Nipple confusion, also called nipple preference, is a broad term to describe when a baby is having a hard time adapting when they switch back and forth between feeding directly at the breast and a bottle.
Common signs of nipple preference
- Fusses or cries when you bring them to your breast
- Arches their back or turns away from you when you try to feed at your breast
- Doesn’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 parents are given a nipple shield to help with feeding while they are in the hospital. This may help get a baby to latch at the chest but is not a long-term solution. It doesn’t address why your baby is having a hard time latching and removing milk.
Breast vs. Bottles
The way a baby gets milk at the breast is different from bottle feeding. It is also important to look at how you are involved in each method of feeding. 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 for what might be going on and why your baby may be showing a nipple preference.
- Requires a wide-open gape
- Uses the jaw and tongue muscles to remove milk
- 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
- 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)
- Shallow gape still results 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 parent's chest and be able to move their whole body, arms, and legs as they find their way to the parent’s nipple to begin to nurse. After your baby is born and they are 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 expressing your startle reflex. If someone blows air in your face, you automatically blink. It just happens and is not done by choice.
What if that doesn’t happen like that for your baby?
- They may have been in a position that puts a strain on some of their muscles while in utero.
- Do they have oral restrictions limiting their ability to open 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 chest
What can you do to help
- Practice skin-to-skin with your baby - when your baby is skin-to-skin they can be close to their source of food. They can regulate 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 delayed.
- Don’t swaddle - swaddling restricts your baby’s body from expressing the reflexes used during feeding. This can make feeding much harder and may even cause tension to develop.
- Early feeding cues - get in 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 chest. Waiting longer or until they cry is a late feeding cue and they will not be as organized to feed. It is like if you pay attention and eat when you are hungry, you probably 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.
- Use an alternative way to supplement if needed - use a supplemental nursing system right at the chest, cup feed or syringe, or spoon-feed
What about better bottle feeding?
- Always pace bottle feed - this method of feeding allows your baby to more actively feed and slows down the feeding to avoid overfeeding.
- 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 on your chest
How your baby is or is not able to feed tells us a story. 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 to help investigate how you can make them 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.