Is nipple confusion real? What experts say about your baby's feeding preferences

Can parents prevent nipple confusion? Experts say there are ways to help your baby learn to transition between breast and bottle feeding. (Photo: Getty Creative)
Can parents prevent nipple confusion? Experts say there are ways to help your baby learn to transition between breast and bottle feeding. (Photo: Getty Creative)

Having a little one means a lifetime full of choices. From the moment a baby comes into the world the options are never-ending, and one of the first and most important decisions parents will make is not only what their child will eat, but how.

As new parents and parents-to-be, the term nipple confusion may cause … confusion itself.

What is nipple confusion? And, what are the signs that a baby is struggling with switching between breast and bottle feeding? Yahoo Life chatted with moms and dads, parenting experts and pediatricians about nipple confusion and what it means for a mom's milk supply or a baby's ability to handle introducing a bottle.

Mindy Cockeram, a certified lactation educator and author of the book Breastfeeding Doesn't Have to Suck: Tips, Tricks and Knowledge for a Great Experience says in order for parents to fully understand the term "nipple confusion," they need a bit of clarification on the phenomenon.

"I don't actually think babies get confused whatsoever between a silicone teat with milk dripping out of it quickly versus a warm breast where they have to work much harder to get the same amount," says the Redlands, Calif. educator, "they start to prefer one over the other."

Cockeram explains babies can get used to the fast flow that comes with feeding from a bottle, getting incensed when put back to their mother's nipples, from which milk is more slow-flowing. Alternatively, many babies reject the artificial nipples involved with bottle feeding and insist on breast milk due to Mom's warmth and the comfort of skin-on-skin contact.

Is nipple confusion real?

"This topic has been highly debated by experts," says Hali Shields, a certified doula at New Kind, a virtual postpartum wellness company. The board-certified wellness coach and certified lactation education counselor says although there are differing opinions about whether or not nipple confusion is real, "it's believed [to be] by most practitioners."

Shields, who lives in St. Augustine, Fla. has over thirteen years of experience with babies and has helped more than 350 families as a lactation consultant. Shields says based on what she's encountered in her practice, she certainly believes nipple confusion is real.

Shields confirms she's seen babies have a nipple preference or struggle to latch onto the breast once they have become accustomed to bottles, as some babies have difficulty switching back and forth between the two feeding methods.

Nipple confusion signs

Laura Erlich, a holistic fertility and obstetric specialist and founder of Mother Nurture Wellness from Los Angeles, Calif, says there are some common signs that a baby is experiencing nipple confusion.

"Babies with nipple confusion will have difficulty latching onto the breast and may become frustrated and even refuse the breast," Erlich explains. "It is common that mom will develop sore nipples because the baby's latch is too shallow, since the bottle doesn't require a deep latch in order to get milk to flow."

Although in many cases nipple confusion comes down to what each individual baby prefers, it can be sign of an even bigger issue than just getting a baby to take a bottle or a breast.

According to Erlich, it's important to confirm your baby doesn't have a tongue or lip tie if they are having difficulty latching. This condition often presents as nipple confusion, when in actuality, the baby is anatomically unable to latch and feed.

Deborah Rothschild is a mother of two teenagers who both experienced what seemed to be nipple confusion as infants. Later, Rothschild learned her children both had tongue ties — a condition present at birth that restricts the movement of of the tongue.

"Both my kids were tongue and lip-tied (a condition where the tissue attaching baby's lip and gums is too tight and also causes movement issues) and that was the cause of their 'nipple confusion,'" says the Marlboro, N.J. mom. Because it took several specialists to get her babies' diagnosed with these issues, Rothschild says her family still deals with long-term effects from the time they were lip and tongue-tied.

"We are literally paying the price to undo the damage the ties caused," she says, "including open-mouth breathing, scoliosis, excessive cavities and digestive issues."

Erlich says this doesn't have to happen. "Tongue-tie is easily corrected, so speak to your pediatrician [about having them evaluated] if your baby isn't latching well," she says.

How to stop nipple confusion

Shiri Perl, a nurse and lactation consultant at Nest Collaborative in Maplewood, N.J., offers recommendations for parents who hope to breastfeed their children but still plan to use bottles as well.

"First, have a non-lactating parent or family member feed the infant the bottle and the lactating parent only offer the chest directly to help build associations," says Perl. "Using methods such as paced bottle feeding, which mimics the rhythm of breastfeeding, can also help prevent a preference for the flow. And lastly, be patient, cool and calm."

"Offering the chest frequently in a dimly lit room without distractions, trying new feeding positions and feeding while the infant is sleepy can all help bring a nipple-confused baby back to the chest," she adds.

Amy Tanzillo, a lactation consultant and founder of Thrive Breastfeeding, is a mother of three from Washington, D.C. who also suggests paced bottle feeding to reduce a baby's likelihood of developing a preference between bottle and breast. She explains that positioning the baby in a more upright position and holding the bottle more horizontally slows down the feeding. This pacing of feeding often helps with transitioning back to the breast, as baby doesn't become accustomed to a fast flow from the bottle.

Dr. Harland Adkins, a pediatrician, says parents should, "make skin-to-skin contact with [their] baby and praise [their] baby every time they make the right step: such as opening their mouth, placing their tongue down and firmly latching on."

"Stay on the lookout for hunger cues," Adkins says, "Feed your baby before they start crying and massage the breast before latching your baby so your milk comes more instantly."

If you're still at the beginning of your journey and hope to avoid nipple confusion altogether, Erlich adds, "the key is just to avoid going back to a bottle until breastfeeding is fully established."

When to introduce a bottle

According to Erlich, 3-5 weeks of age is the best time to begin introducing a bottle. That window offers enough time to establish breastfeeding and also avoids the risk of the other kind of nipple confusion, wherein the baby will only take the breast and refuses bottles. Erlich adds that while exclusively breastfeeding may work for some parents, going back to work with a baby who won't take a bottle can be stressful, so getting your baby used to a bottle is essential.

No matter what preference your baby might have, Adkins, shares his number one piece of advice for parents is to take it all in stride. "Personally," he says, "I believe nipple confusion should not be blown up to be a big issue, as babies are quick to learn and adapt to new things."

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