Newborn “Nipple Confusion” Should I Worry?
Introduction
Hi all, we hope you are well during these turbulent times! Today we will be hearing from our very own IBCLC Margaret Willis as she talks about a phenomena in the breastfeeding community called Nipple Confusion. For almost 30 years, first as a volunteer and then IBCLC, Margaret has walked alongside diverse families in their breastfeeding journeys. With empathy and humor, she listens to parents’ individual stories to better work with them on practical solutions. She can help with all ages and stages: the early weeks’ intense learning curve; worries about weight gain, feeding skills or supply; the return to work and pumping transitions; and sometimes hard-to-untangle questions with charming older babies and toddlers. As always, we hope you enjoy!
“Nipple confusion in breastfed newborn ” is a phrase that causes…well, confusion. Is it a myth and not a real concern? Or, conversely, a dire certainty? The phrase exists because feeding is a complex skill, and the breast and bottle involve different muscles, oral signals and rhythms. Humans have covered the planet because we’re adaptable. So enough young babies can toggle between breast and bottles right from the start, that some may pooh-pooh the idea of confusion. But tell that to a new family struggling with a formerly latching newborn, now crying at the breast. Some breastfeeding supporters reframe the problem as “nipple preference’ or “flow preference”—that the baby, likely already been having initial breastfeeding difficulties, finds bottle’s unnaturally firm oral signal or easy flow a relief. But parents don’t care about terms – they want to know how to head off such struggles, or get a non-latching baby back on the job.
A newborn is wired for breastfeeding, and unaware of recent ideas like bottles. So welcome your baby to the world with skin-to-skin contact, to cue them to feed frequently in those early hours and days. Under normal circumstances, avoid unneeded bottles, and focus on helping a baby hone their breastfeeding skills across those early weeks, before introducing a bottle (a tool that families commonly needed in the modern world).
But that rosy scenario is not the first chapter of many breastfeeding stories. According to recent CDC statistics, more than 17% of breastfed babies get bottles in the hospital; others start supplements at early well-baby visits for similar concerns with weight, diaper output, jaundice, blood sugars, temperature stability, feeding ability or energy levels. A medically indicated supplement can be a tough judgement call. With true concerns, the first rule is always to “feed the baby” – they need energy to breastfeed better. Supplements can buy time. The best supplement is your own milk, so begin pumping to provide at least some of the medically indicated supplement and start chipping away any needed formula or donor milk.
While other temporary supplementing methods offer certain advantages, bottles are culturally familiar. If a newborn (or older baby) has to learn about a bottle, use some slow- paced methods encourage some breastfeeding behaviors of a wide mouth and an active, jaw-dropping suck. And perhaps “dessert” back at the breast to keep them enjoying and learning about the real deal. And hope that your baby is one of the adaptable souls happy to feed on whatever comes their way.
Feeding is an expected activity for any newborn mammal – so if the baby needs supplements and/or is getting upset with the breast, the family also needs focused help from a knowledgeable IBCLC. Parents quickly and rightly realize that they can’t battle the baby about feeding –they are wooing their child along in the learning.
A few other tips on wooing along a non-latching baby:
Cuddle the baby upright on your chest, perhaps skin to skin and wait until they organize and seek the breast – big or small, people need to feel that everything is their idea!
Help the baby exaggerate a wide “sandwich” of breast, deep enough to trigger the suck (and compete with the strong signal of a bottle).
If they are doing anything like a latch, compress the breast to give them some flow – nothing convinces a baby like milk.
Discuss with your IBCLC whether a silicone nipple shield might be a temporary “training wheels” to give the baby an easier target
Protect the supply with frequent pumping – it’s easier to woo a baby to breastfeed if their efforts are rewarded with milk.
A non-latching newborn is a stressful situation for loving parents. Some may decide to pump exclusively, and should be applauded for every drop the baby gets – “just” pumping is huge, ongoing effort. But do not rush to that idea, or too quickly count out the non-latching baby – try to buy them some time to learn. As long as the feeding effort stops when either of you are upset, there’s no downside to frequent practice sessions, which provide valuable touch and face-to-face interaction. Keep looking for clues in the baby’s better efforts. A baby who’s having initial difficulties gains so much when the parents can help them stay in the game. After all, if your child wasn’t the Michael Phelps of swimming right from the start, you’d still want to them out there splashing and getting better.