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| |    Breastfeeding and Nipple Confusion by Laura Jana, M.D., F.A.A.P. reviewed by Marjorie Greenfield, M.D. The basic idea behind "nipple confusion" is that babies who are offered both the breast and an artificial nipple on a bottle can sometimes have difficulty switching between the two. They can lose their desire to breastfeed, or even develop sucking problems. This "confusion" can also be created by the use of a pacifier. While nipple confusion is fairly common, some babies are able to breastfeed or bottlefeed interchangeably from birth, while others are not. Each baby is different and you can't always predict which one's will have problems. Different sucking techniques for breast and bottle The sucking technique is very different for sucking milk from a breast than it is for getting milk from a bottle. With a bottle, milk passively flows out of the nipple and requires very little effort on the baby's part, whereas breastfeeding requires the baby to latch on and actively "draw" milk out of the breast. This takes effort, and coordination of the tongue, jaw, and throat muscles. Some babies get confused if they haven't become skilled at the breastfeeding technique before being exposed to the bottle. Others simply decide to "take the path of least resistance" and refuse the breast in favor of the passive bottle method. Use of a pacifier The pacifier, too, is an artificial nipple which requires a different type of suck than the breast. Pacifier sucking can become a problem when it replaces time that your baby needs to spend nursing at the breast, both to get enough milk and to continue to stimulate your body's ongoing milk production. But pacifiers also serve a useful purpose in allowing a baby to get non-nutritive sucking (meaning that the sucking is not done to provide nutrition but to satisfy a desire to suck) without making a mother's nipples sore or requiring that she put her baby to breast for most of his waking moments. Introducing a bottle or pacifier Most parents want to know when they should (or can) introduce a bottle. This depends on how well breastfeeding has been established as well as other circumstances such as a mother's return to work or upcoming absence(s). In general, waiting until at least 3 weeks of age for a baby who is breastfeeding and gaining weight well allows your milk supply to be well-established and the technique to be mastered. As for a pacifier- the practical approach is that parents should decide if it seems to be interfering with or replacing their baby's desire or ability to nurse at the breast. If not, then there is usually no problem with allowing an infant to use one.
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