Nipple Confusion and Breastfeeding
The Effect Artificial Nipples May Have on Nursing
This article is an overview of nipple confusion. The differences in feeding mechanics and the consequences of nipple preference on breastfeeding is discussed.
Nipple confusion (also referred to as nipple preference) can occur when a breastfed baby is given artificial nipples. The baby has difficulty adjusting the different suckling required of bottlefeeding to the suckling required of breastfeeding. The resulting effects of nipple confusion can deter the nursing relationship.
The Range of Reaction to Artificial Nipples
Not all babies who are given bottles develop nipple confusion. Further, babies that do develop nipple confusion may vary in the severity of reaction to the breast. Some babies will have no trouble going back and forth between breast and bottle. Other babies' nipple confusion will be so severe that they reject the breast entirely. The confusion is caused because the mechanics of breastfeeding and bottlefeeding are completely different.
The Mechanics of Nursing
- The placement and movement of the tongue, lips, and jaws is unique to breastfeeding.
- A breastfed baby must open his mouth wide to accept the nipple and part of the areola far back into the mouth.
- Lips are splayed outward to form a seal.
- The tongue and jaws work in tandem to press the areola against the palate.
- The wave-like motion of the tongue extracts milk from the breast.
- The breastfed baby exhibits a visible pause at the breast and a suck-suck-swallow pattern develops.
- Milk does not begin to flow immediately from the breast. It takes a minute or two for milk to letdown and the baby to receive milk.
The Mechanics of Bottlefeeding
- Bottles are gravity flow devices. If a bottle is turned upside-down, the milk naturally drips out.
- The mouth does not need to open widely to receive milk, and the nipple does not need to be placed at the back of the mouth.
- The bottlefed baby must push his tongue forward to control the flow of milk from the nipple.
- The milking motion of the tongue seen at the breast does not appear in the bottlefed baby.
- The bottlefed baby can retrieve milk using only the lips or by "chewing" on the end of the nipple.
- Milk flow is immediate.
- There is no rhythmic pause in sucking.
The Possible Consequences to the Breastfed Baby
When the baby applies the style of bottlefeeding to the breast, the upward thrust of the tongue pushes the nipple out of the mouth. It may appear that the baby is spitting the nipple out or "not wanting" to breastfeed. It is not that they baby does not want to breastfeed, it is that he needs to be taught how to breastfeed.
The compounding issue is that the baby has not learned to open the mouth wide enough to compress the nipple and areola adequately. Because of that, milk consumption is inhibited. This may affect weight gain of the baby.
The other factor is seen in the baby's behavior. The baby becomes impatient at the breast because he is used to the immediacy of bottlefed feedings. Baby may fuss and whimper while nursing, pulling off and on in frustration. Extreme cases can result in complete refusal of the breast.
The Possible Consequences to the Nursing Mother
Mother's milk supply may decrease. Because the baby is not latched on and nursing correctly, milk is not extracted efficiently. The mother is not stimulated to produce more milk. Further, the ineffective latch causes the nipple to be compressed and results in damage to the nipple. If sore nipples are a problem, see Lanolin Treatment for Nipple Pain.
Nipple confusion does not happen to every baby. However, for those babies who do develop nipple confusion, it can be a major deterrent to breastfeeding. Mothers should know that it is possible to coax a baby to breast. The help of a lactation consultant can help mother and baby overcome nipple confusion.
References:
Huggins, Kathleen, R.N. M.S., The Nursing Mother's Companion. The Harvard Common Press: Boston, MA, 1999.
Newman, Jack M.D., Pitman, Teresa. The Ultimate Breastfeeding Book of Answers. Three Rivers Press: New York, 2000.
