LatchingLearn the BasicsNewborn Mama 0-4 months

Clearing up the Confusion about Nipple Confusion

Once you have identified that your baby is nipple confused and you have taken measures to 1. feed the baby, 2. protect your milk supply, and 3. seek out help, then we can zoom in close and try to get that kid back to sucking on mama’s nipple!

As explained in the nipple confusion blog, a nipple confused baby is waiting for a super stimulus to tell him to suck. The classic nipple confused baby looks like an angry trout on a fishing line. He wildly thrashes his head back and forth in a vicious root reflex. The nipple may be in his mouth and yet he is still flailing and rooting wildly. His breathing quickens and you can tell in a matter of seconds that he will start screaming.

I want to stop here for a moment and empathize with this sweet little screaming banshee. It is really normal for us as mothers to internalize our children’s behavior and blame ourselves. But, as with most things in parenthood, we cannot control our child’s emotions. More importantly, we must resist the urge to project our own feelings and thoughts onto our babies.

Let me speak on behalf of your nipple confused baby for you.

As your bring the baby to the breast, he begins to root around eagerly. He is thinking “I smell milk! I am hungry. Where is it?!” Root, root, root.

Now, remember, this baby does not know that this is where food comes from. He does not feel right at ease at the breast because he has not learned this by experience yet.

You attempt to latch and put the nipple in his mouth. You drip milk in his mouth. This seems to make him even more agitated. You think, “He doesn’t like the breast.”

He is thinking, “I am really hungry!! I am smelling the milk. I can even taste the milk. But I can’t get the milk. This is so frustrating!!!”

You pull him away, calm him, and start again. Each time he gets more agitated, you get more frustrated and despondent.

So, as you sit and battle at the boob, please remember that your baby isn’t saying, “I don’t like to breastfeed” or “I don’t like you.”
He is saying, “I am confused and frustrated!”

In order to get a baby back to the breast:

You must have patience.

Your ability to breathe and keep yourself relaxed during this process is critical. I don’t believe babies can “feel our stress.” If they can, it is just a mean thing to say to a new mother. New mothers are stressed. Period. Telling them that their baby feels their stress just adds insult to injury. Patience is important simply because you can’t lose your shit while doing this. If you lose it, you are done for this session.

You must have perseverance.

This will be two steps forward, one step back. It can take days or weeks to coax a baby to the breast. Now, don’t confuse perseverance with compulsion. We are running a marathon, not a sprint. Perseverance in this case means being dedicated to working at it multiple times a day, but not necessarily every time you feed the baby.

When working with a mother on this, I typically start with the recommendation to attempt to latch three or four times a day at a feeding when both mom and baby are relatively calm and awake, i.e. not 3:00 am.

You must know how to work with the root reflex.

This is where the magic happens.

Here is a more mild version of the root reflex. She isn’t pissed yet, but she is getting close.

A lot of consultants and nurses will tell mothers to “wait for the baby to open wide” or “wait for the baby to open wide like a yawn.” That is their way of describing the root reflex. But a real, strong root reflex isn’t just a wide open mouth; it is what I can best describe as a “head shake.” As a baby gets more anxious at the breast this head shake becomes more violent, so you need to be able to control it. Having a strong and confident grip on the baby can make all the difference.

So, start here. Get in the right position, and get a strong, confident grip on your baby.

Wait for the root and assertively latch. If baby doesn’t take, back off and start over again.

Not only do you need to stay patient, your baby needs to stay patient. 

Always keep the baby at around a 3-4/10 on the baby freak out meter. If baby starts to get overly worked up, offer a finger, a pacifier, or a few sucks from the bottle, but keep the baby in position at the breast. The transition to and from the breast is often more upsetting for the baby.

When attempting to get the baby latched, taunt the baby with the nipple on her top lip, wait for the root, and push baby assertively from the shoulders. If the baby doesn’t start sucking within a few seconds or pulls away from the breast, start over. Don’t push the baby into the breast and try to hold her there. She will get piiiiissssed–as would you if someone was smothering your face with a boob.

We can, however, tolerate a moderate level of frustration from the baby. Holding steady at 3-4/10 means the baby is aggressively working at the breast, but is clearly irritated. If he jumps to a 5/10, he may stop rooting and just scream. You are the only one who can gauge how much is too much frustration for either you or the baby, but it is a little higher than you may think. It is okay to push yourself and your baby a little.

If after five to ten attempts or so of taunting, rooting, latching, but baby still pulls away or won’t suck, it has become clear that baby just isn’t getting it. Now is the time to whip out the shield. At this point, we are…

Embracing nipple confusion.

The baby wins… for now. If baby is looking for a super stimulus, let’s give him one. The nipple shield works quite well to bridge that gap between bottle and breast. A lot of the breastfeeding world likes to bad mouth nipple shields, but honestly, I think they are an awesome tool for a number of circumstances, one of which is nipple confusion.

This is a really nipple confused baby. He can’t seem to get hang of the shield, let alone the bare breast. The key here is to aim the tip of the shield to the roof of the baby’s mouth where that suck reflex it located. If he can’t get onto the bare breast, we can now use the nipple shield (start with a size 24mm Medela Contact Nipple Shield, please) to trigger the suck reflex and trick the baby onto the breast!

This baby did eventually learn to latch with the shield, then without the shield. Notice in the video how the mom talks to the baby. She is staying calm and patient even though he is acting like we are poking him in the ribs instead of offering him food.  She and I are even teasing him a little to make light of the ridiculousness.

Note: This baby doesn’t even get to the point where he is able to suck, but your baby may suck on the shield and pop off a few times before staying put. Remember, a bottle fed baby gets milk right away. A breastfed baby has to trigger the let down. It may be helpful to dribble milk into the corner of the baby’s mouth to keep him sucking. You know, with your third hand.

Ha! I knew we were smarter than a newborn baby!! Getting the baby on with the shield will now teach the baby that we weren’t trying to torture or kill him on the breast after all. We were simply trying to give him food! Every time he nurses he imprints this memory onto the breast. You will see a little less fussing each time he comes to the breast. Eventually, you will find him hop right onto the shield and nurse no problem!

Now, you are nursing with a nipple shield. Enjoy this success! Get really good at nursing with the shield! Eventually, you will want to work on getting off the nipple shield for the sake of convenience. There is no rush. But, when you are ready, work with your consultant and take your time. Trust me, if you can get a nipple confused baby onto the breast, you can definitely get him off the shield.

The baby who will not budge:

I have this picture on my wall of my office. This is Jackson. His mother exclusively pumped for him for a full year. Jackson never fell for any of his mother’s nor my attempts to coax him back to the breast. He bested us. And, frankly, Cana and I were pretty sore about it for a while. But, you know. Babies are people after all. They come pre-programmed with a particular temperament and I believe that the sooner we are able to fully realize and accept this about each of our unique and spectacular children, the easier it will be to process and move through the trauma of not being able to control their thoughts, emotions, and behaviors.