Breast, Pacifier, or Bottle: How to Avoid Nipple Confusion

Nipple confusion: what does it mean?

For parents of a breastfed infant, nipple confusion is like a myth looming overhead. Blamed for almost every difficulty—especially for complicating or even ending breastfeeding—it could occur when a bottle is introduced, or rarely when offering a pacifier. So-called "confused" babies would then refuse to keep nursing at the breast and accept only the bottle.

In reality, from a physiological perspective, the link between bottle use and breastfeeding disruption has never been scientifically established. Nipple confusion actually seems to originate in a baby's difficulty latching onto the breast, which may make a bottle more appealing. Therefore, the term "confusion" is actually rather ill-suited to the phenomenon.

How can I tell if my baby is experiencing nipple confusion?

Identifying nipple confusion is not easy. It is first and foremost a matter of identifying a sucking disorder in an infant, baby, or very young child. In practice, what adults call "nipple confusion" can appear in children in several ways.

• Baby gets frustrated while nursing, cries, or seems to refuse breastfeeding altogether.
• He or she can no longer latch properly, repeatedly latching and unlatching, or pinching the breast, which might be painful.

These reactions can also be signs of GERD (gastroesophageal reflux disease), infant colic, pain, or hidden discomfort. If simply observing your baby does not point you in the right direction, consult your primary care physician or pediatrician. If you are unfamiliar with them, you can also meet the Association of Lactation Consultants for more guidance.

Could it all just be about milk flow?

Because drinking from a bottle and nursing at the breast are two very different experiences—just as some babies prefer breastmilk to infant formula—others might develop a preference for the faster flow from a bottle. This can happen, for example, if milk production is moderate. Even with effort, baby receives less milk from the breast than from a bottle and may therefore prefer the bottle.

Nipple confusion: what causes it?

The cause of nipple confusion is unique to each baby, their birth, and their story. However, the most common causes are not directly linked to the introduction of a bottle nipple, but rather to:

• a lack of tongue mobility caused by a physical restriction, often in the upper lip area,
•  Tension developed during pregnancy or birth that causes stiffness in the tongue, mouth, or even the head,
• a coordination issue with sucking and swallowing,
•  prematurity of the baby,
•  decreased breastmilk production, etc.

Nipple confusion: what are the consequences?

Sucking: an essential role for babies

Among the primitive reflexes present at birth is sucking. Developed in the womb, this ability supports newborn feeding, helps babies relax, and serves many other purposes.

• With every feeding, the sucking motion changes intracranial pressure, which helps shape the baby’s skull since their bones (including temporal, sphenoid, and ethmoid bones) are not yet fused at birth. The palate also develops to ensure proper teeth alignment and the development of airways.
• Sucking also supports the growth of the jawbones and many facial muscles, which influences part of the baby's overall facial structure.
• When a baby nurses, they must breathe through their nose. This type of breathing best oxygenates the brain and activates the vagal system, which promotes relaxation.

Solutions for your baby

Getting back to breastfeeding basics

Once the source of confusion is identified, don’t hesitate to restart breastfeeding from the beginning (or almost). Offer the breast frequently to your child, day and night, but don’t force it. You can also gently compress your breast to increase milk flow, and do so in a calm place, one-on-one with your baby.

Consider alternatives to the bottle

Not everyone knows it, but there are several ways to feed milk to a baby. Depending on the child’s age, these methods vary in their accessibility and popularity.

• The Lactation Aid Device (LAD) helps avoid the use of bottle nipples.
• The oral syringe squirts milk directly into baby’s mouth from the sides.
• The soft cup, spoon, or cup-bottle lets older babies suck in milk. Because their need to suck isn’t completely satisfied this way, returning to the breast is often made easier.
• A glass or cup, used in a sitting position from 6 months old.

Update the bottle/nipple combo 

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