Does your baby prefer the bottle instead of the breast? Here’s how nipple confusion occurs and what you can do about it.

By nature, babies know how to nurse from their mother’s breast from birth. But in the event there’s difficulty in latching on or sucking and they are given a bottle or pacifier before breastfeeding is properly established, they may develop a preference for the bottle instead. This is known as nipple preference or nipple confusion.

It’s common to think that nipple preference happens when a baby finds it’s easier to receive milk from a bottle than his mother’s breast, and then ‘forgets’ how to nurse. But, experts say that breastfeeding is an instinctive process and most babies won’t prefer a bottle to the breast unless they are having trouble getting enough milk from the breast.

How do you know if your baby is not receiving sufficient milk from your breast?

If he is refusing to nurse, your nipples are sore, there’s breast engorgement or your baby’s weight gain slows down – these are all good indication that he has not been feeding well.

Here’s where you need to identify the causes of why your baby isn’t keen on breastfeeding. For many, it’s usually because he’s not he’s not latching on well, or it may be that you don’t have enough milk or are having trouble with letdown. Call your healthcare provider or a lactation consultant for advice.

In the long run, nipple preference can lead to less nursing or ineffective sucking at the breast, which in turn may diminish your milk supply and interferes with the long-term success of breastfeeding.

Nipple preference can also cause you to cut feedings short and offer your baby a bottle, depriving him of the high-calorie, high-fat hindmilk (the milk produced at the end of feedings) that’s so important for growth.

It may be easier to turn to the bottle, especially if your baby is having trouble learning to latch on or suck correctly, or you’re concerned about your milk supply. Before breastfeeding is well established, it’s a good idea to avoid bottles and pacifiers. This said however, pacifiers and bottles can still be used. If your baby is nursing well, the occasional suck on a pacifier can calm your little one when you’re unable to nurse immediately or soothe him when your arms, breasts, and patience are strained. If all is going well with nursing and he’s getting enough milk, then he won’t lose interest in nursing.

If there are difficulties in breastfeeding, get help from lactation experts. While you rectify the issue, you may be advised to express milk to give to your baby in a bottle, for the time being. He or she can show you how to encourage your baby to approach the bottle in the same way as your breast. Generally, your baby should gape his mouth wide open to the bottle teat, with his tongue down and forward. He should do this for every feed.

Signs of Nipple Confusion

• Baby thrusts their tongue upward during sucking and pushes the breast out of the mouth.
• Baby doesn’t open her mouth wide enough and therefore only sucks the tip of the nipple, which can cause nipple pain.
• Baby becomes fussy and irritable because milk does not flow as easily as with a bottle.
• Moms milk supply often decreases because baby does not latch on correctly.
• Baby refuses the breast completely.

Other Types of Nipple Confusion

Separations: Sometimes nipple confusion occurs in an older baby, previously nursing well, whose mother has returned to work or school. If the mother’s milk supply is low due to lack of stimulation during separations, the baby may begin to prefer the quick, easy flow of the bottle.

Rectify it: The key to reversing this situation is to re-stimulate the mother’s milk supply. Mothers also can gently re-focus on the breastfeeding relationship by nursing more often when at home with the baby and cutting back on the number of optional bottles.

Bottle refusal: Another type of nipple confusion refers to a baby who refuses to accept a bottle.

Rectify it: In such situations, offer the bottle in a low-key manner. Keep practice sessions playful. Reassure the baby often, and stop whenever baby seems stressed. By continuing to offer tastes from the bottle, baby will soon get the idea. Some babies will not accept a bottle from the mother, but will accept a bottle from a father or a babysitter.

For those with a nipple-confused baby, here are some ways to cope with the situation:

• Breastfeed your baby when she is calm.
• Pump milk a few minutes before feeding your baby, so that your milk ejection reflex is stimulated and your baby does not have to wait for the milk to start flowing.
• Keep your baby close to you, with skin to skin contact while trying to breastfeed.
• Keep your baby close to your uncovered breast during the night and even the day with a sling.
• Use of a nipple shield can help coax these infants back to the breast.
• Protect breastmilk supply by increased breastfeeding/pumping.