Nipple confusion was a real enough threat circulating in stories among the womenfolk I knew, that I made my sister write on my baby shower invites, “No bottles, pacifiers or rubber nipples of any sort.” Maybe I was just a little bit paranoid but I knew that I wanted to breastfeed. This week we want to demystify nipple confusion and talk about what causes it, how to prevent it and how to remedy it if it happens to your baby. (photo of my daughter and me taken by Shawndra Buemi)
How it Happens
Nipple confusion (also called nipple preference) happens because according to La Leche League International (LLLI), “Breast and bottle feeding require different oral-motor skills.”
When suckling at the breast, a baby will draw the soft tissue of the nipple to his or her soft palate of the mouth and then use his or her tongue to extract the milk. When feeding from a bottle, a baby will use mainly his or her mouth to extract the milk. Think of how you get soda through a straw or water from a sports bottle. It’s basically the same for a baby drinking from a bottle. If a baby is introduced to the rubber nipple before he or she masters the breast, the baby may then imprint upon the rubber nipple because it is considered a “super stimulus” according to the LLLI. If this happens then a baby may try to use the bottle technique when feeding at the breast. Thus creating “nipple confusion.”
The same thing can happen when an infant is given a pacifier too soon. Remember that pacifiers are a mom-substitute, meant to be used when mom is unavailable for soothing at the breast. The suckling motor skills are the same no matter if for food or comfort so the rubber nipple on a pacifier will still contribute to nipple confusion.
The American Academy of Pediatrics recommends in their publication Ten Steps to Support Parents’ Choice to Breastfeed Their Baby (linked at the end of this blog) that artificial nipples (including pacifiers)be discouraged until breastfeeding is well established - at the earliest one-month of age.
Identifying the Problem
The most common indicator is when baby doesn’t seem to be nursing effectively. Mom's nipples get sore and the baby's weight starts to drop. Your breasts will feel engorged and eventually your supply will diminish in response to what your body determines as less demand.
What if you follow all the rules and then it happens? Maybe you go back to work and are pumping for your caregiver and BAM! Baby prefers the bottle to Mom. Sigh. It happens. The opposite happens too sometimes and that is also worrisome. When I went back to work, my daughter refused to eat until I got home. She wanted no part of any other method. If your baby does start to prefer the bottle and you’re not quite ready to give up breastfeeding, first identify your support. Many times your pediatrician will start urging you to supplement with formula if your milk supply has dwindled or the baby isn’t successfully extracting the milk. If this is not what you want to see happen then seek out a supportive lactation professional. Get back to square one with you and your baby. Do this when your baby is hungry but not starving. You want him or her to be motivated to eat but not frustrated and in need RIGHT NOW.
Sometimes it helps to get a head start so the milk is already flowing and the baby doesn’t have to be patient for the “letdown” to happen. You can do this manually or with a pump. Then, when you’re at a slow drip, encourage your baby to latch on.
And relax, if you’re tense and worried, your baby will pick up on that. Whatever happens, or doesn't happen, you and your baby will be okay. Focus on that.
Vanderbilt Health Illustration
Bonnie Jean Feldkamp is a writer and mother of two who lives in Louisville, KY