Lorna C. Aliperti, APRN, IBCLC

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Nipple Confusion

What Moms Say

I read the literature, heard the stories and believed nipple confusion was a threat to my success with breastfeeding. I knew I always wanted to nurse. When Jack was born eight weeks early, I thought breastfeeding was not an option. He was in the Newborn Intensive Care Unit and hooked up to machines that made it impossible for me to nurse him. However, I quickly learned that I could pump and give Jack my breast milk through a gastric tube. I was thrilled but then I remembered the nipple confusion theory and thought my success was doomed. I continued to pump and bottle feed Jack the two weeks he was in the intensive care unit. That went extremely well but Jack was nearing discharge and I was informed I could start to breastfeed him. My fear and anxiety about his nutritional well being was at the forefront of my mind. I questioned whether I should attempt breastfeeding him. Should I struggle with him on my breast, have him lose weight and set him back nutritionally when I can easily give him a bottle? I was certain he would not latch on and suck so why try? But I did try and much to my surprise Jack had little trouble latching onto my breast. Since he was premature, he had difficulty with the suck, breathe, and swallow pattern but not with latching on and initial sucking. With much practice and assistance and encouragement from my spouse, nurses, physicians and Lorna, Jack and I worked on successful breastfeeding. We had to switch back and forth between my breast and the bottle of expressed breast milk to maintain his nutrition and weight but I realized there was no confusion between the two nipples. He took the milk from both sources early on and continues to do so. I have even introduced a third nipple; the pacifier. Sucking is extremely important for newborns. The pacifier has assisted in his sucking abilities. Recently I have noticed that Jack has become so comfortable with the sucking motions on my breast that when I give him a bottle or pacifier he opens his mouth wide as if I am giving him my breast and he needs to adjust (not the other way around!). I am happy to say that nipple confusion was not a problem with us and have learned that it isn’t with many moms and babies. The generalization of the nipple confusion theory almost prevented me from the breastfeeding experience. Everyone has different situations and reasons for needing more than one option of feeding their baby. My advice is to try with different nipples and keep working at it. Babies are smarter than we think. I believe with persistence and perseverance the baby will learn.

–Sheila Speight Iacono, RN, MSN

It took over 3 weeks for me and my daughter to learn how to breastfeed. I had flat nipples, which were infected, and she had difficulty latching on. I was pumping, supplementing with formula – using several different types of nipples, and nursing – with and without a nipple shield, sometimes all in the same day! But once she learned how to latch on, she never forgot. Days would go by where I could not nurse but she always got right back on – despite the great difficulty in the beginning. I guess nursing is like riding a bike.

–Ann Sacchetti

When I started my daughter had trouble latching on and lost weight thus I started to give her my milk from a bottle – I was determined that I was going to breast feed or at least she would get my milk. She was smart and learned very quickly (1 1/2 weeks old) that she was getting milk fast from the bottle. However, at 6 weeks, just as I returned to work, she latched on and we continued for 18 months. Thus I don’t give too much merit to “nipple confusion”.

–Suzanne Malloy

What the Research Says

A recent review of the literature examined the evidence for and against nipple confusion and concluded: “The relationship between exposure to artificial nipples and pacifiers and the development of the aversive feeding behaviors associated with nipple confusion is neither refuted nor supported in the research literature.”

D. Dowling, W. Thanattherakul, Nipple Confusion, Alternative Feeding Methods and Breastfeeding Supplementation: State of the Science, Newborn and Infant Nursing Reviews, 2001, 1(4)217-223.

Keep in mind…

There is only so much time in a new mother’s day, and alternative feeding methods such as cup or syringe feeding are often time consuming. If they are needed, the baby is usually not latching effectively and the mom should be pumping to maintain or increase her supply. Feeding methods which don’t leave a mom enough time to pump can create more problems than they solve. A baby doesn’t have to be confused to prefer a bottle when the mom doesn’t have enough milk.