Is nipple confusion real?

Nipple confusion refers to a baby who is refusing to feed at the breast after a bottle was introduced. It is rooted in the idea that the bottle can confuse the baby due to its varying shape, flow, design, etc., leaving parents unable to figure out how they are supposed to feed at the breast.

Nipple confusion is a very real fear for many new parents—the idea that your baby may struggle to understand how to feed at the breast or the bottle is overwhelming. Every parent wants to be sure they can always feed their baby the way they need to. I balanced this concern with my own babies, and now as a lactation consultant, I work with parents every day to make sure they can make sure their baby moves between breast and bottle without issue. 

Is nipple confusion a real concern?

Most advice you might read or receive says to avoid offering the baby a pacifier or bottle within the first few weeks of life to avoid nipple confusion. But you can rest easy with the knowledge that this isn’t what is actually happening! You can feed a baby at the breast and with a bottle, all the while seamlessly transitioning between the two. If a baby is refusing the breast after introducing a bottle, we are dealing with:

1. A breastfeeding challenge that needs an IBCLC to evaluate and support.
2. A baby who is struggling with how the breast and bottle are being balanced: also something an IBCLC can address.
3. A baby who is having oral function challenges and is smart enough to tell you the bottle is easier at this moment.

Your baby isn’t confused. They are extremely smart and very good at expressing themselves.  What we have to do is listen and learn how to work with what they are telling us they need.

Understanding and addressing nipple confusion

In most cases, the issue is number 2—it’s all about balancing the breast and the bottle. As a professional, I actually recommend babies who need to feed at the bottle and the breast have the bottle introduced and used regularly within the first few weeks of life. Babies learn what we establish as normal—if your baby has always had the bottle and breast, there would be no reason for the baby to suddenly reject one if we are balancing them properly. We can’t expect a baby to seamlessly move between different methods of feeding if we are not using both methods regularly and successfully.

To support the transition between breast and bottle, I recommend choosing a bottle with a nipple that mimics the natural flex, stretch and movement of a mom’s breast. For example, 95%* of moms say that their baby accepted the nipple on Tommee Tippee’s beloved Closer to Nature bottle, due to its soft silicone nipple that feels like skin. 

Simplifying combination feeding

Parents sometimes find the idea of combination feeding to be a challenge, as bottle feeding and pumping are more work for most parents than feeding exclusively at the breast—especially when things are going well. What I recommend in these cases is that we utilize new pumping technology with wearable in-bra pumps, like Tommee Tippe’s new Made For Me™ In-Bra Wearable Breast Pump, along with feeding from bottles that seamlessly integrate with your pumping equipment to help reduce the burden of pumping on the lactating parent.  

Taking it one step further, the pump even comes with unlimited, private sessions with a lactation consultant to help support your ability to balance breast and bottle as effortlessly as possible. These sessions are also invaluable for first-time parents, as the key to successful pumping is to choose the correct flange size based on your specific nipple measurement. I’ve seen many lactating parents have difficulties with in-bra wearable breast pumps because they are using the incorrect flange size for their nipple size.

Infant feeding technology is getting more and more intuitive—and technology like this helps to reduce the burden on parents to feed their babies the way their lifestyles and needs demand. Nipple confusion does not have to be a part of your feeding journey! If you are struggling to balance feeding from the bottle and the breast, get connected with an IBCLC as soon as possible.

A version of this story was originally published on July 30, 2023. It has been updated.