Originally published on February 11, 2014; Revised August 27, 2024
Author: Robin Kaplan, M.Ed, IBCLC, FNC
The short answer is “we don’t know”. There is so much information out there about nipple confusion. Some will tell you that if anything other than a breast *touches* your baby’s mouth, he’ll never want to breastfeed again. Others will regale you with stories about how their exclusively breastfed baby had bottles! cups! pacifiers! in the first few hours of life and had no problem switching back to breast. Each baby and situation is different. It’s never a given that your baby will, or will not, develop nipple confusion if he/she has a bottle before breastfeeding has been successfully established.
ABOUT SDBFC
The San Diego Breastfeeding Center was established in 2009 by Robin Kaplan, International Board Certified Lactation Consultant, Functional Nutritionist, and parent. Her vision was to create a judgment-free, inclusive support system for families navigating infant feeding challenges.
SDBFC offers a wide range of one-on-one breastfeeding, infant feeding, and nutrition consultations - as well as classes, support groups, online articles, and social media - making it your one-stop-shop for all things infant feeding!
What is Nipple Confusion?
Bottle nipples and breast nipples have a very different feel to the baby, so sometimes when babies are used to one and they are introduced the other, it can seem confusing. You can help to prevent this by choosing a bottle nipple with a sloped, wide base rather than a small, thin, long nipple. This will help the baby to continue to open his/her mouth widely while feeding, which is what we want him/her to do while at the chest/breast. However - it is often a “flow preference”, rather than nipple confusion, that can cause a baby to have a difficult time switching from bottle to chest/breast. Even the “slow flow” bottles the nurses use in the hospital flow much faster than the breast, especially during those first few days when milk volume is low. Plus, even with those “slow flow” bottles, the baby doesn’t have to work very hard to get the milk to flow into his/her mouth. When the bottle is tipped, the milk often just pours into his/her mouth. At the chest/breast, the baby has to suck for a while to elicit the “letdown” of milk, and then throughout the feeding is only rewarded when he/she sucks at the breast. With a bottle, the milk pours into his/her mouth whether he/she’s sucking or not. These babies are smart! They learn very quickly that with one form of feeding, they don’t have to work as hard.
How Can I Avoid Flow Preference?
The easiest way to avoid flow preference is to only feed your baby at chest/breast until breastfeeding has been established, baby is back to his/her birth weight, and has gone through his/her first growth spurt that occurs around 2-3 weeks of life. However, there are many different situations when it may be necessary or appropriate for a baby to fed in an alternative way during those first few weeks of life. Some of these situations may include: premature babies who haven’t developed the suck, swallow, breath pattern yet; birth complications that force parent and baby to be separated for some period of time; anatomical challenges that prevent the baby from being able to latch on properly (tongue/lip ties); or sometimes parent’s preference - damaged nipples, etc. If you do feed your baby another way, there are things you can do to avoid the possibility of your baby developing a flow preference, or preferring an alternative feeding method. If your baby is able to latch comfortably, one option is to supplement at the chest/breast using a tube and syringe, and to either deliver the supplement very slowly and only when baby is actively sucking, or allow the baby to pull the supplement on his/her own. This helps the baby to continue to associate the breast with food, as well as ensuring baby has to work for the flow. If you do bottle feed, you can pace the bottle feeding so that it simulates a feeding at the breast - I’ll discuss this in greater detail in the next paragraph.
What if I Need/Want to Give my Brand New Baby a Bottle?
If a baby does receive a bottle, there are some things you can do to help prevent a flow preference from developing. The most important thing to realize is that there really isn’t a truly “slow flow” nipple, and that most bottles are the same, even the ones that claim to be designed for a nursing baby. It’s not so much the bottle you choose, but the method you use to feed the baby. Baby should be fed in a paced manner, so that the length and pace of the feeding mimics a breastfeeding session. The amazing online breastfeeding resource, KellyMom, has a great article on how to properly bottlefeed a breastfed baby - http://kellymom.com/bf/pumpingmoms/feeding-tools/bottle-feeding/. Another great resource regarding bottle/breastfeeding is www.breastandbottlefeeding.com. Both sites contain a great amount of information on “nipple confusion” and flow preference and how to avoid them.
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Ashley’s Success Story
As an IBCLC, I work with a lot of moms trying to get their babies back to breast after being fed via bottle. I’m always excited to share my own story to give them some hope and let them know that it is possible to transition a baby who is exclusively bottle fed to a baby who exclusively breastfeeds! My first child was born in New York City, in the fall of 2007. The hospital I delivered at had two lactation consultants on staff, but the one who was scheduled to work the day my daughter was born was in a car accident and not able to come in. So I fed my baby with an incorrect latch for a day and a half. By the time the lactation consultant arrived on the day we were being discharged, my nipples were cracked and bleeding. I was in extreme pain and every feeding brought bouts of panic and anxiety with it. Looking back, I realize that she had a lip tie and that may have been causing the painful latch. I chose to pump for a few days to allow my nipples to heal, and found that pumping and bottle feeding caused much less stress. So I exclusively pumped for my daughter for 4 months.
Exclusive pumping is hard work! You’re basically doing double feedings - by feeding the pump, then feeding your baby. Plus with the constant washing of pump parts, I felt like I was chained to the house every three hours so that I could pump to maintain my supply. On the flip side, there were benefits to it as well. My husband could feed the baby and I was able to get out of the house early on to do things like laundry. :) However, I always felt like I was missing out on a HUGE piece of those early months with my baby. I’d always assumed I’d breastfeed exclusively, and felt like a failure that I wasn’t. I kept trying periodically, but my baby would often cry at the breast and I would get frustrated easily and give up, assuming it would never happen. But I kept trying, and finally, at 4.5 months, she was latching regularly and I was able to put away the pump! She nursed until 14 months old, and I’d never felt such pride or accomplishment about anything before. I use this story to encourage moms that just because their babies aren’t latching RIGHT NOW, that doesn’t mean that they won’t later.
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About the Author
Robin Kaplan has been an IBCLC since 2009, the same year that she opened up the San Diego Breastfeeding Center. Robin was the founding host of the Boob Group podcast and published her first book, Latch: a Handbook for Breastfeeding with Confidence at Every Stage in 2018. Melding her passions for supporting lactating parents and holistic health, Robin finished her Functional Nutrition Certification in 2023. In her free time, she enjoys hanging out with her two teenage boys, hiking, traveling, weaving, cooking, and searching for the best chai latte.
Did you know that lactation consultants not only help with breastfeeding, but can also help with bottle feeding? It’s true! We are here to offer guidance with all aspects of feeding (introducing solids, as well!) and know a ton about bottles and how to balance them with breastfeeding.