Alexiyah Coughlin, BSN, RN, IBCLC
Nursing your baby is an intricate journey, with many nuances. It’s a full-time job even without any complications. Any obstacles feel like overtime without the extra pay. It’s natural to want to avoid things that may complicate the process. Let’s talk about the elephant in the room: nipple confusion.
Nipple confusion is a term denoting a chest/breastfeeding complication, where infants may learn to favor or adapt to other suckling mediums, such as rubber or silicone. When this happens, babies exhibit difficulty with a variety of aspects of nursing: general interest, latching, patience for letdown, and milk transfer. Research shows that newborns may go through a phenomenon called “imprinting”, where they “fall in love” with the first substance they receive comfort and nutrition from. This brings many concerns to light, especially in the beginning stages of lactation, and is the foundation for global recommendations against many nursing tools, including nipple shields, bottles, and even gloved finger feeding, especially for the first newborn feeding. Because of this, companies set out to create and market “breast-like” products, claiming they would fix the implications of nipple confusion. Unfortunately, there is nothing that compares to breast tissue, and most lactation consultants would agree! But the controversy still lies with the use of these tools, and it’s important to clear the air.
Newborn Nipple Confusion & Pacifiers
Historically, pacifiers have been around since the early 20th century with the modern patent in 1901. They were originally made of natural rubber. Today, the majority of pacifiers are made of silicone and come in a variety of shapes and sizes. They are intended to serve as a comforting alternative between feeding sessions, a tool to keep babies calm.
Pacifiers are one of the most controversial tools in the world of lactation, and have been long blamed for nipple confusion. Older studies confirmed that pacifiers may interfere with the breastfeeding journey, prompting large healthcare organizations, like the World Health Organization (WHO) to come out with statements to discourage their use for nursing infants. Much of this information is outdated, with many newer, more rigorous studies available that have been unable to prove poor outcomes related to lactation and pacifier use. In light of these new studies, many professionals have adapted their recommendations, but parents are still receiving conflicted information.
The truth is, it really depends on you and your baby! Recommendations are based on what we know about the topic in general, but every baby and nursing journey is different. I always recommend ensuring that breastfeeding is well-established before introducing pacifiers. Established feeding can take a couple of days, to a couple of weeks, or even a couple of months. Some infants are well-established almost immediately. Others, especially those who are preterm, low birth weight, or who have blood sugar issues, may take a bit longer and may be more at risk for nipple confusion and other lactation complications. Once breastfeeding has been established, and you are confident in your baby’s skills, pacifier use can be a really helpful fix to “non-nutritive” sucking (when babies suck for comfort, rather than nutrition), giving parents a much-needed break. The most important thing is to be familiar with your baby’s hunger cues, and make sure you are not substituting the pacifier when the baby is needing to eat. Pacifiers can certainly interfere with on-demand nursing, but waiting for breastfeeding to be established before introducing them can reduce this issue. Pacifiers also seem to correlate with reduced risk of sudden infant death syndrome (SIDs), which is an added benefit to their use.
Ultimately, it is your own parenting decision on whether you want to use pacifiers as a tool. They’re not right for every family or every baby, but professionals should be careful to completely discourage their use to allow parents to make educated decisions based on the most up-to-date information we have.
Newborn Nipple Confusion & Nipple Shields
Nipple shields were developed in the early 17th century. Remarkably, they were originally made of lead. Thankfully, we’ve come a long way, and today’s nipple shields are produced with silicone. These are intended as a breastfeeding tool to assist newborns who have difficulty latching directly to the breast. Sometimes, this is because of flat or inverted nipple shape. Other times, it may be due to infant oral anatomy. Regardless, nipple shields are often utilized by hospital staff, but they can also be purchased in stores or online.
If we go back to the beginning of the blog and think about the process of imprinting, we will understand the controversy, especially when these are often introduced in the first days of life. They are sometimes used as a “quick fix”, without a full disclosure on the risks that might come with their use. Additionally, these are an extra step to an already busy process, and ill-fitting nipple shields can contribute to nipple damage. Furthermore, some research shows that nipple shields may blunt stimulation and decrease milk supply. Ideally, we want to avoid any barrier between human skin and the infant’s mouth. But lactation isn’t always perfect, and these tools wouldn’t have been invented if it was.
When are nipple shields a good tool?
This is another situation where we need to pay attention to each individual family! Nipple shields can save a chest/breastfeeding journey, just as often as they can impair one. Utilizing them the right way is key, and weighing the pros and cons is essential. If you need to use a nipple shield, you’ll want to make sure you’re fitted to the right size by a qualified lactation consultant to reduce nipple damage, discomfort, and decreased milk production. Using them for the least amount of time is ideal, which means working with a lactation consultant to wean the baby from the shield as soon as possible. Sometimes, their use can be completely avoided with early help from a lactation consultant. If a nipple shield is working for you and your baby, it’s a tool that you can keep in your belt.
Infant Bottle Nipples
Bottles have been around for centuries, and have evolved, just like other tools. They are intended for feeding pumped milk or formula, in the absence or inability of nursing. Newer bottles are being produced and marketed to mock the shape and texture of breast tissue, making the selection process a conundrum for families.
First of all, it’s important to know that no bottle or bottle nipple will compete with your breast. Thus, it is more important to select a bottle and nipple that suits your baby’s preferences and needs. Some babies prefer a wider nipple, while others prefer the standard nipple size and shape. It’s important to evaluate your baby’s latch to the nipple, and the response to the feeding. Excessive gassiness or fussiness after a bottle feed may signify air trapped in the infant’s stomach. This can result from a poor latch to the bottle, or a faulty ventilation system. Additionally, nipple confusion becomes a topic, especially when babies are introduced to the bottle in the first few days of life. This can be limited by a technique, called paced bottle feeding, where infants are only allowed to take milk slowly from the bottle, reducing their tendency to favor the fast flow of the bottle, over waiting for a letdown. A lactation consultant can help you learn how to pace a bottle feeding.
Bottles are a tool that are often unavoidable. Even if you are nursing perfectly at breast, it’s likely that you’ll need an alternative when you’re away from your baby. We will talk about some of the other options next, but bottles are often the favored choice, and that’s okay!
Finger Feeding & Cup Feeding
Finger and cup feeding are alternatives to bottle use when nursing is not possible or temporarily unavailable. They can also be excellent tools when a baby refuses or is unable to latch to breast or bottle. Generally, these are considered favorable by lactation professionals, but they have their downsides as well.
Finger feeding is a technique where an infant latches to a finger, with a tube or syringe that administers nutrition to the baby. This can be used with supplemental breast milk or formula, and is common in the first couple of days when lactation is compromised. Unfortunately, finger feeding is often a tedious process, and parents are usually reluctant to continue it long-term for this reason.
Of note, finger feeding is less likely to cause nipple confusion when done with a clean, ungloved finger, since it is the only alternative to nursing at breast, where the infant is exposed to human skin. It can also be a great bonding experience for the non-birthing parent.
Cup feeding is another technique, where the baby receives milk from a cup. It’s just like it sounds, where parents slowly help their baby drink milk from a cup or a spoon. This can be a great option for newborns who will not latch to a bottle, and may be a little more efficient than finger feeding for older infants. Cup feeding is considered less likely to cause nipple confusion, and some professionals may even recommend skipping over the bottle in babies who are old enough to take milk from a sippy cup, or infants who are struggling to adapt to bottle feeding after exclusively nursing for a period of time.
We are here for you!
No matter what tools you’re using, breastfeeding can be a complicated undertaking! Please feel free to leave a comment or schedule a pumping appointment with us if you still have questions. We are proud to have skilled lactation consultants on our team as a resource to pumping moms everywhere. Rumble Tuff users can schedule a FREE appointment here: https://rumbletuff.com/pumping-appointments/. You’ve got this, and we’ve got you.