Nipple confusion

Feeding from a bottle, or any other artificial nipples or teats, requires a different sucking technique to the one your baby uses to breastfeed. As a result, it’s possible that introducing these will result in your baby becoming ‘confused’, and leave them struggling to latch onto your breast to feed¹.

When breastfeeding, your baby has to open their mouth wide in order to latch on and suck from your nipple. In fact, breastfeeding involves your baby using a combination of their jaw, mouth and tongue to enable them to get milk from your breast². When bottle feeding however, your baby doesn’t need to put in as much effort, and can get a constant flow of milk from the bottle. This is something that can further enhance nipple confusion.

If you’ve chosen to combination feed or bottle feed your baby, the paced feeding technique can be helpful. It mimics the way your baby would breastfeed, and allows them to control the flow of milk. You can read more about paced bottle feeding here.

There are a number of signs that could indicate that your baby is experiencing nipple confusion. These include your baby³:

• Thrusting their tongue upwards whilst sucking on your nipple. This can lead to your baby pushing your nipple out of their mouth and failing to latch.
• Not opening their mouth wide enough to latch onto your breast, which can lead to your nipples becoming sore and your baby taking in less breast milk.
• Becoming fussy and unsettled during their feed. It’s possible that your baby will become frustrated when they find that their milk isn't instantly available due to nipple confusion, and there might be a delay in milk flow.  

A very simple way to avoid nipple confusion is to wait until breastfeeding is fully established before introducing bottle feeding, dummies or any other artificial teat into your baby’s routine.

There’s no exact time frame when it comes to how long it will take to establish breastfeeding, but it can take several weeks⁴. Once you and your baby feel comfortable and confident with breastfeeding, you may want to introduce a bottle for some of your baby’s feeds.

Paced bottle feeding may help to avoid nipple confusion, as it mimics the way a breastfed baby feeds, potentially making the transition between breast and bottle a little smoother. Choosing the right kind of teat may also go some way to avoiding nipple confusion. Teats that have a shorter nipple and a wider base hold more milk horizontally without the bottle being tipped, and can be better suited to paced bottle feeding⁵.

In order to continue breastfeeding and maintain or increase your breast milk supply, you can also try:

• Holding your baby close and practicing skin to skin when you feed them. Not only will this help your baby to feed, it will also help to increase your milk supply. 
• Putting your baby to the breast on a regular basis. 
• Expressing your breast milk regularly. 

If you need any further advice or support with breastfeeding, your midwife, health visitor or a lactation consultant will be able to help. 

In addition to the suggestions we’ve given above, there are a number of techniques that you can use to ensure a smoother transition between breastfeeding and bottle feeding.

In the first instance, be sure to introduce the bottle into your baby’s feeding routine gradually, and wait until breastfeeding is fully established. This can go some way to reducing the risk of nipple confusion, and avoiding your baby preferring to feed from the bottle rather than breast. This gradual introduction can also help to maintain and support your breast milk supply, as introducing a bottle can impact on the amount of milk that you produce⁴.

When giving your baby a bottle for the first time, keep in mind that it may take them a little while to get used to the bottle nipple and different sucking action. Try paced bottle feeding, which mimics breastfeeding and involves touching the bottle teat to your baby’s upper lip, encouraging them to draw it into their mouth.

Other things you can try include⁴:

• Offering your baby a bottle when they’re content and settled, as they’re more likely to respond. You might want to try offering the bottle after a breastfeed for example. 
• Holding your baby upright as you feed them and looking into their eyes. This can support the bonding process between you and your baby and help them to feel calm and secure. 
• Staying consistent. For example, decide which of your baby’s feeds will be done by bottle, and try to stick to this each day.

If you find that your baby is still struggling to latch on to your breast, and you’re worried about the impact of nipple confusion on your baby’s feeding journey, always seek advice from your midwife or health visitor. They may recommend that you speak with a lactation consultant, who can provide you with the advice you need.

Depending on where you live, you may also have the option of going to a breastfeeding cafe. Here you’ll find support with breastfeeding in general, so look at what’s available in your local area.