Worried about nipple confusion? Try these smart strategies to help bottle feeding and breastfeeding work well together.
Almost all breastfeeding moms have times when they need to be away from their babies, whether they are working or just want to go out for a "date night" every now and then. And that means your baby will need to eat from a bottle, not the breast, in your absence. Mothers often worry that their babies will start to prefer bottle feeding over breastfeeding, or that they will they become "nipple confused."
In my work as a lactation consultant, I get tons of questions about nipple confusion—whether it exists and what they can do to prevent it. The answer depends on the baby. Some babies have no issue switching from bottle feeding to breastfeeding. But others absolutely do have an issue, and will start to become fussy at the breast, or even refuse the breast altogether.
The reason why this happens is simple: bottle feeding is sometimes easier for babies to manage than breastfeeding. Bottle nipples are firmer and often less difficult to latch on to. And unlike breastfeeding, where the flow is determined by how fast and strong the baby sucks, bottles flow more consistently—and often a bit faster than the breast.
But don't fret. If your baby is having an issue switching between breastfeeding and bottle feeding—or if you just want to prevent this from happening in the future—there are some concrete actions you can take to make bottle feeding and breastfeeding work well together.
- Buy the slowest flow bottle nipples. "Many moms fear nipple confusion, but mostly what we see is flow preference," says New York-based lactation consultant Leigh Anne O'Connor. "If the bottle is too fast, then the baby does not have to use his muscles the same way he does at the breast. With this in mind, I encourage a slow flow bottle." O'Connor adds that you don't need move up a size as the baby grows, and it's best to stay with the slowest possible nipple for the entire time you are trying to balance bottle feeding and breastfeeding.
- Encourage your caregivers to practice something called paced bottle feeding. In a nutshell, paced bottle feeding is an attempt to mimic the tempo and feel of breastfeeding while you bottle feed. It's recommended that caregivers feed babies on demand and not on a schedule. It is useful to hold the baby upright and hold the bottle horizontally, so that the milk doesn't flow too fast down the baby's throat. Give the baby lots of pauses and check in with the baby frequently to see if it's time for a break. For more details, see this La Leche League handout on paced bottle feeding.
- A good milk supply = a happy baby, so make sure you pump every time your baby receives a bottle. It can be hard to keep up with pumping, especially while you're busy working, but pumping as frequently as you breastfeed is important for keeping up your milk supply. A hearty milk supply will keep your baby happy and content at the breast.
- Make sure your caregivers know that there are other ways to soothe a baby besides bottle feeding. Some caregivers are quick to offer a baby a bottle anytime it fusses, but it's useful for caregivers to know that there are other options, including rocking, shushing, putting the baby down for a nap, and pacifiers for when babies want to be soothed but aren't hungry. This will avoid overfeeding and unnecessary reliance on bottles.
- Nurse your baby often when you are together. It can be tempting to begin to use bottles for relief even when you are with your baby. Of course, the occasional bottle won't hurt, but you want to take advantage of the time you are together to solidify your breastfeeding relationship, so try to breastfeed as much as possible then.
- Don't be surprised if your baby wants to nurse very frequently when you come back. Many babies want to make up for lost time and will nurse a lot when they are with you. Rachel O'Brien, a Boston-based lactation consultant, explains why this is actually a good thing. "When babies are separated from their nursing parent, they often make up for lost time by eating less milk from the bottle and breastfeeding more whenever possible," O'Brien explains, "We call this 'reverse cycling'—for example, some babies end up nursing more often during the nighttime hours and eating very little during the day. Reverse cycling is a great way to protect your breastfeeding relationship, though it can be exhausting!"
Perhaps the best advice I can give a mother who wants to make sure her baby doesn't begin to prefer bottle feeding over breastfeeding is to make sure to keep to make your breast a place of comfort for your baby. Breastfeeding is not just a feeding method—it's a way to bond with your baby. Keeping that in mind, and remembering to offer the breast for comfort as well as food, will help keep your breastfeeding relationship alive despite the separations you and your baby face.
More than anything else, support is important when you are experiencing challenges with breastfeeding. Make sure to reach out to friends who have balanced breast and bottle, and don't be afraid to contact a lactation consultant or breastfeeding counselor if you want advice tailored to your specific situation.