How to Avoid Nipple Confusion for the Breastfed Baby

How to Avoid Nipple Confusion for the Breastfed Baby

If a breastfed baby is given a bottle during the first few weeks while he is still learning how to breastfeed, “nipple confusion” can occur. A nipple-confused baby may have difficulty latching or may try to use a bottle-feeding type of suck on the breast. The type of suck used for bottle-feeding will not be effective in getting milk from the breast and may irritate mom’s nipples.

Differences in the way a baby sucks on the breast vs. a bottle

  • To latch to the breast, baby must open his mouth widely. A baby does not need to open wide to suck on a bottle.
  • When sucking on the breast, baby’s tongue makes a wave-like motion; it begins at the tip of the tongue and moves toward the back. The tongue compresses the breast against the roof of the mouth. A bottle fed baby uses his tongue differently and may lift the back of his tongue to stop the flow of milk and protect his airway.
  • If a breastfed baby needs a rest, he simply quits sucking and the milk flow slows. Milk may flow from a bottle even when baby is not sucking, forcing baby to continue feeding without a break.


Signs of nipple confusion

  • The following is a classic sign of nipple confusion: Baby’s open mouth is near the breast but he moves his head back and forth as though he is unable to find the nipple. The baby is looking for something longer and firmer than the mother’s nipple.
  • This can be very frustrating for both mom and baby!


Helping a ‘nipple confused’ baby return to the breast

  • Snuggle baby skin to skin (baby in just a diaper against your bare skin.) This helps to calm baby and tap into to his natural instincts.
  • Make a ‘ledge’ or ‘sandwich’ of breast tissue when latching. This can help baby to feel something firm against his tongue.
  • Attempt when baby is calm. If he is particularly hungry and frustrated, you may need to feed him a bit from a dropper, spoon or bottle to calm him before reattempting.
  • In some difficult cases, a nipple shield may used to help coax baby back to the breast.

If you are struggling, consult with an International Board Certified Lactation Consultant or someone skilled in helping women with breastfeeding.


How to prevent nipple confusion

Every baby is different. Some babies develop nipple confusion after one bottle. Others may develop it after several bottles. Still others may go back and forth from bottle to breast with little difficulty.

  • Avoid all artificial nipples for the first 3 to 6 weeks. This gives baby time to practice proper breastfeeding sucking patterns.
  • If and when you do introduce a bottle, choose a slow flow nipple. Babies can become hooked on the fast flow of bottles and may become frustrated when the milk flow from the breast is not as rapid. Different brands use different words to refer to their slowest flow nipples: ‘slow flow’, ‘0+months’, ‘newborn’ etc. There is no research to suggest that any one brand is best. (Some have very clever marketing information on their packaging. Beware! Just because a brand claims to be ‘most like mother’ or ‘best for breastfed babies’ does not mean it is!) For more information on choosing a bottle and nipple, see this excellent post by The Leaky Boob.
  • Be sure to coax baby to open wide before putting the bottle in his mouth.

If at all possible, try not to use a bottle every day. Offering a bottle every day may lead to decreased milk supply.

Pregnant and not sure how to prepare? Download our FREE ebook: 5 Crucial Ways to Prepare for Breastfeeding.


Other posts you may enjoy: Is it Okay to Give a Breastfed Baby a Pacifier? and Baby Prefers One Breast.


thumbnail-cindy-and-janaCindy and Jana are Registered Nurses and International Board Certified Lactation Consultants who have assisted over 20,000 families.



Comments (7)

  1. CP says:

    My baby has not had a bottle yet, but I was given a nipple shield in the first couple days. Without any guidance on positioning or latching to help with getting him on the breast. I hadn’t seen one before and foolishly I accepted the shield. It most definitely caused nipple confusion in my baby. He attaches to the shield like a bottle, not a breast. He doesn’t open wide and he hates to stay on my breast (he usually stays on the shield). Nipple shields may have their place, and I’m sure they make a good transition from bottle to breast, but as a first-line attempt to help a breastfeeding mom, it’s a terrible idea. It reduced my milk supply as well, because he was much less efficient at getting milk out with the shield as from the breast directly. I’ve had a lot of trouble weaning him from the shield. I feel like it prolonged the learning phase for my baby.

    • cindyandjana says:

      Thank you for sharing your story. You have worked hard to breastfeed your baby! An International Board Certified Lactation Consultant should be able to help you. Let us know (through the “Get in Touch” link) if you need help in finding one.

  2. PJ says:

    My baby is 5 months old now and now she is totally depended my bottle feed instead of mother feed. Is there any way by which I can move back to mother instead of bottle feed??

    If yes, then pls guide me the way with few examples.

    Your early reply on this will be highly appreciated.

    • cindyandjana says:

      Thanks for reaching out with this question. Yes, it is possible to return to breastfeeding. The most important things are:
      Keep time near the breast pleasant. (Snuggle lots skin-to-skin. Bathe with her.) Try bottle feeding against your bare breast. Part way through the bottle, gently try offering the breast. Offer the breast when she is sleepy
      Keep up your milk supply ( or increase your milk supply if it is low. You can read about how to do this here.)
      You can find more tips in this excellent article by KellyMom: Help — My Baby Won’t Nurse!
      If you need more specific guidance, feel free to email me through the “Get in Touch” button on our website.

  3. Katherine says:

    My baby is a weeks old. I had a hard time in the beginning to breastfeed because it hurt my nipples too bad, but I still did anyways. After my milk came in it seemed harder for her to latch on and my milk just pours out and I figured well maybe my areola is to hard for her to stay on. Well I used a pump it helped relax them to and softer them up and she latched on a couple times, yay. 2 nights ago we stayed up for 3 hours trying to get her to feed but she refused and so I figured we take a break try again. Well the break didn’t help and I got scared and gave her milk in a bottle type medicine dropped and she drank that. I tried again after she woke up to feed but she only stayed on the tip of my nipple, without it actually being in her mouth and sucked on the milk that was just dripping out because my letdown. Well I got worried ahe wasn’t getting enough milk because she only wetted 3 diapers and soiled 2 and it wasn’t a big poop and changed in consistency. Someone suggested giving her a pacifier yo see if it would help her suck and well it didn’t and now all she is doing is just placing her lips on my nipple and sucking on the letdown. I’m worried that something may be wrong. Did I mess up giving her the medicine bottle and pacifier or is it something else

    • cindyandjana says:

      Hello Katherine,
      I am sorry that you are struggling. You did not ‘mess up’! The first weeks of breastfeeding are the hardest. It will get easier.
      If your baby is having trouble latching because your breasts are too full, have a look at this post: Try lots of skin to skin snuggling.
      Is there an IBCLC or La Leche League group in your area? It would be beneficial to meet with someone in-person to get assistance.
      P.S. Contact me using the ‘Get In Touch’ button on this website if you need a more details.

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