You only need to watch babies suck on a bottle nipple and suckle at the breast to see that these are two very different processes. The baby at the breast must use his mouth and tongue quite differently from a baby sucking on a rubber bottle nipple or even a pacifier.

During the first few days after giving birth, mothers produce only a small amount of a special kind of milk, called colostrum. This milk is very high in antibodies and is a laxative, helping to prepare the baby’s intestines – which were not used to digesting food before birth – to handle the milk that the breasts will soon be producing. The breast of a new mother are fairly soft as well. This makes it easier for the new baby to learn to latch on.

So the baby’s initial feedings at the breast do not yield large volumes of milk. This is how nature intended it to be while the baby is leaning to breastfeed. But if the bbay is given a bottle of formula, or even of expressed breast milk, he learns a very different style of sucking. The bottle nipple is rigid and can be forced into the baby’s mouth.

It is also true that some babies learn to drink from a bottle as well as from the breast, but many do not, and it is difficult to know in advance which babies will have problems. A baby who is already having problems with latching on, or is reluctant to take the breast, will almost certainly have even more difficulties if given bottles or pacifiers. And even babies who are doing fine at the breast can be confused or have their breastfeeding technique disrupted if they are given bottles. Even one bottle can create problems, especially if it is given early on.

Actually, the babies are not confused. They know exactly what they want. If they go to the breast and don’t get much milk because they are not latched on well, and are then given a bottle and get a fast flow of milk, they will develop a preference for the bottles. Babies don’t have to be potential rocket scientists to figure it out.

For this reason, many will describe this situation as “nipple preference” rather than “nipple confusion”. This term can be pretty upsetting to the mother, however, who may already be feeling emotional about the problems she is having breastfeeding her baby, and now is told that the baby “prefers” the bottle to her breasts. It may feel like the baby is rejecting her. “Nipple confusion” suggests that the baby really does not want to breastfeed but is temporarily confused.

The solution here is to fix the latch so that the baby is able to get the milk just as readily at the breast.

Even when babies seem to be able to do some feedings at the breast and some from a bottle, this is often the first step to early weaning. The baby’s suckling technique, which may be “good enough” un the early weeks when the mother’s milk supply is very plentiful, may deteriorate as time goes by, and then the mother’s breasts don’t get enough stimulation to keep up her milk production. As it gets harder for the baby to get the milk from his mother’s breasts, he begins to prefer the bottle. Recognizing that her milk supply is down, his mother gives him additional bottles, and her milk supply decreases further. Before long, the baby shows a definite preference for the bottle – and ends up weaning.

A range of problems may result from the early introduction of rubber nipples, which causes the baby to latch on poorly. These include breast refusal, poor weight gain, high bilirubin levels, sore nipples, colic and breast infections.

It is surprising that some people deny the existence of”nipple confusion”. These individuals have probably seem one of the babies who seem to manage both breast and bottle. These same people would certainly agree that a baby may prefer one sort of rubber nipple over the another; that a baby may take both breasts but prefer one side over the other; that a baby might prefer the mother’s protruding nipple over her other flatter nipple. Almost every mother’s nipples are flat compared to a bottle nipple, so it’s not surprising that babies might learn to prefer the bottle nipple to the breast, or at least be confused about the sucking technique they should use.

It’s also interesting that many of the people who say there is no such thing as nipple confusion are the same ones who urge parents to give their babied a bottle early on so that the baby will be willing to take one. They warn parents that if they delay the introducing a bottle, the baby may always resist being given a bottle. In other words, their concern is that the baby will have a persistent preference fir the breast. What they forget to mention is that a bottle is not the only way to supplement a breastfed baby, should that become necessary.

Adapted from Dr Jack Newman’s The Ultimate Breastfeeding Book of Answers.
Dr Newman is the leading researcher in the field of breastfeeding, is a popular speaker at breastfeeding conferences across North America. A father of three, he now lives in Toronto, Canada

Tags: artificial nipples, breast refusal, milk production, nipple confusion, nipple preference