Breastfeeding Help: Nipple Confusion

Nipple confusion is a common reason for breastfeeding failure. It most often plagues newborns, but can occur at any time throughout the breastfeeding relationship. Following are the causes of nipple confusion, ways to prevent it, and what to do if it happens to you and your baby.

What is nipple confusion?

Nipple confusion is characterized by a reluctance or refusal to nurse at the breast. Perhaps it should more rightly be called "nipple preference." The baby is not confused; he just learns to prefer artificial nipples instead of the real thing. Nipple confusion is especially common in newborns who have been introduced to a bottle or pacifier, but it can also occur in older babies when bottles or pacifiers are used too frequently. Nipple confusion can cause baby to go on a nursing strike, which can impact the mother's milk supply and, if not properly handled, signal the end of the breastfeeding relationship.

How can nipple confusion be prevented?

The best way to prevent nipple confusion is to avoid mom substitutes. This means no pacifiers and no bottles. The first six weeks after birth are crucial, so artificial nipples should be avoided at all costs during this time. If for some reason artificial feeding is necessary during the first six weeks, try using a bottle with a slow-flow nipple. Better yet, try feeding baby with a small cup or syringe.

Nipple shields can also cause nipple confusion. There are circumstances in which a nipple shield may be necessary, but if possible, nipple shields should be avoided.

Can nipple confusion be corrected?

Nipple confusion can be corrected, but it can take some work. The first step is to get rid of all nipple substitutes - put away bottles and pacifiers. Better yet, get them out of the house altogether.

Offer the breast when baby is calm, such as right after a good nap or first thing in the morning. Some babies are adept at "dream feeding," in which the breast is offered while baby is asleep. This dream feeding can help correct nipple confusion. Offer plenty of skin-to-skin contact, and carry baby in a sling or wrap between feedings so that she can smell your milk. Review proper latching techniques to ensure that baby will get the most out of nursing. You may even want to pump or hand express a little breastmilk before nursing to stimulate letdown. If baby doesn't have to work so hard to get the milk, she is more likely to remember how nice it is to nurse from mom.

For more information on nipple confusion, talk to a lactation consultant, or see the links at the end of this article.

**This is one of a series of articles about common breastfeeding problems. To see the rest of the series and other articles by this writer, please click on the picture of the baby's bottom, at the top of the article beside the author's name. **