What is nipple confusion and how to avoid it

The term nipple confusion or nipple preference has been used to describe an infant’s frustration when they are having problems switching from the breast to a baby bottle and back again.

Difference between bottle and breast

Babies don’t really get confused about the different feeding methods, but they can develop a preference for the bottle. This is because they use different techniques to remove milk from the breast than when drinking from a bottle.

When breastfeeding babies control the flow of milk from the mom where the baby sucks and swallows during a letdown, then rests and breathes between letdowns.

When using some baby bottles, babies don't have to work as hard because of gravity and because the nipple causes the milk flow to be more continuous.

Nipple confusion/preference occurs when the baby switches back to the breast and doesn't understand why the milk flows differently than it did with the bottle. Some babies have difficulty alternating between a bottle and the breast and some do not.

How to avoid nipple confusion

There are different ways to try to avoid or resolve nipple confusion.

1. Choose a bottle with a round nipple

If you want to combine breastfeeding and bottle-feeding a round bottle nipple is preferred. Go for a round nipple that is designed to mimic the mother’s soft nipple in shape and size.

2. If your baby uses a pacifier, choose a baby bottle that matches the pacifier nipple

If your baby already is accustomed to easily switching between breastfeeding and using a pacifier, choose a baby bottle with a nipple that matches the pacifier.

3. Choose a bottle that offers nipples with different flow rates

The flow rate refers to the size of the hole(s) in the nipple, affecting how quickly milk flows into your baby’s mouth. For newborn babies, a slow flow rate is recommended for slowing down bottle-feeding to better mimic breastfeeding, to better control milk intake, and secure babies do not overeat. Normally, will the flow rate change over time as the baby grows, and the older the baby gets they will prefer a faster flow rate.

4. Use a method called ‘paced bottle feeding’ when bottle-feeding your baby

Paced bottle feeding is a method of feeding your baby that aims to slow feedings to closely mimic breastfeeding. The method slows down the flow of milk and makes the baby work harder to get the milk (like they would with breastfeeding) and at the same time allows the baby to take breaks which reduces the risk of overfeeding that may result in discomfort to the baby.

When babies feed at the breast, they easily self-regulate how much they eat. Paced bottle-feeding mimics the natural rhythm of breastfeeding, where the baby sucks and swallows during a letdown, then rest briefly between letdowns.

“Some babies who have gotten used to drinking from a bottle will get frustrated with the slower flow from the breast. At the beginning of breastfeeding, there is only a little milk available to the baby. Most of the milk comes when the let-down reflex happens after 30-60 seconds of sucking. Only then, will the baby get a large amount of milk. In contrast to the bottle, where the milk will flow steadily immediately.”

- Kirsten Lise Andersen, Authorized Children´s Nurse/Health Visitor, Working With Baby

Read our step-by-step guide and watch our video guide to paced bottle-feeding here >