The Truth About Nipple Confusion

Here's the best advice on integrating pacifiers, bottles and breast shields.


Since "artificial nipples" require babies to use different tongue and mouth positioning than when nursing, they may interfere with breastfeeding. Here's the best advice on integrating pacifiers, bottles and breast shields:

Procrastinate on pacifiers. Ban the binky for at least a month after birth, says pediatrician Cynthia Howard, M.D., M.P.H., president of the Academy of Breastfeeding Medicine. "Mothers of babies who use pacifiers before they're 30 days old are 20 percent more likely to end breastfeeding earlier," she adds. But once nursing is well-established—typically around four weeks—soothing your baby with a pacifier is fine.

If you supplement, use a cup. Cups may be less confusing to newborns than bottles, says Lori Feldman-Winter, M.D., a member of the American Academy of Pediatrics Executive Committee on Breastfeeding. If you and your pediatrician decide it's necessary to give your baby extra breast milk or formula, try offering it via small, disposable paper cups. If your baby is gaining weight and nursing is going well, after four weeks a bottle or two a day shouldn't cause problems.

Shield with care. If you have flat or inverted nipples, or your baby is having extreme difficulty latching on (as is often the case with premature babies), ultra-silicone breast shields worn over the nipple can help. Weaning your baby off them can be a challenge, however, so use them for as brief a period as possible.