What is Nipple Confusion?

What is nipple confusion? It's a "first world problem" that happens because sucking on a rubber teat requires a very different mouth and jaw action than sucking on a real nipple.

When babies breastfeed, they relax and open the mouth wide. Next, they pull the milk out with gentle peristalsis (a wave of muscular contraction passing from the tip to the back of the tongue). Bottle-fed babies, on the other hand, open their mouths less widely and tend to bite the nipple, between the gums, to promote the flow of formula (You can imagine how that feels on your nipple!). This is what causes nipple confusion.

Signs of Nipple Confusion

If a baby is breastfed and bottlefed in the same way, they may have nipple confusion. Here are signs that your baby may have nipple confusion:

  • Your baby thrusts his tongue upwards while sucking. This movement can cause your baby to push the nipple out of his mouth.
  • Your baby doesn’t open his mouth wide enough. If your baby doesn’t open his mouth wide enough, he will not get enough milk from the latch, and the mother’s nipples will be very sore as a result.
  • Increased fussiness. If mother’s milk isn’t instantly available because your baby has nipple confusion, then this will cause a delay in the let-down reflex from the milk.

[Related: What is Baby Tongue Tie Surgery...and Does My Baby Need It?]

How to Avoid Nipple Confusion

It’s best not to use bottles and pacifiers until the nursing is going well. (Although, it’s no catastrophe if your baby gets a pacifier a few times in the hospital.) Once your baby has the hang of nursing, I recommend giving one bottle feeding per day (preferably of breast milk or—if you don’t have enough milk pumped—breast plus some warm water that you previously boiled. But don’t dilute the milk more than once a day. Frequent watered-down feedings are bad for her health.) This way, your baby will learn how to take a bottle from another caregiver, in case you get sick, become unavailable, or have to return to work.

How to Fix Nipple Confusion

You can work on reversing nipple confusion by increasing your low milk supply in order to spend more breastfeeding time with your baby. 

When to Introduce a Bottle

Wondering when to introduce a bottle to a breastfed baby? If you wait longer than 4 weeks to introduce the bottle to a baby, you may be rudely surprised by your baby’s emphatic rejection of the rubber nipple! Once you start bottles, try not to skip more than one or two days without giving one. (Some babies stubbornly refuse the bottle if their moms take too long a break.)

Final Thoughts on Nipple Confusion

Introducing a bottle to your baby’s feeding schedule can cause nipple confusion. With the above tips, you can help your baby avoid nipple confusion while getting the benefits of bottle feeding and breastfeeding. 

If you’d like to learn more about breastfeeding, check out our breastfeeding tips.

About Dr. Harvey Karp

Dr. Harvey Karp, one of America’s most trusted pediatricians, is the founder of Happiest Baby and the inventor of the groundbreaking SNOO Smart Sleeper. After years of treating patients in Los Angeles, Dr. Karp vaulted to global prominence with the release of the bestselling Happiest Baby on the Block and Happiest Toddler on the Block. His celebrated books and videos have since become standard pediatric practice, translated into more than 20 languages and have helped millions of parents. Dr. Karp’s landmark methods, including the 5 S’s for soothing babies, guide parents to understand and nurture their children and relieve stressful issues, like new-parent exhaustion, infant crying, and toddler tantrums.

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Disclaimer: The information on our site is NOT medical advice for any specific person or condition. It is only meant as general information. If you have any medical questions and concerns about your child or yourself, please contact your health provider.