Is Your Baby Actually Nipple Confused? Breast Refusal After Bottle
Read time | 7 minutes
"I gave my baby several bottles of expressed breast milk when he first came home from the hospital because he was jaundiced and too sleepy to nurse well. Now, at three days, my milk has come in, and he's not sleepy anymore, but I can't get him to nurse. He takes the bottle fine but cries when I try to breastfeed him. I think he's become nipple confused, and I don't know what to do."
Annie from Breastfeeding Basics answered this exact question (I copied it directly from her post) back in 2017, and I wanted to provide my insight.
Did I come up with this idea because I struggle with coming up with content ideas?
Yes.
Do I understand that this topic has been covered ad nauseam by other lactation consultants?
Also yes.
But if there's one thing I've learned over the years, it's that each lactation provider comes up with their own perspective and way of explaining things, and I hope to shed some updated information on the idea of nipple confusion.
But first, let's take a peek at the key points Anne Smith made in her 2017 post on nipple confusion.
Bottle feeding mechanics differ from breastfeeding mechanics
The risk of nipple confusion is most significant when introducing the bottle/pacifier in the first few days of establishing nursing
Breastfeeding is a learned behavior, and while sucking is reflexive, latching is not
If a baby struggles with going between breast and bottle, there are strategies which may be helpful to include: patience, avoiding artificial nipples, offer the breast frequently and at early hunger cues, elicit a let down by hand expressing/massaging before latching, ensure proper intake, try sleepy time nursing
Babies prefer at-the-breast/chest feeding, but once they get feeding established, they may go between breast and bottle fine
Before tackling the question above, it's worth noting that the idea of nipple confusion itself, is debated.
The concept of nipple confusion implies that babies become confused by introducing artificial teats/nipples and that confusion leads to an inability to feed at the breast.
The language around this phenomenon- babies struggling with breastfeeding after bottle feeding- has changed slightly, with some providers attributing the difficulties to a flow preference.
As Anne mentions in her post, the way a baby feeds at the breast is different than when they breastfeed. Not only are different muscles and suck mechanics used, but the tactile inputs to the oral space alter significantly as well.
One could argue that it's the changes in mechanics, the oral sensations, AND the flow rate of bottles, which results in difficulty.
Read Now: Is Paced Bottle Feeding Really Necessary? to learn more about flow rates of bottles and how it affects feeding safety
I, personally, stay away from any language that implies babies are incapable or incompetent.
In many cases, the babies who struggle with going back and forth do so because of underlying feeding challenges.
Keeping with the idea of avoiding language implying a lack of capabilities- and with a better understanding of feeding mechanics- we know that babies don't have to learn how to latch.
Babies with no underlying medical, physical, or neurological issues can latch perfectly fine immediately postbirth. Like sucking, latching is reflexive in that babies are born with the ability.
That's not to say even parents feeding babies with perfect oral function, absolutely no birth trauma, unmedicated delivery, and excellent mental, physical and neurological states don't have issues.
They can and do.
However, much of the challenges we see are, at a minimum, due in part to interference or disruption of the programmed latching sequence.
I've talked about this before, so I won't bore you here with the science of latching; however, you can hop over and read that post if you're interested.
Read Now: The Science of Latching: learn more about how your baby was literally born to feed!
So If I were answering the question, I would do so as follows:
Dear Shondra...
"I gave my baby several bottles of expressed breast milk when he first came home from the hospital because he was jaundiced and too sleepy to nurse well. Now, at three days, my milk has come in, and he's not sleepy anymore, but I can't get him to nurse. He takes the bottle fine but cries when I try to breastfeed him. I think he's become nipple confused, and I don't know what to do."
Dear ‘wonderful parent I’ve not yet had the pleasure to meet’,
It's never easy to deal with a baby that has difficulties latching. Still, it can be even more overwhelming when your baby refuses to nurse after you've resolved the obvious original issue.
It sounds like you did exactly what you needed to help your little one through the super sleepy phase of jaundice, which can be an absolute pain to navigate.
I understand the concern surrounding nipple confusion - it's a concept that is talked about frequently. The great news is it's unlikely that your baby is confused at all! As exciting news as that is, I can imagine that doesn't make the situation any easier, nor may it assuage any guilty feelings that often accompany early bottle introduction and breast refusal.
My advice would be to reach out to a lactation consultant who can observe a breastfeeding attempt AND a bottle feed. Often, the issue that caused a bottle's need in the first place is to blame for any challenges with nursing/latching. Even if your baby doesn't latch during the visit, your lactation consultant should be able to watch a bottle feed and do a physical assessment to identify any culprits of feeding challenges.
They can also provide you with how to bottle feed in such a way to promote a return to the breast. Many parents have heard of paced bottle feeding, which is certainly helpful in cases like these, but the LC can show you therapeutic bottle-feeding techniques.
Side note: I understand this is a bit different than Anne's approach of avoiding artificial nipples all together. In cases where babies are non-latching, even though alternative feeding methods are available, bottles tend to be most accepted/preferred by stressed out, exhausted parents. Bottles don't have to be a hindrance and instead can be a tool to promote breastfeeding.
Between now and your appointment with your Lactation consultant, I always encourage lots of skin to skin. It's best not even to attempt latching during these skin to skin sessions, as difficult as that may be. Get comfortable, put on a show, read a book, play a mobile game, and relax without expectations.
At a minimum, the skin to skin will be beneficial, and your babe may surprise you. Left to follow their instincts, they may latch unprompted.
What you're dealing with is something we see commonly, and most babies go on to latch and feed well with a little bit of professional support.
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Did you deal with 'nipple confusion'? If so, what advice would you give this parent?
