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Health & Fitness

Nipple Confusion: A Misnomer

Welcome to my blog! It is my observation as a baby nurse, with experience caring for many thousands of newborns, that "nipple confusion" is not what it seems.

Babies Are Smart
When you introduce a bottle to a baby who is learning to breastfeed, some babies do refuse to nurse at the breast again ... temporarily. This is what lactation consultants call "nipple confusion." But, I believe your baby is not "confused" but is simply choosing the path of least resistance. 

The Flow of Milk
At the very beginning of feeding it's easier for your newborn to get milk from a bottle than from your breast. Milk from a bottle flows easily and immediately. With the first suck your baby gets a mouth full of milk, and instant gratification.

But breastfeeding is different. Getting milk from your breast requires some sucking without reward until letdown (release of milk from the glands) allows the milk to flow easily. This translates to more work for your newborn.

When your baby has fed from a bottle, and is still learning to breastfeed, your baby may get impatient with breastfeeding when the milk does not flow immediately. Your smart baby made a discovery, and is simply wanting the path of least resistance. There is no confusion about it.  

Helping Your Baby
There are some things you can do to help your baby successfully transition from bottle back to breast. Not all babies find this challenging, but here are some tips that should work for both of you if needed.

You may express some milk with your hand or a pump to stimulate letdown and get the flow of milk started before you put your baby to breast. This readily available milk makes it easier for your baby to get instant gratification without too much work.

You may also leave some expressed milk on your nipple to give your baby the smell and taste that promotes a good latch (that is, a wide-open mouth as full of mom as possible). A good latch helps your baby get the milk more easily.

You might also try putting your baby to breast before fully awake, letting natural sucking cues take over while your baby is still sleepy.

My Experience
My plan for feeding my baby was to exclusively breastfeed, but I recently learned (while writing the breastfeeding section of my book Newborn Baby Manual) that my Mom and sister sneaked in a few bottles of formula. Thank goodness!

As a first-time mom I believed that I was supposed to automatically know how to breastfeed since the nurses in the hospital did not offer to help me. At feeding times my son did more sleeping than feeding, and when the nurses asked how it went I would tell them he wasn't really hungry. I didn't know then what I know now. I can only assume he was given a bottle when he was taken back to the nursery. I finally got help with breastfeeding in the ER when I took my son for what I thought was projectile vomiting. After the exam and X-ray the doctor was surprised to report that he was "90% air!" The problem, he said, was a poor latch. The ER nurse spent a few moments with me, showing me how to obtain a proper latch ... as defined above, a wide-open baby mouth as full of mom as possible for a deep latch. So much better!

I continued to successfully breastfeed my son for 14 months, despite the bottles he had in those early days of learning. Feeding from a bottle simply gave him the nourishment he needed at the time until I was able to learn how to breastfeed.

In the hospitals, caring for those thousands of newborns, I witnessed the same success repeatedly. In fact, in some cultures, new moms chose to supplement breastfeeding with a bottle until their milk supply was well established. Their babies learned to breastfeed well.

Both Ways
So you see, it is possible to introduce a bottle to your newborn who is learning to breastfeed, and be successful with breastfeeding. It just may take a little patience, understanding, and perhaps a little help too.

For you and yours,

D. Fravert, RN 
www.newbornbabymanual.com

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