What to Know About Nipple Confusion

Medically Reviewed by Dan Brennan, MD on February 15, 2024
3 min read

Nipple confusion is when your baby has difficulty switching between a bottle and a breast. Babies usually use different techniques to drink from a breast and a bottle. They are born with an instinct for breastfeeding but sometimes appear to become confused after the introduction of a pacifier or bottle.

Nipple confusion is caused by introducing a pacifier or bottle after breastfeeding. It might seem like your baby forgot how to latch on to your breast. There are two types of nipple confusion.

Type A. This type occurs in younger babies who have difficulty latching onto the breast after the introduction of a pacifier or bottle.

Type B. This type happens in older babies who spontaneously begin to prefer a bottle over their parent's breast for feeding.

Many babies have no issues switching between artificial nipples and breasts. There isn't any way to tell if your child will have a nipple aversion after the introduction of a pacifier or bottle. Premature babies might be more susceptible to this condition.

The symptoms of nipple confusion in babies include:

  • Struggling to latch on to the breast
  • Crying at feeding times
  • Changes in sucking patterns during breastfeeding

The breastfeeding parent may also have symptoms, such as:

  • Breast engorgement, if your baby hasn't been drinking enough during breastfeeding
  • Less milk production

There are ways to prevent nipple confusion in your baby:  

  • Wait until your baby is at least four weeks old before introducing a pacifier or bottle
  • If your baby needs supplemental nutrition, use a spoon, syringe, feeding cup, or supplemental nursing system
  • Use skin-to-skin contact during feedings
  • Breastfeed before your baby gets hungry so they're not fussy
  • Express some milk into your baby's mouth before feeding to encourage latching
  • Keep yourself and your baby calm during feeding. You can try:
    • Singing
    • Different nursing positions
    • Getting into a comfortable position for yourself during feedings
    • Ask your partner to help during feedings
  • Try using a slow flow nipple during bottle feedings so your baby is used to the slower flow of milk from the breast
  • Try using a nipple shield while breastfeeding to see if your baby prefers the firmer feeling of an artificial nipple

Some organizations recommend never giving your baby a pacifier as long as they are breastfeeding. However, the American Academy of Pediatrics says that using a pacifier can help to prevent sudden infant death syndrome (SIDS).

Some people do not believe this condition is real. Only about half of pediatricians and postpartum nurses agree that using bottles or pacifiers can cause nipple confusion. 

Experts believe that babies who have trouble breastfeeding may be more likely to be drawn to bottles and pacifiers. So they are not sure if the bottle causes breastfeeding issues, or if the ease of bottle feedings is a solution to breastfeeding issues.

Studies have been done that support both sides of the argument.

Evidence supporting nipple confusion. One study showed that parents who introduced baby formula in the first six months of their baby's life breastfed for shorter periods of time. Experts believe this supports the theory of nipple confusion, but could also be a sign that any issue with breastfeeding, not just confusion, could lead to shorter periods of breastfeeding.

Another study showed that when compared with babies who were exclusively breastfed, those who also had bottles were 26 times more likely to stop breastfeeding.

In one study about babies who had trouble breastfeeding, researchers found that the babies were less likely to continue breastfeeding if a bottle was introduced.

Another study found that babies who used pacifiers at one-month-old were much more likely to stop breastfeeding by six months old.

Evidence against nipple confusion. One study examined the sucking patterns of babies that were exclusively breastfed, exclusively bottle-fed, and a mixture of both. The study found that babies used the usual sucking pattern regardless of the method used.

Another study restricted one group's access to artificial nipples in the first five days of life, and the other group was not. Both groups were breastfed, and there was no difference between the average length of time the babies breastfed.

A study on premature babies using pacifiers found no difference in the length of time of breastfeeding.

Regardless, if you are having issues with feeding, you can ask your doctor or a lactation consultant for breastfeeding support.