Nipple confusion (also sometimes referred to as a "nursing strike") can occur when woman who was breastfeeding her infant switches temporarily to bottle feeding, when a newborn infant is bottle fed during the hospital stay prior to its first trip home, or when a pacifier is used too frequently to soothe the infant soon after birth. Because of the dissimilarity between the artificial and real nipples (the nipples on bottles are generally shorter, differently shaped, and allow fluids to pass through them at a different rate than real nipples), infants that have been bottle fed sometimes have difficulty achieving the oral configuration, latching technique, and suckling pattern that allows breastfeeding to occur successfully. Usually, the infant can be retrained to the (real) nipple, but in some rare cases, nipple confusion prevents successful breastfeeding so completely that the infant can no longer feed from the breast, and must be bottle fed throughout the preweanling period.
The best way to avoid nipple confusion is to avoid bottle feeding and excessive pacifier use. If breastfeeding is not possible, the infant can be fed using a spoon, cup, or a dropper, or with food that has been scooped onto a finger. If bottle feeding is absolutely necessary, try to find a bottle with a relatively long nipple designed to match the configuration of the nipple and breast tissues in the infants' mouth.
If nipple confusion does occur, silicone nipple shields can be used as a way to ease the transition from bottle feeding back to breastfeeding. These give the breast a similar tactile quality that the baby may have associated with feeding from a bottle. There are also supplementary systems available that use a length of soft tubing attached to a bottle that a breastfeeding mother can attach to her breast, allowing the infant to get milk while suckling at the breast.
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Neifert, M., Lawrence, R., and Seacat, J. (1995). Nipple confusion: Toward a formal definition. Journal of Pediatrics, 126(6), S125-S129.
Noble, R. and Bovey, A. (1997). Therapeutic teat use for babies who breastfeed poorly. Breastfeeding Review, 5(2), 37-42.