Posted on

Nipple Confusion and its solution

If anyone deserves a break, it’s a nursing mom! Your desire to have your little one take breast milk from a bottle every now and again so that you can get out of the house and go for a much-needed walk (or at least take a shower or a nap) is completely understandable. But are you worried that your little one won’t take to the bottle easily? Heard one too many “nipple confusion” sagas from friends and lactation specialists? Or has that theory been discounted by your paediatrician and your mother-in-law, leaving you more confused than ever?

What is nipple confusion during breastfeeding?

Nipple confusion is when babies who are used to sucking from bottles have a hard time getting back on the breast. They may have difficulty latching on and may protest the different size or texture. Nipple confusion sometimes occurs in young infants who are breastfed, given both a bottle and a pacifier within a few days of birth. Sucking on a breast, a bottle and a pacifier all require different sucking techniques. Young infants can become confused about which sucking technique to use for which kind of nipple.

A hungry infant who has difficulty sucking becomes quickly frustrated, making feeding your baby difficult and frustrating both for you and your child.  While not all young infants suffer from nipple confusion, enough do that it poses a real problem for many new parents.

Is nipple confusion real?

Most babies have no problem switching from breast to bottle and back again. Others, particularly those who take a little longer perfecting the art of suckling at the breast, do find it hard to transition from breast to bottle, and then back to the breast. This is why most experts agree that you should wait until your newborn gets the hang of breastfeeding (about three weeks) before you break out the bottle.

If breastfeeding hasn’t hit its groove by the three-week mark, wait a little longer before introducing the bottle.

Why do you need to hold off before you switch off? If you don’t wait until your baby has perfected her breastfeeding skill, there’s a risk she’ll give up breastfeeding sooner than you’d like.

Does your baby know the difference between breast and bottle?

Newborns catch on pretty quickly they don’t have to work nearly as hard to get milk from a bottle with a rubber (or silicone) nipple as from your breast. To breastfeed, your baby needs to master the fine art of taking your nipple far back into her mouth and then using her tongue to pump out the milk (which can take a minute or so before it starts flowing). With a tilted bottle, a baby has gravity on her side: She can suck with her lips and get all the milk she wants right away. So the baby suffering from nipple confusion may not be befuddled so much as opinionated. She prefers the bottle. And why wouldn’t she? It’s the quicker, easier route to a full belly.

The main reason for developing nipple confusion for bottle-feeding

The main reason for nipple confusion is just simply the fact that bottle feeding for a breastfed baby is completely different from natural breastfeeding. Regardless of what’s in the bottle, it is all about “your breast vs the bottle”, in which your baby has to suck in 2 different ways.

Additionally, the difference in:

  • Mouth muscles used while sucking from the breast are more than in the baby bottle.
  • His tongue moving differently in each situation.
  • The elasticity of breast skin vs the bottle teat.
  • The milk flow rate from the breast and the baby bottle

Nipple confusion can result at the end of breastfeeding and is a big issue.


Usually, breastfeeding mothers face the nipple confusion issue when they tend to pump/express breastmilk before returning to work or study.

Here are the measures you should take to avoid and fix nipple confusion during mixing between breast and bottle feeding.

When to introduce the bottle

Give breast-only feeding the recommended three weeks for your milk supply to get well established and for your newborn to really master the technique, and then feel free to give yourself that longed-for break.

Tips for introducing the bottle

Some babies take to bottle-feeding right away, others protest. If you’ve got a stubborn bottle feeder on your hands, be ready to offer a choice of formula, nipple sizes and style, and formula-feeding times until he decides which one he prefers. If your baby baulks at breast or bottle, here’s a game plan for handling that nipple confusion (or preference!):

What to do if your baby won’t take a bottle

Go back to square one. Revisit the basics of latching on and remind your baby how soothing breastfeeding can be by cuddling her skin-to-skin. It may require a few sessions of fumbling at the breast before she gets back on track, but it’ll be worth it!

Make it easier. Get your milk flowing (either manually or by pumping your breast milk) before your baby starts to eat, so she doesn’t have to work that hard for the milk. (Just pump enough to get things dripping; you’re not looking to fill a bottle just yet.)

Time it right. She should be in the mood for a meal (aka hungry) so she’s motivated to give it a try…but not so famished that she can’t get her baby brain around relearning an old trick. If she’s starving, she may not have the patience to latch on or suck hard enough to get the milk she wants—and that might lead to a full-blown frenzy of frustration, which can throw both of you off track.

Back off on the faux nipples. If the whole switching process has given your baby a bad case of nipple confusion, just stick with breastfeeding till she’s got it down solid. (This means you’ll need to put away the pacifiers too, just in case she’s gotten too fond of sucking for satisfaction with her lips.)

What to do if your baby prefers breastfeeding

Let Daddy do the feeding. Sometimes a baby is just too attached to Mom’s nipple, so hitting the bottle while Mom is so close by (yet buttoned-up) seems wrong. But it may be a different story if someone else is bringing on the bottle — whether it’s Dad, Grandma, or your best pal. But don’t worry that you’ll always need a Mommy stand-in at feeding time — once your wee one gets the hang of the bottle, she won’t care who gives it to her!

Try different nipples types. If one nipple doesn’t succeed, try, try another one. Just watch the flow rate. The milk should come out fast enough that your baby doesn’t get frustrated…but not so fast that she can’t keep up with the flow. A drop a second when you turn the bottle upside-down is just right.

Make bottle feeding as much like breastfeeding as you can. Interact with your baby. Switch arms halfway through so she has something different to look at. Burp her. But remember that while some newborns want bottle feeding to be just like breastfeeding, others take to it better if the experience is completely different. So if that’s the case with yours, try a different location or even a different position.

To avoid nipple confusion

  • No bottle introduction or pacifier during the first month
  • Avoid giving your breastfed baby a pacifier
  • Start introducing the bottle 3 weeks before work to give him a space to learn the new skill

How to fix nipple confusion?

You can do that by decreasing the gap as much as you can between breast and bottle. The whole idea of how to fix nipple confusion is to mimic the natural process of breastfeeding.

While you try to introduce the artificial nipple, do your best to decrease the difference between the natural nipple of you and the synthetic bottle nipple.

Breastfed baby breast refusal may be due to the type of bottle

The ordinary classic baby bottle has 2 huge disadvantages with regards to nipple confusion:

  1. It is light in weight
  2. It has a narrow/small bottle nipple.

And for that, it is much easier for your breastfed baby to get his milk from the regular bottle rather than your heavy, wide breast. By the time, he would prefer this small/light nipple rather than your breast. So, it is far from your heavy, wide breast nipple.

How to fix that?

Pick a wide base baby bottle that has a wide nipple to mimic the size of your breast. Also, the wide neck bottles are closer to your breast regarding their weight. And remember that your breast is like a heavy sandwich for your breastfed baby to latch on to it.

Nipple confusion makes your baby refusing the breast due to the flow rate

Breast milk ejection from the breast is a time-consuming process. This process is mediated through the lactation hormones, Oxytocin and Prolactin. Your breastfed baby may take around 2 mins to receive the breast milk during natural breastfeeding.

However, the milk comes easily and quickly in the case of bottle-feeding.

How to fix that issue?

Try to choose the slow flow rate teat to make the process slower. On the fast flow bottle nipple teat, it may make it easier for your baby to get choked.

Another way to mimic the slow milk rate of breastfeeding is to apply pauses while bottle-feeding. Don’t let your baby latch on to the bottle for the whole 10 mins of feeding, as gravity makes the milk flow faster from the bottle compared to the breast. 

So, what to do instead?

During bottle feeding, you can control the flow by making pauses every 2 minutes for 10 seconds.  These pauses will stretch the time needed to finish the milk from the bottle.

By doing that, you mimic breastfeeding sessions’ duration and flow rate. This lets your baby switch between both ways of feeding without feeling a huge difference.

Did your breastfed baby latch onto the bottle properly?

Your baby having a good latch during breastfeeding is crucial for a successful breastfeeding journey.  After latching onto your breast deeply,  he should do so on the bottle as well. A shallow latch on the bottle is a probable cause of nipple confusion.

What is the solution for a bottle shallow latch?

Simply, ensure that your baby is catching the wide base of the bottle rather than the tip. Like what happens in the normal latching process while breastfeeding, where your baby is catching the most of your areola within his mouth.

How to achieve that?

First, you should stimulate your breastfed newborn for the wide mouth opening. This could be done by raising the bottle at a higher level than his mouth.

Then hit his nose with the tip of the baby bottle tip.

Naturally, he would widen his mouth opening to catch the bottle nipple.

The second step is to pick the widest mouth opening and insert gently and deeply the bottle. You can control this process by grabbing your baby’s head using your hand.

How to balance breastfeeding and bottle-feeding

Bottle or breastfeeding doesn’t have to be an all-or-nothing choice. By spacing out feedings, finding a formula baby likes almost as much as mom’s breast milk, and making sure nursing time includes lots of skin-on-skin bonding, you’ll be able to enjoy the flexibility of both.