Nipple Confusion is a Myth

There is so much that the world puts onto new mothers, including the pressure to breastfeed their babies. Unfortunately, women do not often find adequate support for breastfeeding and often turn to the internet to answer their questions. 

Nipple confusion is a term that is used to describe when a breastfeeding baby has been exposed to artificial nipples, and now refuses to go back to the breast. While this term might seem straight forward, babies are not confused by using different nipples. Flow preference rather than nipple preference is more likely the cause of this problem.

Even though nipple confusion is not the correct term, there is such a thing as a breastfeeding baby who refuses to go back to the breast after bottle feeding. Between bottle feeding, pacifier use and the use of the nipple shield, there are times when artificial nipples are useful to a breastfeeding mother and her baby. 

However, there are times when they can cause some problems. It is my job to teach you the difference.

Read on and learn the truth about nipple confusion. 

Pacifier Use

A baby’s natural instinct is to suck. This behavior is comforting to them in a variety of ways and helps to regulate their nervous system. Ideally, in the early days of life, a breastfeeding baby should be finding comfort in suckling at the breast. This ensures that mom’s milk supply comes in well. It also ensures that the baby gets enough breast milk to sustain their growth and development. Lastly, it helps you to reach your goal of exclusive breastfeeding more readily.

For the first few weeks of breastfeeding, frequent feeding at the breast helps to establish hormone receptors and increases milk volume to reach a full supply. If you substitute a pacifier for this time at the breast, it can interfere with this process.

As a new mother, I know that you are exhausted. Sometimes, it is tempting to put the pacifier in the baby’s mouth and go back to sleep instead of continuing to work on breastfeeding. It takes a while to get the hang of breastfeeding and it can be frustrating at first. For this reason, I recommend that you do your best to wait on the use of the pacifier until after your milk supply is established. 

Will using the pacifier every once in a while harm your breastfeeding relationship?

Certainly not, but just make sure that you are continuing to offer your breastfed baby frequent feedings at the breast in those first few weeks of life. Early on, we recommend at least 8-12 feedings per day in order to establish your supply and nourish your baby.

Bottle Feeding

If you have been instructed to supplement your baby in the early days of life due to weight loss, for sure you may need to offer the bottle. However, if your baby is doing well at the breast and gaining weight as expected, my advice is to wait to introduce the bottle until after the first one to two months of life.

While bottle feeding either formula or breast milk is not bad, babies can quickly develop a flow preference. They would much prefer the faster flow of milk coming out of the bottle than the work that it takes to remove milk from the breast. Of course, not all babies are the same. Some go back and forth between the two just fine while others struggle. 

However, there are ways that you can help your baby to prefer breastfeeding over bottle feeding.

1. Pace the bottle feeding: Hold your baby in a semi-upright position. Allow the baby to suck on the empty nipple for a moment and then tip the bottle up to allow a flow of milk. Remove the bottle from the baby’s mouth every few minutes and allow them to pause. In addition, use the smallest nipple opening that the baby can tolerate. A slow-flow nipple is adequate for most babies. The type of baby bottle is less important than the size of the nipple opening.
2. Use alternative feeding methods for supplemental feeding: Instead of introducing the bottle, you can feed supplements through different techniques. Cup feeding, syringe feeding and/or finger feeding are all acceptable methods to supplement small volumes to a newborn baby.
3. Feed physiological amounts of supplement: Understand what volumes that you should expect your baby to take at different ages and don’t supplement more than that amount. If you need a guide for that, download my free breastfeeding math guide. 

Use of the Nipple Shield 

While the nipple shield is not traditionally thought of as something that causes nipple confusion, I would like to put it in this category. Many women find the nipple shield to be very useful in their breastfeeding journey. It is a tool that helps women to breastfeed who have “flat” nipples or nipples that don’t easily evert with stimulation. Others find it useful to help preterm infants to be able to get onto the breast. Still others use a nipple shield to prevent or relieve sore nipples. Even as a pediatrician, when I was first nursing my own baby, I found it to be a very useful tool myself.

However, it is important to note that this tool has some drawbacks and consequences that you need to be aware of before you use it. 

1. Interrupts the skin to skin connection: That flesh on flesh connection between the baby’s mouth and the mom’s nipple is necessary for breastfeeding. It helps to send signals to the brain that increase hormone levels. It also sends signals to the milk ducts and leads to greater milk production. A piece of silicone between mom and baby can disturb this process.
2. Easy for babies to cheat: Even though the nipple shield is not the same shape as a bottle nipple, it can be very easy for babies to just suck on the end of the shield. While the end is bobbing in and out of their mouth, they are not transferring milk from the breast. This shallow latch not only leaves a hungry baby, but also decreases your milk supply over time.

In conclusion, nipple shields can be useful tools for the breastfeeding mother. However, be aware of the risks and benefits of their use.

Ignore Outside Pressure

Sometimes new moms will want to bottle feed or supplement their new baby because they don’t understand what normal breastfeeding looks like. You may also feel pressure from outside sources that cause you to doubt that breastfeeding is good enough.

It is important to know what the breastfeeding expectations are for the first few weeks of life. This will enable you to have confidence in your breastfeeding efficacy. Therefore you can ignore the comments from well-meaning family members who think that you should give your baby a bottle.

Breastfeeding Expectations

When your baby is born, they have a certain birth weight. Over the next several days of life, your baby will lose weight. We expect newborn weight loss for both breastfeeding and formula feeding babies.

Learn more about breastfeeding expectations for the first 24 hours of life

– Dr. Andrea wadley

After this initial weight loss, a baby’s weight should start to stabilize before they reach 1 week of life. Subsequently, the baby will regain their birth weight by 2 weeks old. After 2 weeks of age, babies should gain 20-30 grams per day on average for the first 3 months of life.

Initially, your breasts will produce small amounts of colostrum in the first 48 hours of your baby’s life. Most women produce one ounce of colostrum in an entire day for the first two days. Your baby may cluster feed during this time before your milk comes in.

As you continue to breastfeed your newborn frequently, your milk will increase around 72 hours postpartum. When this happens, you will have lots of milk. When the baby nurses, they will take in larger volumes of milk with each feeding.

Breastfeeding moms may experience engorgement when their milk initially increases or comes in. Over the following few days, if you are exclusively feeding your baby at the breast, your milk will down regulate to meet your baby’s needs.

How Can 127 Pediatrics Help Your Breastfeeding Journey?

At 127 Pediatrics, we believe that all mothers should have the tools that they need in order to make the best decisions for their baby’s health. Whether you choose to exclusively breastfeed or choose partial breastfeeding, we want to help you meet your goals for your breastfeeding duration. As a breastfeeding medicine physician and pediatrician, Dr. Wadley believes that starts with a solid foundation of evidence based breastfeeding information.

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© 127 Pediatrics, June 2024

This article is for information purposes only. Please consult your personal physician for medical advice.