Breastfeeding: How to Avoid Nipple and Pacifier Confusion?

Nipple and pacifier confusion is a common concern among breastfeeding mothers, often discussed on forums and social media. It occurs when a baby seems to lose their sucking reflex after being given a pacifier, bottle, or even a silicone nipple shield. But is this a myth or a reality? How can it be avoided, and what can be done if it's already happening? Carole Hervé, an IBCLC lactation consultant, explains everything.

A preference for flow: The main reason for nipple/pacifier confusion

Babies typically prefer a steady milk flow that guarantees they are getting enough breast milk. Some babies may get agitated or impatient while breastfeeding if the milk doesn’t flow as easily as they’d like, especially if the mother’s lactation is low.

In such cases, it might be tempting to offer the baby a bottle of formula. Babies quickly realize that milk flows easily from a bottle, whereas they may have to work harder at the breast. As a result, they develop a preference for the faster flow, leading them to reject breastfeeding.

There are, of course, other reasons why babies get frustrated at the breast. Surprisingly, it can also happen when the milk flow is too fast. As Carole reminds us: "When in doubt, it's always a good idea to consult someone who can properly assess the situation."

What should I do if my baby is looking for a flow that doesn't seem suitable for breastfeeding?

Sometimes, it’s helpful to spend a few days stimulating your milk supply if you notice your baby is wetting fewer than 6 diapers in 24 hours (a clear sign that milk transfer is insufficient).

Several options are available:

• Offer the breast more often,
• Remove the pacifier, which may have been fulfilling the baby’s sucking need to fall asleep or pass the time,
• Reintroduce night feedings if there are few,
• Alternate breasts during the feeding and compress the breast when the flow slows down.

A few days of this increased routine usually helps boost lactation. You can also use a breast pump to accelerate the process.

How do I know if my baby has developed nipple/pacifier confusion?

Your baby may no longer know what to do with the breast. They may chew on it, pinch it, not push their tongue forward to draw out the milk, and become easily frustrated. They may cry on the breast, seem to push it away, scream, or arch their back. Many people might then think the baby has never known how to breastfeed properly. Some babies may even start refusing the breast altogether.

Be careful!!

Many babies behave this way because they feel pain (such as from a sore, or inflammation caused by an ear infection). If you have any doubts, consult a healthcare professional and a lactation expert to assess the situation.

What alternatives can be used if I fear my baby will get used to the bottle?

There are many situations where you may need to offer your breast milk in ways other than directly breastfeeding. For example, when a mother returns to work or needs to be away for an evening. In these cases, a mother can pump her milk and offer it to her baby in containers other than a bottle:

• With a spoon or syringe,
• Using an alternative to the pacifier, such as Calma®,
• With a Lactation Aid device (from birth),
• Using a sippy cup (from 4 months),
• In a glass (from 6 months).

How can I help my baby return to breastfeeding if they seem to have forgotten how to latch?

With patience and perseverance—and often additional support—you can retrain your baby to suckle properly. Start by eliminating all bottles and pacifiers. Offer your baby milk in any form and present the breast during calm moments. Stimulate your milk ejection reflex by hand-expressing or using a breast pump. Breastfeed in a calm environment with minimal external stimuli that could distract your baby, perhaps even in dim lighting. Put your baby to the breast as often as possible (try the Biological Nurturing approach described by Suzanne Colson, where you sit comfortably in a chair with your back slightly reclined and bring your baby "to the right address"). Avoid forcing your baby. Try again frequently without waiting for your baby to be hungry.

Remember, the more your baby nurses, the more milk you’ll produce, and the easier breastfeeding will become. A virtuous cycle!

Seek help during the breastfeeding period!

If you have doubts or difficulties, lactation specialists are available to provide personalized solutions based on your and your baby’s individual situation. Every breastfeeding experience is different and may require a specific approach.