Breastfeeding A to Z

Nipple Confusion

Nipple confusion isn’t a medical term, (1) but if in the first few weeks of life baby is given an artificial nipple (pacifier or bottle nipple), they can then have difficulty sucking on the breast.  This is because the way the baby sucks on each is different.  Your baby’s most sensitive organ is their mouth. (1)

In the first 2-4 weeks of life, your baby may have trouble going back and forth between breastfeeding and using a pacifier or bottle nipple.  Unfortunately, babies do not come with a label that tells us whether they can do both breast and artificial nipples (pacifier or bottle) at the same time. (1)

A bottle or pacifier is not needed for normal growth and development of your breastfed baby, but may be something you want to be able to use.  Often families decide to use one or both.  If you are going to use them, be aware they can cause nipple confusion.  The confusion comes when the baby tries to suck on something besides the breast (a bottle or a pacifier) and then can have difficulty latching on to the breast the next time they go to feed.  Currently, the AAP recommends waiting until your baby is 3-4 weeks old before introducing a pacifier. (2)(3)

If at all possible, avoid giving baby anything besides the breast until the first weight check that establishes the baby is gaining weight and breastfeeding is going smoothly.  Then if you wish to use a bottle or pacifier you can use them without interfering with breastfeeding your baby.  If you notice after giving your baby a pacifier or a bottle they have trouble latching-on at the next breastfeeding, hold off on introducing a pacifier or bottle again for a week or so.  This is just an indicator that they are not ready to learn something besides breastfeeding for now.  When they are a little more experienced at breastfeeding, you will be able to introduce a bottle or a pacifier if you desire.  They may still have something to say about whether they accept one or not.

Until that time, when you know your baby is gaining weight and breastfeeding is going well you can use a clean finger to provide a soother or comfort for your baby.  If you use your clean little finger with the pad-side of the finger pointed towards the roof of the baby’s mouth and a short finger nail this can provide a comfort for your baby, without jeopardizing their ability to latch-on to the breast.

For some babies, if an artificial nipple (pacifier or bottle) is introduced in the first 2-3 weeks of life they may have great difficulty getting back to sucking properly on the breast.  A pacifier or a bottle nipple requires an infant to press the nipple to the roof of their mouth to hold the pacifier in the mouth or control the flow of milk.  In the case of breastfeeding, the baby needs to take more of the breast in its mouth than with a bottle and the tongue moves in an “s” or wave-like motion. (1)

Allow your baby to learn how to breastfeed well and wait to introduce a pacifier or bottle nipple until they are at least 2 weeks old and have regained their birth weight.  Preferably longer, as stated previously, the American Academy of Pediatrics recommends waiting until your baby is 3-4 weeks old before introducing a pacifier if at all possible. (2)  If you are unable to breastfeed your baby before that 2 weeks is up you can use a clean/sterilized eyedropper, a sipper cup, a spoon or a flexible medicine cup (like the type on top of liquid medicine), as a substitute for a bottle nipple.  Expressed breastmilk is preferred in this situation.  If that is not possible, check with your health-care provider regarding the specific type of formula that they would recommend for your baby, especially if there is a history of allergies in your family.

In our practice, we often found babies were able to use a bottle or pacifier sooner if they were latching on to the breast with no difficulties, baby could be heard swallowing and a weight check had confirmed they were gaining weight.  This is your best insurance policy that your baby has learned to breastfeed well first, before they begin to learn to suck on something else.  Once breastfeeding is established, most babies have no difficulty going back and forth between breast and bottle, or breast and pacifier.  If you notice when you give your baby either a pacifier or a bottle nipple that the next time they attempt to latch on to the breast they have difficulty, they are not ready to be doing both.  Give them another week or two of just breastfeeding and then try again.


  1. Lawrence, RA, Lawrence, RM, Breastfeeding: A Guide for the Medical Professional, 7th edition, Maryland Heights, MO, Elsevier Mosby, 2011, pp 202-3, 248-49, 271.
  2. Kleinman, RE, Greer, FR, Pediatric Nutrition, 7th edition, Elk Grove Village, IL, American Academy of   Pediatrics, 2014, p 51.
  3. Wambach, K, Riordan, J, Breastfeeding and Human Lactation, 5th edition, Burlington, MA, Jones & Bartlett Learning, 2016, p 294.