Introducing Bottles and Pacifiers to a Breastfed Baby

by Anne Smith, IBCLC

Many babies switch forth effortlessly between breast and bottle from day one. Others become "nipple confused" if artificial nipples are introduced during the early days of nursing.

The mechanics of breast and bottle-feeding are quite different. When a baby nurses, his tongue and jaws must work together rhythmically, cupping his tongue under the areola, and pressing it up against his palate. This flattens and elongates the tissue around the nipple. He then drops the back of his tongue to form a groove for the milk to flow from the nipple to his throat. He swallows, then takes a breath. His lips are flanged out tightly around the breast to form a tight seal.

When a baby drinks from a bottle, the milk gushes out (you'll notice that the milk drips out if you hold a bottle upside down). In order to keep from choking, he lifts his tongue uses it to block the flow of milk. He purses his lips around the hard rubber nipple, and he doesn't have to use his jaws at all. There is a constant flow of milk that he doesn't have to work for, unlike during breastfeeding, where the milk "lets down" initially, then slows to a trickle, and the process repeats as the baby sucks harder and longer. This occurs several times during a feeding, and is one of the reasons breastfed babies are less likely to become obese than bottle-fed babies: they regulate their own intake by how long and vigorously they suck. Bottle-fed infants will often finish a bottle not because they are hungry, but because they love to suck, and the milk flows so easily.

The risk of nipple confusion , whether by introducing a bottle or pacifier, is greatest during the early days of nursing. The longer you wait to introduce artificial nipples, the less risk there is of confusing your baby. Breastfeeding is a learned behavior, in most cases, although there are some babies who seem to be born knowing exactly what to do. Although sucking is a newborn reflex, the mechanics of effective latching on aren't. It usually takes a couple of weeks, and sometimes longer, for mothers and babies to get really good at nursing. By that time, any problems you had in the beginning, such as engorgement or nipple soreness, should be pretty much resolved, and your baby's pattern of weight gain should be established.

If nursing is going along smoothly, there should be no reason to use artificial nipples in the first few weeks of breastfeeding. Nursing frequently and using the breast as a pacifier are what builds a good milk supply and helps you and your baby develop a special closeness during the period immediately after your baby's birth. Use the fact that you are exclusively nursing during the first few weeks to get more rest. Let friends and family wait on you, do your laundry, cook for you, etc. You have a perfect excuse. Yes, if you gave the baby bottles, someone else could take over a feeding while you slept, but missing that feeding during the early weeks while you are establishing your supply for your baby who is growing so quickly during that time may decrease your milk production. Once your supply is well established, skipping occasional feedings won't be a big deal. Your time of baby's total dependence on you will last for a very short time, although it can seem like forever when you are overwhelmed with the twenty-four/seven responsibility for this little person at a time when you are physically exhausted, emotionally drained, and sleep deprived. Nobody ever said it would be easy, and if they did, they were either lying, or they never nursed a baby.