It is a common recommendation from breastfeeding experts to forego artificial nipples (pacifiers or bottles) for the first few weeks or even months of breastfeeding to avoid the dreaded and ever-elusive nipple confusion. Instead, it is recommended that any sucking be done directly at breast and if that is not possible, a finger is an adequate substitute.

Let me start by saying that nipple confusion is real. Not all babies get confused when offered a variety of things to suck on, but some do. This can cause a speed bump in breastfeeding success if a mom has a great consultant helping her out. It can be a breastfeeding game-ender if she doesn’t.

When a baby is given anything other than a soft mama nipple to suck on, a pacifier or a bottle, it stimulates a reflex on the roof of the baby’s mouth that makes him suck. This sweet spot is right at the juncture of the hard and soft palate in the baby’s mouth. This is not however, the same reflex that babies use to suck at the breast. The root reflex (like when baby tries to eat his own shoulder) is the reflex that gets a baby latched on and sucking. The problem comes when a baby becomes used to using the suck reflex instead of the root reflex to suck.

Anyone who has put her nipple in her baby’s mouth and had that baby refuse to suck, then put a bottle in the baby’s mouth and he instantly sucks, knows what I am talking about. He doesn’t like the bottle better than you; he is simply a reflex-driven animal. When your baby is frantically thrashing around at the breast with the nipple in his mouth like an angry trout on a fishing line but will not suck, he is nipple confused. He is waiting for that “super stimuli” to make him suck, but he simply won’t get it at the breast.

Now, in the spirit of Balanced Breastfeeding, I am going to pose two very important questions that help bring the issue of nipple confusion into the realm of practicality, reality, and balance.

If nipple confusion is, in fact, real…

  1. So what?
  2. How do you fix it?

So what? So, if nipple confusion is real, is it the right thing to make a blanket statement that artificial nipples are bad for breastfeeding?

This works out just fine if you happen to have a newborn baby that pops out of your body, latches onto the breast, and never stops latching. This is fine if your nipples aren’t cracked or bleeding and each nursing session doesn’t feel like the baby has broken glass in his mouth. This is fine if your milk comes in at the right time and in the right quantity to provide your baby with all the nutrition he needs. This is fine if you have a baby who nurses, then settles and sleeps for a few hours so you can rest.

But, what if your baby won’t latch on to your breast?

What are you to do if your nipples are so damaged and painful that you simply can’t bear to let the baby breastfeed?

What if your milk comes in a little late or you don’t make quite enough milk and the baby needs supplemental nutrition in addition to breastfeeding?

What if you have a baby that really likes to suck? All the time. To the point where you can’t put the baby down and therefore can’t get any rest.

Is it really fair to ask a mother to nurse through the pain even though it is likely doing more damage to her nipples? Shouldn’t we rather give her the option to pump to protect her milk supply, allow her nipples time to heal, feed the baby from a bottle, and seek help?

Is it really fair to ask parents to feed or supplement their baby with a dropper? Or a syringe? Sure, it sounds like a reasonable enough request to have a parent do this, but have you ever actually done it yourself? Have you ever been sleep deprived, balancing a baby on your lap with a finger in his mouth, a syringe in your opposite hand trying desperately not to spill a drop of precious breastmilk? If you have done this, you know for sure that it is a challenge for a few feedings and ridiculous for more than a day or two.

Is it really fair to sacrifice a mother’s ability to rest and heal herself mentally and physically for fear of possible nipple confusion?

Is it really fair to give a partner no tools to help?

No. It’s not fair.

So, let’s be reasonable:

Ideally, for the first one to two weeks of breastfeeding, avoid offering the baby a pacifier or a bottle in place of breastfeeding. This will give the baby an opportunity to learn how to breastfeed with as few “super stimuli” as possible.

If at all possible, wait until breastfeeding is “going well” before you introduce a new nipple. “Going well” means breastfeeding isn’t painful, baby is getting onto the breast relatively easily, staying on the breast for a full feeding, and having adequate diapers for his age.

If you do opt to give a bottle or pacifier during this time, be on the lookout for suspicious behavior when the baby comes back to the boob. If he is taking longer to figure out how to latch on, latching more shallowly, fussing at the breast, etc., he may be getting confused. If you see any of this shady behavior, hold off on giving the baby the pacifier or bottle for a few more days. Then, try again.

So, what if your baby is nipple confused?? … Read more… also, follow the rules.