Can Artificial Nipples Hurt Instead of Help?
By Michele St. Martin
Nipple confusion, also known as nipple preference, can occur when artificial nipples are introduced to babies before breastfeeding is well established. It happens because the baby learns to use the artificial nipple of a bottle or pacifier, and then has a hard time making the adjustment to the different way of sucking at the breast.
There are some members of the medical community who question whether nipple confusion exists, but most lactation consultants will tell you that they see it frequently. As with most other difficulties new breastfeeding mothers may experience, nipple confusion can be overcome.
The Cause
Babies who experience nipple confusion prefer the ease of drinking from a bottle with an artificial nipple to the “work” of nursing at the breast. Nipple confusion can take one of three forms:
- A baby may accept the breast but refuse to suck.
- A baby may refuse the breast altogether.
- A baby may attempt to suck but latch incorrectly.
The latter is what happened to Alttara Scheer of Hartsdale, N.Y. Scheer’s son, Cullen, experienced a severe case of nipple confusion – he spent the first few days of his life in the NICU, and she wasn’t permitted to nurse him for the first day. On day two, Scheer began to breastfeed her son, but was told that her son couldn’t come home until either her milk came in or until she gave permission for Cullen to drink formula. “Of course, I wanted my baby home with me!” she says. “The sooner the better. And, since I was initially not allowed to breastfeed him, my milk was slow to come in.” Scheer agreed to the formula (“Under duress!”), and that was the beginning of two and a half months of agony.
Her son’s nipple confusion led to “agonizingly painful” nipples and a bout of thrush that took Scheer more than two months to clear up. Not only did the hospital insist on the formula, they also gave her son a pacifier despite the sign on his isolette stating, “Exclusive Breastfeeding.” Scheer feels that the introduction of the pacifier aggravated the problem.
Fortunately, cases like Scheer’s are becoming less common, according to Ann Calandro, BSN, RNC, IBCLC. Calandro says that hospitals are becoming more “baby friendly” and giving bottles less often.
Calandro also says that nipple confusion is most likely to occur in the baby’s first month of life. “Lactation consultants always recommend that (babies) receive no bottles in the early days,” she says. “They need to learn correct breastfeeding first.” Calandro advises waiting to introduce a bottle until breastfeeding is firmly established.
Sometimes nipple confusion occurs because of a well-intentioned act: introducing a bottle so that the baby’s father can bond with the baby through feeding. There are many other ways for Baby and father to bond besides the father feeding the baby, says Calandro. Scheer agrees, saying that her husband did “everything but feeding! Changing, holding, just spending time with the baby. Eye-to-eye and skin-to-skin contact.”
Dawn Berry of Kennedale, Texas, echoes this, adding that her husband, David, talks to their baby, Trey, a lot. “Trey has always responded to David’s voice,” she says. “There are times that the only thing that soothes Trey is David’s voice.”
The Difference
In order to fully understand nipple confusion, it’s necessary to understand how a baby experiences breastfeeding differently than bottle feeding. “At the breast [the baby] is in control,” says Calandro. “He nurses. He breathes. He rests. He is calm and his oxygen levels remain high. On the other hand, bottle-feeding is passive. The bottle is poked in the baby’s mouth, usually just in the front of the mouth and wiggled around. The flow begins. Many bottles flow very quickly, rather like a funnel. Very little pressure must be exerted from the lips to begin the rapid flow. Many times the baby tenses up while drinking a bottle, clenches his fists and learns to hold his tongue back to keep the rapid flow from choking him. He gets very little time to rest. His oxygen levels decrease. His tummy fills rapidly.”
Introducing a Bottle
If a mother wants to introduce a bottle at some point – perhaps it’s necessary at times for her to pump her milk for feedings while she’s not home – when’s the best time to do this? Calandro admits this is a tricky call to make. “There is a little window when bottle-feeding is easiest to teach, and for most babies, that is around 4 to 6 weeks,” she says. Trying too early could lead to nipple confusion, while waiting too long might have the effect of the baby refusing the artificial nipple due to dislike of the taste or flow.
This was Berry’s experience. She was blessed with a good nurser in her son, Trey. Berry was afraid of nipple confusion and subsequently waited what she now feels was too long to introduce Trey to a bottle. He never took to the bottle, and Berry gave up trying. She now wishes she’d done things differently. “As strong a nurser as Trey was and still is, he probably wouldn’t have been too adversely affected by my trying a bottle sooner,” she says. “There definitely have been times that having the option to give him a bottle would be nice.”
Catherine Foster has experienced both ends of the spectrum. Her daughter experienced nipple confusion when Foster gave her a pacifier. “[The baby] wanted to nurse 24/7 from the very beginning, and I was getting sore,” she says. “I knew about nipple confusion and everything, but I was desperate. And sure enough, it caused her to start nursing wrong.”
Foster, who attended La Leche League meetings, called her La Leche Leader for suggestions about nursing and how to deal with sore nipples. With patience and persistence, she was able to get her daughter to nurse properly. However, she says, “Neither of my children would take an artificial nipple once they were established in nursing.”
If nipple confusion does occur, Calandro encourages moms to seek professional help. She also counsels that all bottles be stopped and suggests frequent skin-to-skin contact between Mom and Baby. “Use a cup to feed for a day … meanwhile Mom should pump to keep her milk supply up and to obtain breast milk for her little one,” Calandro says. “Patience, patience and more patience!”
