For nursing moms, having the flexibility to switch from breast-feeding, to bottle-feeding, and back again seems like a dream.

It would make things much simpler — like a dinner out, going back to work, or just taking a much-needed shower. But if you’re dreaming about making this a reality, you may also have concerns.

What if your baby has a hard time learning to drink from a bottle? What if your baby suddenly refuses to breast-feed? What if your baby experiences nipple confusion?

Luckily, you don’t need to worry too much. Most babies don’t have trouble going from the breast to a bottle, and back to the breast. But keep in mind that breast-feeding is a learned behavior. It’s best to avoid offering a bottle before you both become confident at this skill.

Here’s what you should know about nipple confusion and what you can do to avoid it.

What Is Nipple Confusion?

Nipple confusion is a broad term. It can refer to a baby who refuses to feed from a bottle, or one who tries to breast-feed in the same way they feed from a bottle. For a baby, the action of nursing involves coordinated movements of the mouth and jaw.

In fact, these movements are unique to the act of breast-feeding. For something that babies make look so easy, there’s a lot going on.

According to Dr. Sears, these are the mechanics of breast-feeding:

  • To properly latch on to the breast, a baby opens their mouth very wide so that the nipple and a big part of the areolar tissue can reach deeply inside.
  • A baby uses their tongue to do two things at once: hold the breast tissue in place against the roof of their mouth, and create a trough between the nipple and the areola.
  • The baby’s gums compress the areola and their tongue moves rhythmically from front to back to draw out milk.

Drinking from a bottle doesn’t require the same technique. The milk will flow no matter what a baby does because of gravity. When a baby feeds from a bottle:

  • They don’t have to open their mouth wide or create a tight seal with properly turned-out lips.
  • It isn’t necessary to draw a bottle nipple deeply into their mouth, and there’s no need for the back-to-front milking action of the tongue.
  • They can suck only with their lips or “gum” on the rubber nipple.
  • If the milk flows too quickly, a baby can stop it by thrusting their tongue up and forward.

Signs of Nipple Confusion

If a baby tries to breast-feed in the same way they feed from a bottle, they may do the following:

  • thrust their tongue up while they’re sucking, which can push the nipple out of their mouth
  • fail to open their mouth wide enough during the latch (in this case, they can’t get much milk, and their mother’s nipples will be very sore)
  • become frustrated their mother’s milk isn’t instantly available because it takes a minute or two of sucking to stimulate the let-down reflex

The last scenario can be an issue with an older baby. One example is a baby whose mother’s milk isn’t as readily available because of a schedule change like returning to work.

Longer stretches between breast-feeding can reduce your milk supply. A baby may begin to show a preference for the immediacy and ease of a bottle.

How to Avoid Nipple Confusion

The best way to avoid nipple confusion is to wait to introduce bottles and pacifiers until breast-feeding has been well-established. This usually takes somewhere between four and six weeks.

If your baby is having trouble breast-feeding after you introduce a bottle, try these tips.

  • Stick with breast-feeding if you can. If that’s not an option, try to limit bottle sessions to when you aren’t around.
  • Make sure to practice good breast-feeding techniques so you and your baby are both comfortable.
  • If your baby seems to get frustrated because your milk isn’t readily available, remedy that by pumping a bit to jump-start your let-down reflex before you nurse.
  • Don’t wait until your baby is ravenous to breast-feed. Try to time it so you both have the patience to get things right.

What if My Baby Refuses to Breast-Feed?

In the case of an older baby who shows a preference for the bottle over the breast, keep your milk supply up by pumping regularly when you’re away.

When you’re together, make time to nurture your breast-feeding relationship. Nurse more often when you’re home with your baby, and save the bottle feedings for when you’re away.

What if My Baby Refuses the Bottle?

If your baby refuses to feed from a bottle altogether, there are a few things you can try. See if your partner or a grandparent can give your baby a bottle. If that’s not an option, try to keep bottle-feeding sessions low-stress.

Reassure your baby, and keep the mood playful and light. Try to mimic breast-feeding as much as you can. Make sure there’s lots of cuddling and eye contact. You can also switch your baby to the other side halfway through the feeding to change it up. If your baby gets upset, take a break.

Experiment with different kinds of nipples, too. Look for those that will supply your baby with enough milk to keep them interested. Once your baby is exposed to the bottle and understands that it’s another form of nourishment, it won’t take long for them to get on board with the idea.

The Takeaway

There are resources available if you need help navigating bottle- or breast-feeding. Talk to your doctor if you need a recommendation for a lactation consultant, or reach out to your local chapter of La Leche League International