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 delivers 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/flow preference, please email 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 developed a flow preference 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 she wants to nurse, even if you and everyone around you thinks she 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.