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What is nipple confusion?  

The term ‘nipple confusion’ (or ‘nipple preference’) describes a baby’s frustration when switching between the breast and a baby bottle or pacifier. Read on for some tips to help your child with those tricky transitions. 

 

What causes nipple confusion?  

When breastfeeding, babies control the flow of milk by coordinating their sucking, swallowing, resting, and breathing. Bottle feeding, however, works a little differently: milk often flows more easily due to gravity and the design of bottle nipples, which provide a steady flow without requiring as much effort. (Some babies may even develop a preference for bottle feeding because it requires less effort to extract milk.) 

 

These differences can sometimes cause nipple confusion (also referred to as nipple preference), where a baby struggles to transition between breastfeeding and bottle feeding because the milk flows differently.  Additionally, if the bottle nipple fits and feels too unfamiliar, some babies may struggle with latching right from the start. Bring a pacifier into the mix, and the situation can become even more complex. If the shape of the pacifier nipple is also different from a bottle or breast, some babies may struggle to effectively between all three. 

How to help avoid nipple confusion 

If you think your child is struggling with nipple confusion, don’t panic. There are several ways you can try to help them.  

 

1. Choose a bottle with a round nipple  

If you want to combine breastfeeding and bottle feeding, a round bottle nipple is usually preferable as it mimics the natural shape, fit, feel, and movement of a nipple during breastfeeding. This will help make your baby’s experience of breastfeeding and bottle feeding as similar as possible, promoting a familiar, natural latch and reducing the chances of nipple confusion between the two. 

 

2. Choose a round pacifier nipple to match your bottle nipple  

If you would like to introduce a pacifier to your baby, consider choosing one with a round nipple shape that also matches the ‘breast-like’ features of the round bottle nipple.  

3. Choose bottle nipples with different flow rates  

Different bottle nipples have varying holes that determine how much milk flows into your baby’s mouth (the nipple’s ‘flow rate’). For younger babies, a slower flow rate (with a just one, or a smaller hole) is recommended to mimic a newborn’s natural breastfeeding pace and help control their milk intake. As your baby grows (and grows!) and their appetite increases, they’ll usually start preferring a faster flow rate for bottle feeding. Choosing bottles that support interchangeable nipples with adjustable flow rates helps align bottle feeding with your baby’s natural feeding rhythms, making it easier to transition between bottle and breast. Not all baby bottles offer this function—some have fixed nipples that don’t allow for changes, making it harder to adapt to your baby’s changing needs.  Read more about flow rates here. 

 

4. Use the ‘paced bottle feeding’ method  

When babies breastfeed, they naturally self-regulate how much they eat, where they suck and swallow, then rest briefly before continuing. Paced bottle feeding tries to mimic breastfeeding by making your baby work just a tiny bit harder to draw the milk from the bottle like they would with breastfeeding at the same time - allowing your baby to take breaks. This also reduces the risk of overfeeding which can result in your baby feeling discomfort. Kirsten Lise Andersen, Authorized Children’s Nurse/Health Visitor, explains: “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 [mother’s] 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.” Read our step-by-step guide and watch a video on paced bottle-feeding here.