If you introduce a bottle too early, your baby might develop nipple confusion. Learn more about why it happens and how to help your little one switch between breastfeeding and bottle-feeding with ease.

By Nicole Harris
April 20, 2021
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Credit: Capture Your Moment Photography

Most parents give their babies a bottle at some point, even if they're exclusively breastfeeding. But before introducing a breastfed infant to pumped milk or formula, it's vital to learn best practices. Otherwise your baby might have trouble switching between the breast and the bottle—a phenomenon known as nipple confusion. Keep reading to learn more about what causes nipple confusion and how to prevent it from happening. 

What Causes Nipple Confusion?

Drinking from a bottle requires babies to use different muscles and techniques, according to La Leche League International. When breastfeeding, babies use specific tongue and jaw movements to suck milk from the breast. Bottle nipples, on the other hand, often have a faster flow, which makes milk trickle out quicker and easier. What's more, bottle nipples often have a distinct texture and firmness that differs from human nipples. 

Sometimes babies who are introduced to bottles too early can get confused, especially when constantly switching from breast to bottle and back again. They might apply the sucking motions required for breastfeeding to the bottle (and vice versa) and become frustrated when they don't receive much milk. This phenomenon, known as "nipple confusion, can result in feeding difficulties.

Nipple confusion is also linked with "nipple preference," which usually means a baby turns down the boob in favor of the bottle. They might realize that bottle nipples give them more milk with less effort—so why would they ever drink from the breast instead? Babies who prefer bottle-feeding might also find artificial nipples more comfortable than Mom's real-life nipples.

Nipple preference can happen the opposite way as well, in which babies favor nursing over bottle-feeding. In this case, your child probably relishes in the comfort and familiarity of the breast, or they might dislike the nipple or bottle you've chosen for them. 

Signs of Nipple Confusion

According to La Leche League International, not all babies suffer from nipple confusion, and there's no way to predict if it will affect your little one. That said, babies who were born early—as well as those with a weaker sucking mechanism—may have a higher risk. 

Some telltale signs of nipple confusion include:

  • You have sore nipples after feeding, which could happen if your baby doesn’t open their mouth wide enough while feeding. This improper latch also means your baby won’t get a lot of milk during a nursing session.
  • Your baby appears frustrated or annoyed during mealtime.
  • Your nipple keeps falling out of their mouth—usually from Baby thrusting their tongue upwards while feeding.

How to Prevent Nipple Confusion

Although nipple confusion can be frustrating, it can be avoided most times. The biggest advice from experts: Wait until breastfeeding is established before introducing the bottle—usually about four weeks after birth, says La Leche League International. 

The American Academy of Pediatrics (AAP) also recommends avoiding pacifiers for the first three or four weeks of your baby's life. Pacifiers require different tongue and jaw movements than breastfeeding, which might also cause nipple confusion.

Reversing Nipple Confusion in Babies

What if your baby has already expressed a preference for the bottle or the boob? These solutions can help undo nipple confusion.

If Your Baby Prefers the Bottle: 

To get your little one back into breastfeeding, nurse at the first signs of hunger to prevent fussiness. Expressing some milk before attempting a latch can get Baby excited; La Leche League International calls it an "immediate milk reward for his efforts." 

You should also try pinpointing exactly what's causing your baby's feeding issues and finding appropriate solutions. For example, if they prefer the faster flow of bottle nipples, buy one with a slower flow instead. Slow-flow nipples are usually marketed as "level one," and they mimic breastfeeding more closely than faster-flow options. Using these nipples can help your baby relearn best breastfeeding techniques. 

In the meantime, keep an eye out for deceased breast milk production. If your supply diminishes while dealing with nipple confusion, pumping regularly might help boost it back up. 

If Your Baby Prefers the Boob: 

Sometimes babies will favor the boob instead of the bottle. To combat this type of nipple preference, consider recruiting your partner or a grandparent to give them bottles instead. That way, the baby isn't distracted by Mom's breasts. 

You can also mimic your nursing routine during feedings to provide some comfort and familiarity; experts recommend lots of skin-to-skin contact throughout the day. Finally, it could help to switch the nipple you're using, since some babies respond better to specific nipple shapes, textures, and features.  

Contact your pediatrician or a lactation consultant if you need more help dealing with nipple confusion. They can help you find solutions specific to your baby.