Nipple confusion or bottle preference

Will my baby still breastfeed after using a bottle?

Babies sometimes prefer bottles to breasts. This is called nipple confusion or, more accurately, bottle preference. It may happen because the mother has a very low milk supply, because the baby can’t latch, or simply because it’s easier to get milk out of a bottle. The danger of bottle preference is that it leads to less breast stimulation, a lower milk supply, and then an even stronger preference for the bottle. The bottle is unlikely to cause a bottle preference if used only a few times a week. The risk rises when bottle-feeding is frequent. If mothers use a bottle, they should breastfeed before bottling whenever possible, bottle supplements in appropriate amounts, and if not breastfeeding, express for each of the baby’s feeds. If the baby seems less happy to breastfeed and more interested in the bottle, mothers should change their supplementing tool.

A) Describing nipple confusion

Babies who breastfeed and use bottles may come to prefer the bottle. This is sometimes called nipple confusion, although we prefer the term bottle preference. These babies are not confused; they are very definite in their views!

B) Reasons for preferring the bottle

The cause of bottle preference is uncertain. There are two possibilities (Zimmerman 2015): 

  1. The bottle is given because the baby is having breastfeeding problems.
  2. Bottle preference is caused by simply giving an artificial nipple.

In our experience, the first option is much more common.

1) Breastfeeding problems that can result in bottle preference

a) The mother has a very low milk supply

Babies may prefer the bottle if the mother has a very low milk supply. The lower the supply, the higher the risk of developing this preference. Mothers who make less than 250 millilitres (8 U.S. fluid ounces) of breast milk a day are at high risk of this.

b) Going longer between feeds

Bottles can cause breastfeeding problems because when compared to breastfeeding, babies tend to take more milk from bottles at each feeding and babies are satisfied for longer periods. This results in fewer breastfeeds per day and less breast stimulation. From there, the milk supply may decrease, which leads to more bottle-feeding and so on. This is a predictable effect of bottle-feeding. 

c) Babies who cannot breastfeed

Some babies are born with latching problems, so bottles are introduced to supplement the baby. The bottle is often blamed in these situations. However, the bottle was the response to the problem and not the cause of it.

2) The baby’s exposure to bottles

Bottle-feeding is unlikely to cause problems if used only a few times a week and the mother expresses for every missed feed. The risk of a baby preferring the bottle rises if there is frequent bottle-feeding. Like us, some babies develop certain preferences. 

C) How to prevent and fix bottle preference

Most babies are flexible and will switch from breast to bottle and back but it is generally best to minimize bottle use and wait until breastfeeding is going well. This is usually by six weeks after birth.

When bottle-feeding, ensure that the breasts remain properly stimulated:

If the baby shows signs of being less happy to breastfeed after bottle-feeding, the supplementing tool should be changed. In this situation, the tube-at-the-breast system can be useful.

References

Zimmerman E, Thompson K. Clarifying nipple confusion. J Perinatol. 2015 Nov;35(11):895-9