Dealing with Nipple Confusion (Flow Preference)
The term "nipple confusion" is a bit of a misnomer. The baby who
exhibits the behavior often called nipple confusion is really not confused
at all! He knows exactly what he wants - the nipple that produced the
most milk with the least effort - and, therefore, this behavior should
more accurately be called "flow preference". No matter what it's called,
though, it can be extremely frustrating for the mother-baby dyad who are
trying to successfully combine breastfeeding and bottle-feeding (of her
expressed breastmilk or artificial baby milk).
This is a list I've compiled from my own experiences and from e-mail
from other breastfeeding moms over the past few years. If you have other
suggestions to offer for dealing with nipple confusion, please e-mail me
- When putting a reluctant baby to the breast, try to relax as much as
possible. Baby often senses his mother's tension and responds with tension
of his own.
- Remember, most babies with nipple confusion can usually be coaxed back
into nursing in a day or two.
- When my son became nipple confused after only a couple of days using
bottles at his caregiver's, I "tricked" him into taking the breast. First of
all, I held him in the cradle hold as if I were going to nurse, but I put a
pacifier in his mouth. After he had sucked on the pacifier a few times, I
pulled it from his mouth and placed my nipple close to his face. He rooted
around and latched on. I had to do this a few times before he sucked enough
to get my milk to let down. Once it started flowing, he nursed
enthusiastically. I had to use this method several evenings in a row until
he figured out that he could get Mommy milk from *either* a bottle or my
breast. I don't know exactly how it worked, but my logic was that he would
realize that all artificial nipples didn't bring him milk and that there was
milk in Mommy's breasts.
- Many babies will get frustrated at the breast because the milk doesn't
start to flow immediately. Try expressing some milk onto your nipples and
onto baby's lips as you hold him in the nursing position.
- Try pumping or expressing some milk from your breast first so that baby
gets milk immediately when he latches on. Massage or warm compresses
on your breasts prior to nursing may also help your milk let down and
flow more promptly.
- Make sure the nipples on your baby's bottles are the slow-flow variety
so that he won't get accustomed to having his bottled breastmilk (or
formula) coming out in such big gulps.
- Try offering the breast when baby isn't particularly hungry. He might
have more patience and continue sucking until the milk lets down.
- Limit your baby's exposure to artificial nipples for nourishment or
comfort. This includes pacifiers! PLEASE NOTE: You may hear disparaging
remarks about comfort nursing. Some uninformed person may wrongly tell
you that your baby is using your breasts as a "human pacifier". In
reality, plastic pacifiers are being used by the baby (and parents) to
substitute for the human nipple. Don't fall for that kind of wrong-headed
thinking! Nurse your baby any time s/he wants to nurse, even if you and
everyone around you thinks s/he can't *possibly* be hungry. There are
hungers that do not originate in the digestive system, after all.
- Try nursing the baby when he is sleepy. Sometimes a sleepy baby
"forgets" that he prefers those artificial nipples and ends up latching on
and sucking happily. This is one of the most effective methods to get a
reluctant nurser to latch on, from what I've heard from other moms.
- Sleep with your baby with your breasts uncovered. Keep your baby's
face close to your chest. Your baby can smell you and your milk, and this
may inspire him to latch on.
- During the day, too, to the extent possible, hold your baby on your lap
with his face near your bare breasts. Get as much skin-to-skin contact as
the temperature in your house will allow.
- Get in a warm bath with baby for lots of good skin-to-skin contact.
Baby might relax more fully and latch on without even remembering that he
has previously rejected that idea!
- If your baby still refuses the breast, pump your milk and feed to
baby. You must pump to keep your supply up if baby will not nurse. If you
have to do this, use a cup, spoon, or syringe. Put the milk just at your
baby's lips and let her or him do the rest of the work. If you use a
bottle instead, you will only exacerbate the nipple confusion.
- Call a lactation consultant or your local La Leche League leader if
the problem persists more than a few days.
Breastfeeding and the Working
© 1998 Cecilia Mitchell Miller, unless
otherwise specified. All rights reserved.