How to Prevent Nipple Confusion When Expressing Breast Milk

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how to prevent nipple confusion

If you’re a breastfeeding mom who needs to be temporarily separated from baby, your solution is to express milk and feed via a bottle. Someone may have mentioned the term ‘nipple confusion’ and now you’re worried that a bottle will cause breastfeeding problems for you and baby.

What is Nipple Confusion?

There is a difference in feeding techniques between breastfeeding and bottle feeding. When a baby has problems latching onto the breast because they have adapted to bottle or pacifier use this is called nipple confusion. Another way of describing this issue is ‘bottle preference’.

A baby at the breast will press their tongue to the roof of the mouth to effectively ‘roll’ the milk out of the breast. We all know newborns are fairly helpless, but they are born knowing how to suck, and this action is natural to a baby. It takes a lot of effort for baby to get milk out of the breast. In fact a baby will use 40 facial muscles when breastfeeding –¬† that makes us tired just reading that!


When baby feeds from a regular bottle teat it requires minimal effort. The milk will pour into baby’s mouth, even when they do not actively suck. Baby does not have much control over the milk flow and will often overfeed. It’s not difficult to see that some babies will start to prefer bottles as it means they don’t have to work so hard. A baby who has trouble breastfeeding is more prone to nipple confusion.

Avoiding Nipple Confusion

Avoid nipples for Newborns

The best way to prevent nipple confusion is to avoid introducing a feeding bottle or pacifier to a baby less than 1 month old. This ensures baby is experienced with the breastfeeding technique and your milk supply is more established. The best technique for using a bottle with a breastfeed baby is paced feeding, to mimic the rhythm of breastfeeding.

Alternative Feeding Methods

If your family situation call for early separation of mom and baby this may not be a realistic time frame. You may want to consider feeding you baby your expressed breast milk by cup feeding. This method is easier with a younger babies as they are still taking relatively small volumes each feed. Check out our advice of alternative ways to feed to baby expressed breast milk.

Choosing a Teat

In a baby over a month old using a bottle teat designed for expressed milk can help prevent them become lazy and stopping breastfeeding early. These teats try and mimic a breastfed babies action as close as possible to feeding on the breast. Allowing baby more control over the milk flow makes baby work for their milk, preventing them preferring the bottle over breast.

baby bottles2

Teats to AVOID

If you are breastfeeding a baby expressed milk in a bottle it is best to avoid these teat features:

  • Rigid
  • Very wide or very narrow base
  • Leak easily
  • Fast flow

How to Prevent Nipple Confusion

Lots of Skin to Skin

Going right back to basics with baby is the best method. It will be like starting all over again with a newborn, but they will pick it all up sooner. Ensure lots of skin to skin to so baby can smell your milk and have easy access for a feed. This will also allow you to become more aware of early feeding cues.

Learn Feeding Cues

The problem with pacifier use is that they mask babies early feeding cues. This is the point when baby should be fed. Crying is the last resort of feeding cues and baby will need to be settled before being fed. At this stage they will not have the patience to attempt a breastfeed. Feeding cues are easier to see when you have lots of skin to skin with baby.

Start your let down

Stimulating your let down is why some babies are reluctant to feed at the feed. This can take up to a few minutes. Baby feels like he is working hard for very little reward and gets frustrated. Get ahead of the game and stimulate your let down before putting baby to the breast, this way the milk is ready and waiting.

milk let down article

How to Deal with Nipple Confusion

If you are worried your baby is refusing or reluctant to breastfeed due nipple confusion its best to consult with a lactation advisor. You may need to continue feeding baby expressed milk until the problem resolve, it’s best not to revert to formula.

A breastfeeding consultant will be able to inform you if the problem is in fact nipple confusion. Other breastfeeding issues such as incorrect positioning and attachment, tongue tie or engorgement may also cause baby to reject the breast. Here are some tips to help you deal with the problem in the short term.

Make a Sandwich

A great way to coax your baby back onto the nipple is by making the nipple firmer in their mouth. A great way to so this is by sandwiching your breast between your fingers. The breast tissue feels firmer against their tongue and give them more of a ‘grip’ to get started.

Hand Express

If your baby is getting frustrated by not getting instant milk, hand express a few drops into their mouth. This should stimulate their suckling reflex and get the breastfeed stared. Make sure baby has a nice, wide mouth before they latch to your nipple.

Nipple Shield

If you are really struggling to get baby back  onto the breast, you can try a nipple shield as a last resort. They are not recommended for long term use as they can reduce your milk supply. However they may be enough to coax your baby back onto the breast in the short term.