Nipple confusion generally describes a baby’s inability to breastfeed effectively due to a habit picked up through bottle-feeding. Fortunately, nipple confusion is mostly avoidable. Below are some tips to help minimize the risk.

• How can I encourage breastfeeding skills when I use a bottle?
• How do I choose the right bottle?
• When should I burp my baby?
• How much milk should I feed my baby?
• What should I do if I have further questions?

How can I encourage breastfeeding skills when I use a bottle?

1. Place your baby in a sitting position in your lap so he or she can better control the flow of milk from the bottle. Avoid placing your baby on his or her back for a feed, as the flow from the bottle can be too fast and cause your baby to retract his or her tongue to control the flow − a pattern that would be counterproductive when breastfeeding.

2. Hold your baby so that his or her neck is a little extended.

3. It is very important to touch the bottle’s nipple to the center of your baby’s upper lip and wait until your baby opens his or her mouth wide, as if yawning, before starting the feed. If you give the bottle without asking your baby to open wide first, then he or she may not open wide for the breast.

4. Hold the bottle as flat as possible so that your baby must actively draw milk from the bottle. A little air in the upper part of the nipple is OK.

5. Your baby’s lips should be close to the nipple ring as he or she feeds on a standard nipple, and flanged open on the base of wide nipples. You do not want your baby sucking on only the tip of the nipple as this might cause him or her to take a shallow position on the breast when breastfeeding.
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How do I choose the right bottle?

Dr. Brown’s standard (not wide-neck) bottle is an excellent starter bottle for most newborns. It is available at Target, Wal-Mart, Planet Kids, Toys R Us, Babies R Us, and the Right Start store. The nipple on this bottle is soft with a gently flaring shape, and the vent system eliminates vacuum problems that might prevent a consistent flow. The 4-ounce size is ideal.

If you prefer a non-polycarbonate bottle, but your baby likes the rate of flow on Dr. Brown’s, you can fit the 4-ounce Dr. Brown’s nipple and vent assembly on an 8-ounce Gerber ClearView or Fashion Tints bottle, or an Evenflo glass bottle. The Adiri bottle is an option but can be tricky for a small newborn to handle.

Medela has a non-polycarbonate Breastmilk Feeding and Storage Set. The nipples that come with this set are soft and appropriately shaped.

A few babies may find that the Dr. Brown’s level 1 nipple flows too fast. You will see your baby gulp, choke and look uncomfortable if this is the case. The preemie Dr. Brown’s nipple is slower. An alternative is the Playtex VentAire standard (not wide-neck) bottle. The nipple is almost identical to the Dr. Brown’s in shape and feel, but the flow is much slower. Use this bottle cautiously. When feeding is too hard and frustrating your baby may fall asleep before finishing a feed.

Your newborn should complete a feed (the quantity will be determined by your baby’s physician) in about twenty minutes. Make sure the bottle is flowing properly. If the nipple collapses, air is not flowing into the bottle to replace the milk baby consumes. This makes it impossible for baby to feed. When using a non-vented bottle make sure you see a stream of air bubbles flowing into the milk as the baby feeds. Tighten the collar only enough to prevent leakage but not enough to prevent air inflow.

Avoid the following bottles until breastfeeding is well-established. The nipples for these bottles have a long, narrow “nipple” portion on a flat base. Your baby may learn to latch incorrectly at the breast if he or she sucks only on the narrow portion, a common problem with the small mouth of a newborn.

• BornFree (non-polycarbonate)
  
• Avent
  
• Playtex VentAire wide-neck (“NaturalShape” nipple)
  
• Playtex NaturaLatch* (non-polycarbonate)
  
• Dr. Brown’s wide-neck

* The Playtex NaturaLatch nipple may work well for an older baby whose mouth is large enough to accommodate this nipple.
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When should I burp my baby?

If your baby is feeding contentedly, there is no need to interrupt the feed in order to burp. At the end of the feed support him or her upright against your chest and pat very gently for a few minutes. Babies do not always burp.
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How much milk should I feed my baby?

Put at least half an ounce more milk in the bottle than you expect your baby to drink. Room-temperature milk is fine. Your baby’s doctor will give you an intake goal, often 16 to 20 ounces daily starting on day four. Do not limit your baby’s intake. Continue feeding until your baby refuses to suck and is content.
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What should I do if I have further questions?

If you have further questions about nipple confusion, breastfeeding or bottlefeeding, please call Lactation Consultant Joanna Koch, IBCLC, at -650-967-8715 for advice.

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