Nipple Confusion
Your happy, healthy, week-old breastfed baby is starting to arch at the breast. She mouths the breast as if she has forgotten how to suck. In a panic, you give more of the supplemental bottles you started on your recovery nurse’s advice. Within a week, your little baby is getting almost all of her nourishment from the bottle.
How did this happen?
It all started with nipple confusion. Understanding this problem starts with understanding the difference between your nipples and an artificial nipple.
The human nipple is an elastic piece of flesh that the baby stretches to fit his mouth. The tip of the nipple sits where the hard and soft palate of the baby’s mouth meet — about an inch back in his mouth! Your baby’s jaw, tongue, and lips work together in a fascinating rhythm to pull milk from the breast.
This same motion doesn’t work when tried on an artificial nipple. Instead, the baby must use her tongue to close off the continuous flow of fluid into her mouth. The jaw doesn’t have to compress the nipple in the same way to receive the fluid. An artificial nipple gives instant gratification; there’s no waiting for let-down here.
When a breastfed baby is given a bottle or pacifier, he re-learns his suck pattern to fit the artificial nipple in his mouth. This can happen over a period of time or even with the first introduction of a bottle or pacifier. Because of the different suck patterns needed for a breast versus a bottle nipple, the baby can become confused and not want to take the breast anymore. After all, the bottle gives instant reward with no work on the baby’s part.
Nipple confusion can be overcome, however. The first step is to wean the baby off of all artificial nipples, including pacifiers and nipple shields. Supplements (be it expressed breast milk or formula) can be given using cups or special feeding syringes or through a Supplemental Nutrition System (SNS) if necessary. Working with lactation professionals in close contact with your baby’s doctor, the baby can be coaxed back to the breast and supplements can be stopped.
Many Mothers returning to work are told to give their baby a bottle right away so she can start getting used to the nipple. While this suggestion is well-intentioned, it can lead to an early weaning. The best time to begin giving a bottle is after breastfeeding is well-established, around 4 to 6 weeks of age. A baby doesn’t need to have a bottle every day to become accustomed to the nipple. Once or twice a week will have the same effect of teaching the baby how to take expressed breast milk from a bottle while still preserving the breastfeeding relationship.
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