known as a nursing strike. Sometimes overuse of bottles and teats can contribute to the problem, but more often this is due to discomfort while nursing, perhaps because of teething or illness, or an unpleasant experience that your baby associates with nursing. 

Avoiding nipple confusion

Avoid giving bottles and dummies – It is perfectly possible to breastfeed without ever using bottles or dummies. A baby who gets used to the firm shape of a bottle teat and the rapid flow it provides before breastfeeding has been established, can find it difficult to nurse effectively when switched back to the breast. If you do decide to use a bottle, use it only once breastfeedinis going well. To avoid using a dummy, encourage your baby to satisfy his need to suck by nursing at the breast.

If a supplement is needed

In the early weeks if your baby is unable to breastfeed or needs a supplement until he is nursing well, your expressed milk can be offered by spoon, cup or syringe. Or, ask an LLL Leader about using a nursing supplementer to give extra milk as your baby nurses at the breast.

Returning to work

If you plan to give your baby bottles when you return to work, wait to introduce them until shortly before your return date. A baby who accepts bottles early on may still refuse them as he gets older—so introducing a bottle weeks before you return to work isn’t necessarily helpful.  When Mum Can’t Be There has more information on alternative feeding methods.

Helping baby nurse

Babies are ‘hard-wired’ to breastfeed so it’s almost always possible to get back to breastfeeding using one or more of the following strategies. Your role is to calm your baby, give him access to the breast and follow his cues. It’s your baby’s job to feed.

Make breastfeeding pleasant


Handle your baby gently when trying to feed and minimize distractions. Allow him to take the breast at his own pace to help him relax and feel in control. You’ll want your baby to associate being at the breast with pleasure. Pushing him onto the breast can have the opposite effect—he may instinctively fight against it.

Close body contact

Full body contact with you can trigger your baby’s instinct to breastfeed and help him get a deeper latch onto the breast. As you recline, try letting your baby lie upon you so that his whole front is against you and he is supported by your body. In this position babies often start to suck, and may even attach and feed in their sleep. Watch for early feeding cues—bobbing his head or making sucking motions—and gently encourage feeding. Spend as much time like this as you can—it can be done skin-to-skin if you wish.

Many mothers find sleeping in close contact helps—a baby may take the breast when sleepy but not when wide awake. Taking a long warm deep bath together may also encourage your baby to relax, latch and feed well. You’ll need help to do this safely.

A faster flow

Swallowing encourages sucking, which will help keep milk flowing. A baby who has become used to a continuous fast flow from a bottle may need help to persist at the breast. Your milk production may also have dipped a little without you realising. If needed, you could hand express a little to get the flow going before your baby latches on. Use breast compression to encourage him to continue drinking. Then switch sides to stimulate further let downs. Switch sides several times if necessary

  1. Cup your hand around your breast. Wait until your baby stops swallowing regularly.
  2. Now compress your breast to increase milk flow. Hold it squeezed whilst he continues to swallow.
  3. Then release, rotate your hand and repeat. Do this on both sides or even switch back and forth to keep your baby actively feeding.

Talk to an LLL Leader about using a nursing supplementer. This device delivers extra milk through a tube along your breast as your baby nurses, avoiding the need for bottles.

A firmer feel

If improving attachment and increasing milk flow are not enough, a nipple shield may help provide a firmer feel for your baby. A nipple shield is a thin, silicone teat that can be placed over a mother’s nipple during breastfeeding. Holes in the tip allow milk to flow into the baby’s mouth. While a nipple shield can be a useful tool in some situations it should be regarded as only a temporary solution—a transition towards breastfeeding.

Nipple shields come in different sizes—a comfortable fit is very important. A good latch-on is essential with a nipple shield to make sure your baby gets plenty of milk. If your baby latches onto just the tip, he will compress your nipple causing pain. See Nipple Shields or contact an LLL Leader for more information on using these effectively.

A deeper latch

If your baby has become used to bottles or dummies he may need encouragement to latch on with a wide-open mouth.

  • Rest comfortably with your breast in its natural position.
  • Position your baby ‘nose to nipple’, so he has to open wide to latch on. Make adjustments as your baby grows in length, so he can comfortably adopt this position. His ear, shoulder and hip should be in line.
  • If you need to support your breast, keep your fingers well away from the areola. Cup your breast by placing your hand with your thumb on one side of the areola, fingers on the other. When your fingers are parallel with your baby’s lips, you can shape your breast to match the oval of your baby’s mouth.
  • Pull your baby’s whole body close against yours. Make sure his head is free to tip back so his jaw can drop freely.
  • Once he opens his mouth wide, quickly roll your breast into his mouth and onto his tongue. Aim his lower jaw as far from the base of your nipple as possible.
  • As the breast lands on his tongue, it pushes his lower jaw open wider, resulting in a bigger and better mouthful of breast.
  • Your nipple is the last part of the breast to enter his mouth. When the nipple reaches the back of his mouth this triggers active sucking.

Sometimes just a small adjustment to the way you hold your baby makes a difference. An LLL Leader can provide you with personalized suggestions.

Time and patience may be needed

A baby’s behaviour can change very quickly, especially in response to gentle repetition, so do persist. With time and patience, most babies will breastfeed well once more. In the meantime, hand express or pump your milk to ensure you still make plenty of milk.

Seek support

Support is invaluable when you are experiencing difficulties with breastfeeding.
An LLL Leader will have experience with helping mothers and be a sympathetic listener when you need to share your feelings and find a solution. You will also find support from your local LLL Group meetings.

Written by Sue Upstone, Karen Butler and mothers of LLLGB.

Further Reading
The Womanly Art of Breastfeeding. LLLI, London: Pinter & Martin, 2010

Dummies and Breastfeeding
Engorged Breasts – avoiding and treating
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won’t Breastfeed
Nipple Shields
Nursing Supplementers
Positioning & Attachment
Safe Sleep and the Breastfed Baby
When Mum Can’t Be There

This information is available to buy in printed form from our shop

Copyright LLLGb 2016

Filed Under: Breastfeeding information, Common ConcernsTagged With: bottles, Crying, cups, latch, milk flow, nipple confusion, nipple shields, refusal, teats

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