4 Myths About Nipple Confusion, How To Avoid It and When To Get Help

Lots of breastfeeding (chestfeeding) parents choose to introduce a bottle, whether it’s for medical care or when they inevitably return to work.

But drinking milk from a breast versus a bottle requires different skills. Many babies have no trouble mastering those skills and easily switch between breast and bottle. But for some, going back and forth disrupts their feeding routine — what some people call “nipple confusion.”

Heidi Szugye, DO, pediatrician and breastfeeding specialist, says the term “nipple confusion” can itself be confusing. “When babies are having trouble breastfeeding or bottle-feeding, people may call it nipple confusion,” she notes. “But there could be other things going on.”

Dr. Szugye shares four nipple confusion myths, prevention tips and when to seek help.

Myths about nipple confusion

In general, nipple confusion is when a baby has problems switching between a breast and a bottle. Signs of nipple confusion might include:

• Difficulty breastfeeding after exposure to a bottle.
• Difficulty bottle-feeding after being breastfed.

But for parents and even healthcare providers, there’s a lot of uncertainty around nipple confusion.

Myth 1: Babies are confused

Babies can’t talk, so it’s impossible to know if they’re actually confused. It may be more of a preference, says Dr. Szugye.

For example, bottle-feeding requires less coordination. The flow is faster and comes out right away (no wait time for your milk to let down). Your baby may quickly figure out that they prefer the path of least resistance.

But some babies prefer breastfeeding. Maybe it’s the comfort of being close to you, the relaxed pace or just a habit. But when offered a bottle, they refuse.

Myth 2: Nipple confusion is unrelated to other breastfeeding problems

Nipple confusion can be a too-simple explanation for a more complex situation. When there are breastfeeding issues, it’s important to look at the big picture, advises Dr. Szugye. What you think is nipple confusion could be related to common problems, such as:

• Low milk production.
• Nipple pain.
• Poor latching.

And often, these issues are connected. For example, nipple pain can be a sign of a poor latch. If you’re in pain, it’s natural to want to use a bottle to give yourself some relief. Then, your baby gets used to the faster flow of a bottle and has trouble going back to the breast.

“In this case, you need to get at the root of the problem, which is the poor latch,” explains Dr. Szugye.

Myth 3: Nipple confusion is a formal diagnosis

“Nipple confusion” isn’t an official term healthcare providers use to diagnose breastfeeding problems. In fact, only about half of pediatricians believe that frequent bottle-feeding causes nipple confusion.

“I work with parents and infants all the time who are having a hard time breastfeeding or bottle-feeding or going back and forth,” shares Dr. Szugye. “It doesn’t matter what we call it — the aim is to help families reach their feeding goals.”

Myth 4: Pacifiers cause nipple confusion

Pacifiers have several advantages. They can soothe a fussy baby and are associated with a reduced risk of sudden infant death syndrome (SIDS). As far as the research goes, there’s no clear link between pacifier use and nipple confusion.

But Dr. Szugye recommends waiting until breastfeeding is well established before introducing a pacifier. Babies feed often in the first few weeks. A pacifier can mask signs of hunger. If you introduce a pacifier too soon, you may not recognize when your baby needs to eat.

Tips for preventing nipple confusion

If you’re looking to improve your baby’s ability to breastfeed, these strategies can help:

Wait to introduce a bottle

When possible, it’s best to hold off on bottle-feeding until you’ve established a solid breastfeeding routine. If you need to supplement with formula during the early weeks, talk to your provider about using a spoon, syringe, feeding cup or bottle with a slow-flow nipple in a paced fashion. This way, your baby doesn’t get used to a “different” nipple.

A supplemental nursing system, which simulates breastfeeding, is also an option that allows you to use a tube attached to your nipple to deliver liquid to your baby. Using this approach allows for chest-to-chest feeding, improves bonding and helps redirect your baby back to your nipple over time.

Use paced bottle-feeding

Paced bottle-feeding encourages your baby to eat more slowly like they would during breastfeeding. To practice this technique:

• Use a slow-flow nipple.
• Position your baby so they’re semi-upright.
• Allow your baby to open their mouth and latch on to the bottle.
• Hold the bottle horizontally to the floor.
• When your baby stops sucking, lower the bottle for a few seconds to give them a break.

The flow rates from “slow-flow” nipples vary, so you may have to try a few different brands. If your baby is choking or spitting up after feeding, the flow is probably too high. If your baby seems frustrated or falls asleep, the flow may be too low.

“My rule of thumb is to aim for a feeding rate of about 1 ounce every five minutes,” recommends Dr. Szugye.

Don’t wait until your baby is ‘hangry’

Getting a frantic, hungry baby to latch onto your breast is next to impossible — regardless of whether they’re experiencing nipple confusion. Feeding at the first signs of hunger can avoid this stressful situation.

But if you do find yourself trying to feed a hangry baby, try calming them down first so they can focus on breastfeeding:

• Offer a finger, pacifier or bottle for a short time, then switch them to your breast.
• Place them skin-to-skin.

Get your milk flowing

With a bottle, your baby starts feeding right away. When they go back to the breast, the let-down might take a few minutes. If you find your baby getting frustrated, try hand-expressing some milk before breastfeeding to get your milk flow started.

A note on nipple shields

A nipple shield is a thin, silicone device that fits over your nipple and areola (darker skin around your nipple). A hole in the nipple shield allows milk to flow through a focused point during breastfeeding. If your baby is used to the texture of the nipple on a bottle, parents sometimes think a nipple shield can help them transition back to the breast. However, nipple shields are rarely helpful in these scenarios and aren’t a good long-term solution.

“Nipple shields can decrease the transfer of milk from your breast, affecting your milk supply,” cautions Dr. Szugye. “We recommend pumping while using nipple shields and working closely with a lactation specialist to wean your baby off them as soon as possible if they are necessary for latching your baby.”

When to get help

Lots of parents and babies need help with breastfeeding. And the earlier you get it, the better your breastfeeding experience will be.

“People think there’s a one-size-fits-all approach to breastfeeding. But each situation is different,” reassures Dr. Szugye.

If you’re having issues, let your provider or lactation consultant know sooner than later. They can help pinpoint what’s wrong and offer solutions that can make life easier for you and your baby.