ARTIFICIAL NIPPLES/NIPPLE CONFUSION

Lutey: Anne, I have friends who breastfed their babies exclusively for the first couple of months, then discovered that their baby would not take a bottle at all, even with expressed breastmilk. While I plan to breastfeed, I also want to be able to express my milk and allow family members to help with feedings. How can I make sure my babies will breastfeed and also take a bottle?

Anne: The risk of nipple confusion, whether by introducing a bottle or pacifier, is greatest during the early days of nursing. The longer you wait to introduce artificial nipples, the less risk there is of confusing your baby. It usually takes a couple of weeks, and sometimes longer, for mothers and babies to get really good at nursing. By that time, any problems you had in the beginning, such as engorgement or nipple soreness, should be pretty much resolved, and your baby's pattern of weight gain should be established.

If nursing is going along smoothly, there should be no reason to use artificial nipples in the first few weeks of breastfeeding. Nursing frequently and using the breast as a pacifier are what builds a good milk supply and helps you and your baby develop a special closeness during the period immediately after your baby's birth. Use the fact that you are exclusively nursing during the first few weeks to get lots of rest.

If you know that you want to have the option of giving your baby bottles, this is what I recommend:

At 3-4 weeks (or 2-3 weeks if you are returning to work at 6 weeks) begin pumping after feedings for 4-5 minutes if your baby had a good feeding, or 8-10 minutes if he didn't nurse well or only nursed on one breast. This will get out the rest of the high calorie, fatty hind milk, and will not interfere with your baby's nursing schedule.

Offer him a bottle with a small amount in it at the beginning, and try giving it to him at a time when he isn't frantically hungry. He is more likely to accept the idea of trying something new when he isn't starving. Most babies one month old or less will accept the bottle readily, but if you wait much longer than that, some babies will get very set in their ways and refuse to settle for anything less than the real thing

If you are bottle-feeding a newborn, I recommend a slow-flow orthodontic nipple or Avent newborn nipples. If you are offering the bottle to an older baby, I don't think the type of nipple is really important. A baby older than a few weeks is very unlikely to forget how to nurse just because you give him an artificial nipple.

Once you introduce the bottle, make sure that you continue to offer it to him several times a week. Many mothers have offered bottles when their baby was a few weeks old and they took them just fine, but when they waited a few weeks and tried again, the older baby flatly refused to take it.

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