Hardly any image conveys as much harmony and peace as a baby drinking milk from the breast with devotion. But appearances are deceptive. What seems so peaceful and natural is actually hard work for your baby.
To actually coax milk from the breast, the infant has to exert themselves. A baby first has to learn the right technique to drink effectively from the breast. Although there is the innate sucking reflex, there is more to breastfeeding at the breast.
This learning process can be disrupted in the first weeks of life by aids such as pacifiers and bottles – nipple confusion arises. But what can indicate such nipple confusion? What if your baby goes on a nursing strike? And is it even possible to avoid nipple confusion? You will find answers to these questions in this article.
Signs of nipple confusion
If your baby suffers from so-called nipple confusion, it has difficulty drinking or sucking at the mother's breast. This can happen if different sucking alternatives were repeatedly offered to it in the first weeks after birth – for example, the nipple, the pacifier, and the bottle nipple.
Infants are not yet cognitively developed enough to assign the nipple, bottle, and pacifier to the different sucking methods. Nipple confusion, by the way, has not been known for very long. It was only in 1995 that this phenomenon was scientifically described for the first time in the USA under the term "Nipple Confusion". Since then, more has been known about the causes and the background.
Other causes of nipple confusion
Hard to believe, but some babies have already adopted the wrong sucking reflex in the womb because they were always sucking on their thumb there. Sometimes, incorrect latching can also lead to nipple confusion. So-called nipple shields can also be problematic. As a result, the baby forgets how the breast must be encompassed to empty it optimally. It is not uncommon for such breastfeeding problems to result in milk stasis or mastitis.
How do I recognize nipple confusion?
There are some indications of nipple confusion. If your child shows the following behaviors, you should be alert.
- Your baby sucks a lot, but it is not effective because it does not manage to drink anything.
- It is noticeably restless when drinking, fidgets and sometimes it pushes the breast away.
- Once it has latched on, it loses the nipple again and again.
- It pulls its cheeks in noticeably.
- Your baby does not manage to empty the breast sufficiently or to stimulate the let-down reflex.
- It sucks, lets go again, and so on. It often cries in the process.
- It refuses the breast, despite an increased need to suck.
- Your baby wants to be at the breast more than usual without actually sucking at the breast.
Breast, bottle, or pacifier: How nipple confusion arises
For the breast milk to flow, the baby must already perform highly complex movements when breastfeeding. However, the optimal interaction of lips, jaw, and tongue is not that easy for a newborn. Many mothers therefore find it practical that the little one is also fed with the bottle in between, which is much easier and less complicated for the child.
However, when mothers pump or supplement, this can lead to confusion if the child is supposed to drink from the bottle at times and from the breast at others. It cannot yet understand why it is so terribly exhausting with one and works quite effortlessly with the other. If the baby is then also given a pacifier, the chaos is complete and nipple confusion can occur.
Difference between sucking at the breast, the bottle, and the pacifier?
Sucking at the breast is by far the most difficult for your baby. It is much easier at the bottle because it does not have to open its mouth as wide and does not have to perform a special movement with its tongue as when sucking at the breast. It is enough to press the nipple against the palate. The confusion arises because the milk sometimes comes very easily and sometimes only with great effort. Since this happens to the child seemingly without connection, it triggers confusion and frustration in them. Incidentally, nipple confusion can also occur if you exclusively breastfeed your baby but additionally offer them a pacifier.
What to do if the baby has nipple confusion?
Although there is no guarantee of success, you may be able to resolve the nipple confusion with the following tips. The most important advice right at the beginning: be patient with your baby and yourself:
- It is best not to give your child a nipple or pacifier from the start. It should be fed exclusively with the breast of the mother or the breastfeeding person.
- If your baby rejects the breast or even refuses the breast, this may be due to overstimulation. Put your baby to the breast when it is still half asleep. Ensure a quiet environment with as few stimuli as possible and a comfortable breastfeeding position. Close physical contact between mother and child also has a calming effect.
- If you stimulate your nipples before breastfeeding so that a little milk already escapes, you make it easier for your baby to suck because the milk flow has already started.
If these tips are also not successful, it is best to contact a midwife or a lactation consultant you trust who is familiar with the topic of nipple confusion. It is important that you do not lose patience and do not hold your baby responsible for the nipple confusion.
How can nipple confusion be prevented?
The good news is: not all babies get nipple confusion. However, of course, you don't know in advance whether your own will be affected or not. Therefore, it is recommended not to supplement yet and also not to switch to bottle feeding as long as the baby is still learning how to drink correctly at the breast in the first days and weeks. Pacifiers should also be avoided during this time.
Wait a few weeks with both until you notice that the baby has mastered drinking at the breast safely. After a few weeks, the sucking process has solidified into a routine through practice several times a day. This learning and habituation process can take about six weeks and should not be interrupted if possible, so as not to jeopardize the breastfeeding relationship.
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