Nipple confusion

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Nipple confusion is the tendency of an infant to unsuccessfully adapt between breast-feeding and bottle-feeding. It can happen when the infant is put back onto breast-feeding. Nipple confusion can turn into nipple refusal in which the infant refuses both the bottle and breastfeeding. [1] [2]

Contents

Preventing nipple confusion requires avoiding bottles and pacifiers for the first few weeks after birth. [3] An infant that is used to feeding at the breast and gets switched to a bottle cannot use the same technique as latching on to the breast. An infant who gets used to nipple on a bottle and fast-flowing milk can have trouble making the transition.

Nipple confusion or nipple preference may occur when an infant switches from the breast to an artificial feeding method before the proper breastfeeding routine is established. [1] Young infants who are exposed to artificial teats or bottle nipples might find the switch back and forth from bottle to breast a little tricky as the feeding mechanism of both breasts and bottle differ. An infant learns to feed on different nipples differently. [4]

Causes

How an infant feeds from the breast to bottle differs. A breastfed infant regulates the suction required for the flow of milk from the breast by using small pauses to breathe and to swallow. On the other hand, for a bottle-fed infant, they do not have to create suction as the flow from the bottle allows for a continuous flow. [5] When switched back to the breast, the infant faces sudden confusion regarding the lack of continuous flow that they got adapted to. Bottle-feeding requires no serious effort whereas breastfeeding demands the usage of at least 40 muscles in the infant’s face. This could make it difficult for the infant to latch efficiently and be breastfed well after being fed from the bottle. [5]

Prevention

If the parent does not wait for the infant to perfect their breastfeeding skill, there is a risk the infant might give up breastfeeding sooner than preferred. While some infants easily go back and forth from bottle to breast, not all infants find this constant transitioning easy. However, infants are born with strong instincts to get breastfed. With patience and practice, the infant can be soothed into good feeding habits. Since there is no way to predict whether an infant might face nipple confusion, the use of a bottle or pacifier should be delayed, at least until the infant is four weeks old. [6] This allows the infant to get used to breastfeeding at an early stage. Breastfeeding is advocated for the first two to three weeks. It is important that the infant is latching on well and that the breast milk reserve is well established. In case giving supplements to the infant is medically necessary, they can be given in ways that do not involve artificial nipples. [7]

Nipple confusion can result in sub optimal nutrition for the infant and using artificial nipples is discouraged by the World Health Organization. [8] The American College of Paediatrics recommends the use of pacifiers to prevent sudden infant death syndrome. This, however, conflicts with the recommendations of the World Health Organisation to discourage the use of artificial nipples because it may cause nipple confusion and then inadequate nutrition. [8] [9] [10]

"Un-confusing" the infant

For getting the infant habituated, what is recommended is breastfeeding only when the infant is calm, not switching the infant back to the breast when they are extremely hungry, and more skin-to-skin contact (during breast-feeding) would help reacquaint them. [6] For some special instances, the usage of a nipple shield can be considered to lure the infant back to breastfeeding. [11] To switch to a bottle, a slow-flow nipple is recommended so that the infant has time to adapt to the new technique of feeding. [12] A bottle system that imitates the natural breastfeeding motions of the infant makes the transition of bottle to breast easier. [12] A parent can provide instant gratification to the infant by making it easier for them to feed from the breast. This can be done manually or by pumping your breast milk before the feeding starts, so the process of breastfeeding is a little less hard. [12] [13] Parents facing difficulties can consider a Lactation Consultant or advice from their paediatrician. [9]

See also

Related Research Articles

<span class="mw-page-title-main">Nipple</span> Part of the breast

The nipple is a raised region of tissue on the surface of the breast from which, in females, milk leaves the breast through the lactiferous ducts to feed an infant. The milk can flow through the nipple passively or it can be ejected by smooth muscle contractions that occur along with the ductal system. Male mammals also have nipples but without the same level of function, and often surrounded by body hair.

<span class="mw-page-title-main">Baby bottle</span> Bottle containing liquid (usually milk or formula) to nourish infant

A baby bottle, nursing bottle, or feeding bottle is a bottle with a teat attached to it, which creates the ability to drink via suckling. It is typically used by infants and young children, or if someone cannot drink from a cup, for feeding oneself or being fed. It can also be used to feed non-human mammals.

<span class="mw-page-title-main">Breast pump</span> Mechanical device used to extract milk from human breasts

A breast pump is a mechanical device that lactating women use to extract milk from their breasts. They may be manual devices powered by hand or foot movements or automatic devices powered by electricity.

<span class="mw-page-title-main">Breast milk</span> Milk produced by the mammary glands in the breast of a human female

Breast milk or mother's milk is milk produced by mammary glands located in the breast of a human female. Breast milk is the primary source of nutrition for newborns, containing fat, protein, carbohydrates and variable minerals and vitamins. Breast milk also contains substances that help protect an infant against infection and inflammation, whilst also contributing to healthy development of the immune system and gut microbiome.

<span class="mw-page-title-main">Pacifier</span> Rubber, plastic or silicone nipple for infants or toddlers to suck upon

A pacifier is a rubber, plastic, or silicone nipple substitute given to an infant or toddler to suckle upon between feedings to quiet its distress by satisfying the need to suck when it does not need to eat. Pacifiers normally have three parts: an elongated teat, a handle, and a mouth shield which prevents the child from swallowing or choking on it.

<span class="mw-page-title-main">Breast engorgement</span> Medical condition

Breast engorgement occurs in the mammary glands due to expansion and pressure exerted by the synthesis and storage of breast milk. It is also a main factor in altering the ability of the infant to latch-on. Engorgement changes the shape and curvature of the nipple region by making the breast inflexible, flat, hard, and swollen. The nipples on an engorged breast are flat or inverted. Sometimes it may lead to striae on nipples, mainly a preceding symptom of septation mastitis.

<span class="mw-page-title-main">Inverted nipple</span> Medical condition

An inverted nipple is a condition where the nipple, instead of pointing outward, is retracted into the breast. In some cases, the nipple will be temporarily protruded if stimulated. Both women and men can have inverted nipples.

<span class="mw-page-title-main">Supplemental nursing system</span>

A supplemental nursing system (SNS), also known as a lactation aid, is a device that consists of a container and a capillary tube. It is used to provide additional nutrients to a baby whose mother has low milk supply. During breastfeeding, the end of the tube is placed alongside the mother's nipple so that both the tube and the breast are in the infant's mouth.

<span class="mw-page-title-main">Haberman Feeder</span> Specialty baby bottle

The Haberman Feeder is a speciality bottle named after its inventor Mandy Haberman for babies with impaired sucking ability. The design of the feeder is to simulate breastfeeding.

<span class="mw-page-title-main">Nipple shield (breastfeeding)</span>

A nipple shield is a nipple-shaped sheath worn over the areola and nipple during breastfeeding. Modern nipple shields are made of soft, thin, flexible silicone and have holes at the end of the nipple section to allow the breast milk to pass through.

<span class="mw-page-title-main">Breastfeeding difficulties</span> Medical condition

Breastfeeding difficulties refers to problems that arise from breastfeeding, the feeding of an infant or young child with milk from a woman's breasts. Although babies have a sucking reflex that enables them to suck and swallow milk, and human breast milk is usually the best source of nourishment for human infants, there are circumstances under which breastfeeding can be problematic, or even in rare instances, contraindicated.

<span class="mw-page-title-main">Breastfeeding</span> Feeding of babies or young children with milk from a womans breast

Breastfeeding, or nursing, is the process by which human breast milk is fed to a child. Breast milk may be from the breast, or may be pumped and fed to the infant. The World Health Organization (WHO) recommends that breastfeeding begin within the first hour of a baby's life and continue as often and as much as the baby wants. Health organizations, including the WHO, recommend breastfeeding exclusively for six months. This means that no other foods or drinks, other than vitamin D, are typically given. The WHO recommends exclusive breastfeeding for the first 6 months of life, followed by continued breastfeeding with appropriate complementary foods for up to 2 years and beyond. Of the 135 million babies born every year, only 42% are breastfed within the first hour of life, only 38% of mothers practice exclusive breastfeeding during the first six months, and 58% of mothers continue breastfeeding up to the age of two years and beyond.

<span class="mw-page-title-main">Lactation</span> Release of milk from the mammary glands

Lactation describes the secretion of milk from the mammary glands and the period of time that a mother lactates to feed her young. The process naturally occurs with all sexually mature female mammals, although it may predate mammals. The process of feeding milk in all female creatures is called nursing, and in humans it is also called breastfeeding. Newborn infants often produce some milk from their own breast tissue, known colloquially as witch's milk.

Infant feeding is the practice of feeding infants. Breast milk provides the best nutrition when compared to infant formula. Infants are usually introduced to solid foods at around four to six months of age.

<span class="mw-page-title-main">Infant food safety</span>

Foodborne illness is any illness resulting from the food spoilage of contaminated food, pathogenic bacteria, viruses, or parasites that contaminate food. Infant food safety is the identification of risky food handling practices and the prevention of illness in infants. Foodborne illness is a serious health issue, especially for babies and children. Infants and young children are particularly vulnerable to foodborne illness because their immune systems are not developed enough to fight off foodborne bacterial infections. In fact, 800,000 illnesses affect children under the age of 10 in the U.S. each year. Therefore, extra care should be taken when handling and preparing their food.

Cracked nipple is a condition that can occur in breastfeeding women as a result of a number of possible causes. Developing a cracked nipple can result in soreness, dryness or irritation to, or bleeding of, one or both nipples during breastfeeding. The mother with a cracked nipple can have severe nipple pain when the baby is nursing. This severe pain is a disincentive for continued breastfeeding. The crack can appear as a cut across the tip of the nipple and may extend to its base. Cracked nipple can develop after the birth of the infant and is managed with pharmacological and nonpharmacological treatment.

A blocked milk duct is a blockage of one or more ducts carrying milk to the nipple for the purpose of breastfeeding an infant that can cause mastitis. The symptoms are a tender, localised lump in one breast, with redness in the skin over the lump. The cause of a blocked milk duct is the failure to remove milk from part of the breast. This may be due to infrequent breastfeeding, poor attachment, tight clothing or trauma to the breast. Sometimes the duct to one part of the breast is blocked by thickened milk. A blocked milk duct can be managed by improving the removal of milk and correcting the underlying cause.

<span class="mw-page-title-main">Latch (breastfeeding)</span> The way a baby fastens onto the breast while breastfeeding

Latch refers to how the baby fastens onto the breast while breastfeeding. A good latch promotes high milk flow and minimizes nipple discomfort for the mother, whereas poor latch results in poor milk transfer to the baby and can quickly lead to sore and cracked nipples. In a good latch, both the nipple and a large portion of the areola are in the baby's mouth.

In breastfeeding women, low milk supply, also known as lactation insufficiency, insufficient milk syndrome, agalactia, agalactorrhea, hypogalactia or hypogalactorrhea, is the production of breast milk in daily volumes that do not fully meet the nutritional needs of her infant.

Nipple pain is a common symptom of pain at the nipple that occurs in women during breastfeeding after childbirth. The pain shows the highest intensity during the third to the seventh day postpartum and becomes most severe on the third day postpartum.

References

  1. 1 2 "Nipple Confusion? - La Leche League GB". 2 February 2016. Retrieved 12 August 2017.
  2. ↑ Association, Australian Breastfeeding (2011-07-08). "Breast refusal". Australian Breastfeeding Association. Retrieved 2018-10-27.
  3. ↑ "Your Guide to Breastfeeding" (PDF). Office on Women's Health. Archived from the original (PDF) on 17 October 2020. Retrieved 8 October 2018.
  4. ↑ "Nipple Confusion | Ask Dr Sears® | The Trusted Resource for Parents". Ask Dr Sears. Retrieved 2018-10-27.
  5. 1 2 "what is nipple confusion".
  6. 1 2 "How to Avoid Nipple Confusion for the Breastfed Baby - Newborn Nurses | Cindy and Jana". Newborn Nurses | Cindy and Jana. 2015-01-23. Retrieved 2018-10-27.
  7. ↑ "Alternatives To Bottles | Ask Dr Sears". Ask Dr Sears. Retrieved 2018-10-27.
  8. 1 2 Huang, Ya-Yi; Huang, Chiu-Mieh (1 April 2006). "Nipple confusion and breastfeeding: a literature review". Hu Li Za Zhi the Journal of Nursing. 53 (2): 73–79. PMID   16602050.
  9. 1 2 Zimmerman, E.; Thompson, K. (1 November 2015). "Clarifying nipple confusion" (PDF). Journal of Perinatology. 35 (11): 895–899. doi:10.1038/jp.2015.83. PMID   26181720. S2CID   33481081. Archived from the original (PDF) on 13 August 2017. Retrieved 12 August 2017.
  10. ↑ O’Connor, Nina R; Tanabe, Kawai O; Siadaty, Mir S; Hauck, Fern R (2009). "Pacifiers and breastfeeding: a systematic review". Archives of Pediatrics & Adolescent Medicine. American Medical Association. 163 (4): 378–382. doi: 10.1001/archpediatrics.2008.578 . PMID   19349568.
  11. ↑ Medela. "When to Consider Nipple Shields for Nursing | Medela". www.medelabreastfeedingus.com. Retrieved 2018-10-27.
  12. 1 2 3 Medela. "What is Nipple Confusion and How to Resolve It | Medela". www.medelabreastfeedingus.com. Retrieved 2018-10-27.
  13. ↑ "Breast Pumping: A Guide on When and How Long to Pump | Milk101 | Ameda". Ameda. Retrieved 2018-10-27.
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