Is Your Baby Experiencing Nipple Confusion?

By: Sabrina Granniss, IBCLC

5 min

Overview

Common signs of nipple preference Breastfeeding vs. Bottles Why it matters Reasons feeding may be hard for your baby What you can do to get feeding off to a good start What about better bottle feeding?

Nipple confusion, also called nipple preference, is a broad term to describe when a baby has difficulty adapting when switching back and forth between feeding directly at the breast and a bottle. Your baby may show different signs at the bottle or breast because of the nipple confusion. It can be frustrating for mom and baby, making feeding seem harder. How a baby feeds from a bottle differs from direct breastfeeding. You can use many strategies to help your baby overcome nipple preference, allowing your baby ease of feeding at both.

Common signs of nipple preference

Fusses or cries when you bring them to your breast
Arches their back or turn away from you when you try to feed at your breast
Don’t open their mouth wide
Tongue thrusts or pushes the nipple out of their mouth
Seems frustrated quickly if milk flow is slower
Refuses to nurse and will only take a bottle

When feeding challenges begin in the first few days after birth, many moms are given a nipple shield to help with feeding while in the hospital. The shield may help get a baby to latch at the breast, but it shouldn’t be given as a long-term solution. It doesn’t address why your baby has difficulty latching and removing milk.

Breastfeeding vs. Bottles

The way a baby gets milk at the breast is different from the bottle. It is also important to consider your involvement in each feeding method. You and your baby each have different jobs for successful feeding. How your baby behaves during initiating the latching process and while feeding gives us information about what might be going on and why your baby may be showing a nipple preference.

Breastfeeding

Requires a wide open mouth (gape)
Uses the jaw and tongue muscles to remove milk
The back portion of the tongue moves in a peristaltic or wave-like motion (1)
Resting position of the tongue between sucks is closer to the roof of the mouth indenting on the nipple

Bottle Feeding

Fast flow of milk, which is not dependent on the baby’s sucking
Requires less work from the jaw, face, and tongue muscles
Tongue moves in a piston-like or squeezing motion (1)
A shallow gape can still result in your baby getting milk
Encourages tongue thrust
Resting position of the tongue between sucks is lower in the mouth, with the bottle nipple indenting the tongue

Why it matters

A baby is born to breastfeed. They do not need to learn it; rather, they need to have access to the mother’s breast and be able to move their whole body, arms, and legs as they find their way to the areola and nipple to begin to nurse. After your baby is born and put directly on your belly, they will begin a series of movements that are all driven by reflexes. A reflex happens automatically when it is stimulated. For example, if you are startled, you jump. If someone blows air in your face, you automatically blink. It just happens and is not a reaction done by choice.

Reasons feeding may be hard for your baby

They may have been in a position that strained some of their muscles while in utero.
The birth may have caused them to be uncomfortable in certain positions.
Do they have oral restrictions limiting their ability to open their mouth wide or use the full range of motion of their tongue?
Maybe they have tension in the body that is causing discomfort when they are positioned at the breast.

What you can do to get feeding off to a good start

Practice skin-to-skin with your baby - when your baby is skin-to-skin, they can be close to their source of food. They are able to regulate more easily and organize better for more successful feeding.
Wait to introduce bottle nipples or pacifiers - early introduction can interfere with your milk supply and their feeding cues. If your baby is sucking on a pacifier, early feeding cues get missed, and feeding is delayed.
Avoid swaddles - swaddling restricts your baby’s body from moving and expressing their reflexes. This can make feeding much more challenging and may even cause tension to develop.
Early feeding cues - get in a comfortable position to feed your baby as soon as they show the first signs of readiness to breastfeed. Their eyes may still be shut. Look for them licking their lips, turning their head side-to-side, or moving their hands to their mouth. This is the time to put them on your body near your breast. Waiting longer or until they cry is a late feeding cue, and they will not be as organized and coordinated to feed. It is similar to when you pay attention and eat when you are hungry. You make more sensible choices and eat calmly, versus when you are super hungry, you grab whatever is closest and eat faster.
Infant massage - helping your baby relax can help ease tension and make it easier for them to nurse.
If needed, use an alternative supplement method - a supplemental nursing system right at the breast, cup feed, syringe, or spoon feed.

What about better bottle feeding?

Always pace bottle feed - this feeding method allows your baby to more actively feed and slows down the feeding to avoid overfeeding. Paced feeding in a side-lying position is preferred over your baby being held in an upright, seated position to pace feed.
Use a bottle nipple that is gradually sloped from nipple to base
If you need to give a bottle because of feeding difficulties, always finish feeding at the breast

How your baby is or is not able to feed paints a picture. It gives us information about what is easy and what is hard for them. If they are showing nipple preference or nipple confusion, contact your IBCLC (International Board Certified Lactation Consultant) to help investigate how you can help them be more comfortable, able to use all their feeding reflexes and muscles well, which will make feeding at bottle and breast better as well as build a strong foundation for the rest of their growth and development.

Nipple confusion can be a frustrating hurdle. It occurs when babies struggle to switch between breastfeeding and bottle feeding. Understanding the mechanics of breastfeeding versus bottle feeding and utilizing strategies like skin-to-skin contact, avoiding the early introduction of bottle nipples or pacifiers, and practicing paced bottle feeding can help your baby overcome nipple preference. Remember, seeking support from an IBCLC can provide valuable guidance in creating a comfortable and successful feeding experience for you and your baby, building a solid foundation for their growth and development.