Nipple Confusion

Dear Lisa,

Is there such thing as nipple confusion when not breastfeeding, if so what is it?

“Nipple Confusion”

Dear “Nipple Confusion”,

The term “Nipple Confusion” refers to the difficulty breastfeeding babies have when they switch back and forth between breastfeeding and bottle feeding. Not only is the look, feel and the texture of the nipple different, but the process of sucking requires different mechanisms for each.

The term, “Nipple Confusion” is not typically used to describe babies that exclusively bottle feed. Although, I have taken care of plenty of babies that get used to one nipple, for example the Evenflow nipple and then refuse a different shaped nipple. The same goes for an infant who becomes used to one particular pacifier.(1) This preference for a certain type of nipple or pacifier can cause the parents a lot of grief. If the particular type of nipple or pacifier is not avialable to the baby, the parents experience difficulty feeding and soothing their child.

This like or dislike for a certain shaped nipple is different from the “Nipple Confusion” that occurs in breastfeeding babies who receive a bottle. A breastfeeding baby needs to suck vigorously, using the cheek muscles to draw the nipple well back into his mouth and against the hard palate in order to get milk. (2) The milk from a bottle on the other hand, flows out much more readily from the nipple with a lot less sucking effort. (2)

The bottle fed baby needs to place the tongue in a different position during a feeding. When bottle feeding the tongue needs to be placed more anteriorly against the tip of the nipple to control the flow of fluid. Some babies cannot make this transition back and forth between breast and bottle and as a result may develop problems breastfeeding. In order to prevent this “nipple confusion” and avoid the risk of a baby refusing the breast it is typically recommended to exclusively breastfeed a baby for the first 6 weeks of life.

It is more difficult for a baby to breastfeed because the milk typically does not come out as readily and the procedure requires more “work”. Formula flows out of the nipple more readily and less effort is needed in order to eat. Many parents and breastfeeding advocates fear that if a baby receives a bottle that they will then refuse breastfeeding because it is more difficult to do.

Many parents find success supplementing their breastfeeding baby with a bottle without encountering “Nipple Confusion”. Supplementing offers the other parent the opportunity to be more involved with the infant’s care and encourages parent infant bonding. For example, a mother may choose the 6 p.m. feeding to be a bottle feeding so that the father can feed the child when he gets home from work. As long as the same feeding time is skipped each day and the schedule is consistent the mother’s system will accommodate and not produce milk at that hour and instead produce milk for the next feeding.

If parents choose to supplement with a bottle they should first make sure that the infant has a successful breastfeeding routine established. Once a mother experiences a regular milk let down and maintains an adequate milk supply; and the baby has the ability to successfully suck from the breast and is gaining weight then the bottle can be introduced. In general a waiting period of 6 weeks to 8 weeks is needed before this can be attempted.

In some scenarios, an infant may need to be introduced to a bottle during the early weeks of life. This can occur when a mother is ill and not able to breastfeed, or if the baby has a medical condition that warrants the introduction of formula or a nipple. When this occurs it is important that mothers do not become discouraged.

If “Nipple Confusion” does occur there are measures that parents and health care professionals can take to deal with the problem. The first step is to remove the artificial nipple. Next the infant should be given the opportunity to go to the mother’s breast at frequent intervals. When the baby is at the breast the baby can be stimulated to develop a stronger suckle. (2) A consultation with a Lactation Consultant or Occupational Therapist can assist in this task. In the majority of cases, the babies accomplish breastfeeding successfully and overcome any problems they may encounter with “Nipple Confusion”.

Premature babies, babies with low muscle tone, babies with facial deformities and babies with oral-motor dysfunction tend to have more difficulties suckling. (1) Therefore parents of babies who fit into these groups should avoid switching feeding and suckling techniques if possible. It is a good idea to stick with the same nipple and pacifier in these situations. In addition, children experiencing these issues can benefit from the expertise of an Occupational therapist who specializes in infant feeding.

References:
(1)Betz C, Hunsberger M, Wright S. Family-Centered Nursing Care of Children. 2nd ed. Philadelphia, PA:W.B.Saunders Company. 1994:583.
(2)Riordan J. A Practical Guide to Breastfeeding. St. Louis Missouri: The C.V. Mosby Company.1983:26,47,218.

Lisa-ann Kelly R.N., P.N.P.,C.
Certified Pediatric Nurse Practitioner

Pediatric Advice About Infant Health