‘Nipple confusion’, ‘nipple preference’ or ‘flow preference’ is often used to describe a change in a baby’s sucking pattern or their willingness to breastfeed following the introduction of a bottle or dummy. A baby may have difficulty latching or staying on the breast, be fussy or reluctant to breastfeed, or be unable to remove milk effectively.
Babies are ‘hard-wired’ to breastfeed, so it’s almost always possible to get back to breastfeeding using one or more of the following strategies. Your role is to calm your baby, give them access to the breast, and follow their cues. It’s your baby’s job to feed.
Close contact and skin to skin
Full body contact with your baby, particularly skin to skin, can trigger your baby’s instinct to breastfeed and help them get a deeper latch.
Laid back breastfeeding
As you recline, place your baby upon you so that their whole front is against you and they are supported by your body. Spend as much time like this as you can, skin to skin if possible. For more information, see our article on Positioning and Attachment for more information on laid back breastfeeding.
Make the breast a “safe space”
Handle your baby gently when at the breast to help them associate your breasts with pleasure. Make yourself comfortable, try to take the pressure off breastfeeding and concentrate on bonding and cuddles.
Offer the breast early
Watch for early feeding cues – head bobbing or sucking motions – so that your baby is not too hungry when you offer the breast. Pushing them onto the breast when they are upset may make things worse. Allow your baby to take the breast at their own pace to help them relax and feel in control.
A faster flow
Swallowing encourages sucking, which will help keep milk flowing. A baby who has become used to a continuous fast flow from a bottle may need help to persist at the breast. You could hand express so that milk starts flowing as soon as your baby latches. Use breast compression to increase milk flow then switch sides to trigger a fresh letdown and encourage them to continue feeding.
- Cup your hand around your breast, fingers on one side, thumb on the other.
- When your baby’s swallowing slows, or to increase milk flow, compress your breast firmly. Hold it squeezed whilst they continue to swallow.
- Release, rotate your hand and repeat. Once you have compressed all areas of the breast, switch sides to stimulate further letdowns. You can switch several times each feed.
If improving attachment and increasing milk flow are not enough, a nipple shield may help provide something firmer for your baby to latch on to. A nipple shield is a thin, silicone teat that can be placed over a mother’s nipple during breastfeeding with holes in the tip to allow milk to flow into the baby’s mouth.
A nipple shield can be a useful tool in some situations. It is then regarded as a temporary solution – a transition towards breastfeeding without shields.
Nipple shields come in different sizes – a comfortable fit is very important. A good latch is essential with a nipple shield to make sure your baby gets plenty of milk. If your baby latches onto just the tip, they may compress your nipple causing pain.
See our article on Nipple Shields or contact an LLL Leader for more information on using nipple shields effectively.
When your baby is sleepy
Your baby may take the breast and start sucking when they are asleep or sleepy. It can help to sleep close to your baby so you can easily offer the breast during the night.
Taking a bath together may encourage your baby to relax, latch and feed well. You’ll need help to do this safely. Motion can help. Offer the breast while carrying your baby in a sling, standing up, walking around, or swaying.
Often, an adjustment to the way you position your baby can help them achieve a deeper latch with a wider open mouth. This is especially important as your baby grows heavier and longer. Talk to an LLL Leader for personalised suggestions.
- Relax comfortably with your breast in its natural position. Bring baby to breast, not breast to baby. Reclining positions make this easier because your body supports your baby.
- Align your baby ‘nose to nipple’ so their mouth is in the right place to latch when they tip their head back.
- Pull your baby’s whole body close against yours, from their chest to their hips. It may help to tuck their bottom under your arm.
- Make sure their head is free to tip back so they can comfortably open their mouth wide.
- Skin to skin contact can also help your baby tune in to their natural feeding reflexes.
Bottles and dummies
Wait until breastfeeding is established to introduce an artificial teat. Using artificial teats (bottles and dummies) in the early days is more likely to cause your baby to have a shallow latch at the breast, so delay introducing these until breastfeeding is going well.
Avoid fast flow from a bottle
A baby who gets used to a rapid flow of milk from a bottle without much effort can show a preference for the bottle over time. It is perfectly possible to breastfeed without ever using bottles, but if you do use a bottle ‘pace’ the bottle feeds to slow the flow of milk. See Bottles and other tools for more information on paced bottle feeding.
Alternatives to bottles
If your baby is unable to feed at the breast or needs a supplement, you don’t need to use a bottle. Depending on how much supplement is required, you can use a spoon, syringe, cup or nursing supplementer (this provides extra milk while your baby nurses). See Bottles and other tools and also Nursing Supplementers.
If you plan to give your baby a bottle when you return to work, wait until shortly before. Your baby may accept a bottle early on but refuse it later. If your baby will be older than six months a cup can be used instead.
Nursing provides comfort for babies which is important for their development. Frequent dummy use, especially in the early weeks, may impact your milk production and your baby’s weight gain. Dummies (unlike some bottles) usually have a short teat which means babies have a partially closed mouth when sucking. If a baby uses this mouth position often, they may not open their mouth wide enough when feeding at the breast.
When an older baby or toddler suddenly refuses to breastfeed it is known as a nursing strike. Sometimes overuse of bottles and teats can contribute to the problem, but often this is due to discomfort while nursing, teething, illness, or an unpleasant experience that your baby associates with nursing. See Nursing Strikes for more information.
Time and patience may be needed
A baby’s behaviour can change suddenly, especially in response to gentle repetition, even if it doesn’t seem to be working at first. With time, most babies will breastfeed again. In the meantime, express your milk to maintain supply.
Maintaining milk production
Express your milk if your baby is not breastfeeding well. Express as often as your baby would normally nurse to maintain your milk production. This will also provide milk for your baby until they return to breastfeeding. For more information see Expressing your milk
If your milk is not being removed sufficiently, you may experience engorgement, which makes it harder for your baby to latch on and breastfeed. Gently hand express a little milk before feeding to soften the breast. Reverse pressure softening works by moving fluid away from the nipple area:
- Press all five fingertips of one hand around the base of the nipple. Apply gentle steady pressure for about a minute to leave a ring of small dimples on the areola.
- You can also press with the sides of your fingers: place your thumb on one side of the nipple and two fingers on the other side where your baby’s lips will be.
Support is invaluable when you are experiencing difficulties with breastfeeding. An LLL Leader will have experience with helping mothers and be a sympathetic listener when you need to share your feelings and find a solution. You can also attend your local LLL group meetings.
A stressful time
It can be upsetting if the very activity that soothes a baby – nursing – is a source of frustration or distress. You may feel that there’s nothing you can do. However, with the right encouragement, most babies do breastfeed again. In the meantime, offer lots of carrying and close contact.
Try other things to calm your baby:
- Singing or talking calmly.
- Holding them against your shoulder or in a sling if they don’t like to be held in a “nursing position”.
- A peaceful environment.
- Taking a walk or a bath together.
Be kind to yourself
- Deal with the challenge one feed at a time.
- Reduce commitments and chores to give yourself time to concentrate on your baby. If you have a support person, ask them for extra help.
- Express your milk. This releases oxytocin, which can be calming.
- Use relaxation techniques such as massages, music, warm baths, low lighting and deep breathing.
The Womanly Art of Breastfeeding. LLLI, London: Pinter & Martin, 2010
Dummies and Breastfeeding
Engorged Breasts – avoiding and treating
Hand Expression of Breastmilk
My Baby Needs More Milk
My Baby Won’t Breastfeed
Positioning & Attachment
Safe Sleep and the Breastfed Baby
When Mum Can’t Be There
This information is available to buy in printed form from our shop
Written by Karen Butler, Sue Upstone, Bronwyn Davies and mothers of La Leche League Great Britain.
Copyright LLLGB 2022