Nipple Confusion

If you ask most pediatricians about nipple confusion, they will say there is no such thing. If you ask lactation specialists, they will say it is very real and the worst thing that can happen to a new breastfeeding baby. The truth is most likely in between the two ends of the spectrum. Some babies are just really good at feeding from the get-go and can go back and forth between breastfeeding and bottle feeding; no problem. Others are a bit more picky and lazy with feeds, meaning that a baby will gravitate towards the easiest method of feeding. If the boob is easier, they will prefer that. If the bottle nipple is easier, then why not go for that one? But most babies will learn to feed on both breast and bottle fine no matter when or how we introduce the bottle. The big thing is we try to have baby breastfeed first and, if needed, supplement with a bottle that has a nipple that still makes them work, and maybe even work a little harder, than if they were on the breast. We often do this by using a nipple with a super small hole. If when the baby is sucking on the bottle it’s like a firehose (just leaking out of their mouth without doing very much work at all), we should make the bottle nipple smaller— sometimes even going for a Size 0 or preemie-size nipple. Or sometimes we just want to go a half size up or down on the nipple size. No problem. If you want to take a kiddo from a Size 0 to a 0.5, just take the end of a pen and run it through the bottle nipple hole to slightly widen it.   

Now let’s say you have a baby who is a super happy breastfeeding baby, but you still want the option of a bottle at some point. We really try to introduce the bottle once a day or so after 2 weeks of age and before 6 weeks of age. After 6 weeks of age, babies lose their ability to easily go between the two options either due to preference or muscle memory.  So having a parent regularly offer a feed at night with a bottle once baby is past birthweight is good for many reasons. This gives parents the flexibility of feeding baby with a bottle for date nights and weekends away. This also gives the other parent some nice nighttime bonding and lets the breastfeeding parent get a few more zzz’s at night.