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What is nipple confusion, and how do I know if my baby has it?
Q: Nipple confusion refers to the difficulty a newborn learning to breastfeed may experience when an artificial nipple is provided.
A: The skills needed to nurse and swallow are different when a baby is breastfeeding than they are with bottle-feeding. With breastfeeding, your baby needs to open his mouth wide and take as much of your nipple and areola into his mouth as possible. He uses his mouth to pump milk from your breast. His tongue needs to be placed below your nipple, and his mouth creates a vacuum in order to pump and swallow the milk.

With bottle-feeding, fluid flows readily, so your baby doesn’t need to make the same mouth and tongue motions. The baby’s lips attach to the tip of the nipple, and once the initial suction is created, liquid flows easily. In order to slow down milk flow, a baby uses his tongue to cover the holes of the nipple.

Before good breastfeeding skills are established, it can be confusing for a baby to switch back and forth between breastfeeding and formula feeding. I recommend that mums try and breastfeed exclusively for two to four weeks before introducing a bottle. Once your baby has established a solid pattern of nursing, he should be able to use the bottle without forgetting the skills he needs for breastfeeding.