Nipple confusion, bottles, and alternative feeding options

On January 17, 2012 in the United States, Medela, best known for their pumps, launched their latest “feeding innovation”, the Calma.  The Calma is a bottle that seeks to eliminate nipple confusion and flow preference by making a bottle fed baby work for its milk, similar to how your little one must compress and suck at your breast to get milk out.  According to Medela, this “supports an easy transition from the breast to the teat and back.”

As a registered International board certified lactation consultant, I am very skeptical of these claims.

I have often heard that nipple confusion is a myth, foisted on mothers to keep them stuck to their brand new babies, to keep them from leaving the house, to subjugate us all.  This is simply not true.  Nipple confusion happens.  I have seen numerous cases of it in my practice.  Babies become nipple confused for three reasons – flow preference, difference in movements, and difference in feel.  Medela has the right idea on part of the equation.  Babies that are given a lot of bottles in the early period can decide that it’s not that fun to work a breast when this plastic thingy is way easier.  Most bottles, even the slowest flowing, flow faster than milk from a breast.  However, your baby also moves their mouth differently to get the milk from a bottle than from a breast.  The jaw and tongue movements are not even close to the same, and trying to transfer the movements from one to another can frustrate and upset your baby.  After all, if your baby is new, this whole eating thing is new, too.  Why complicate it?  There’s a bonus too: a baby nursing at the breast will develop their mouth in a way that will help with prettier smiles and better speech, too!

The third part of the equation is the different feel.  If you are giving your baby a softer breast and a harder silicone, they may very well like the way that a bottle feels more – especially since that silicone is, again, delivering milk faster and the mouth movements are different.   Medela hasn’t really done anything to cure that.  I’ve seen and felt the Calma, and, I assure you, it will not be mistaken for breast tissue anytime soon.

The easiest way to prevent nipple confusion is by waiting to introduce a bottle until four to six weeks (three to four at the earliest) and to simply offer the breast more than the bottle.  Some families have other situations, though, that don’t make the whole four to six week thing possible.  So what is a modern mom to do?  For many of us, it is not feasible to never give milk from anywhere but the breast.  We have work, and school, and other children, and obligations, and, man, sometimes Mommy just needs a day (or an hour or two) off.   But babies still have to eat during that time!  And what if your baby has issues with latching at the breast, or you are inducing a supply, or you need to do some supplementing?

Luckily, being a modern mom means that we have some awesome options available to us.  There is spoon feeding, where you can hand express colostrum or milk directly into a spoon and give it to your baby.  This works best in the beginning, when your baby isn’t taking in much milk yet – it would be a fairly long process for a family feeding an older infant.  To spoon feed, you simply use a clean spoon, hold the baby in an upright position (like sitting) and put the spoon at the lower lip, giving small amounts and letting the baby go at their own pace.  A spoonful can be considered a full feeding if you are dealing with a newborn.

Cup feeding is another option.  Cups are widely available, cheap, and easy to use.  Your infant won’t take the cup from your hands and drink like a big kid, of course, but will instead lap at the milk kind of like a baby animal might.  There are special cups sold for cup feeding, but it might be easier and cheaper to just use a shot glass.  With cup feeding, like spoon feeding, you’ll hold the baby supported and upright.  You’ll put the cup to the lips and tilt slightly so that the baby can easily lap at the milk (not so it’s pouring into his or her mouth.)  Allow the baby to eat at his or her own pace.  It may take a while, but that is ok!  Babies shouldn’t be gulping down their feeds – when they do, they often overeat, which can hurt their tummies and set a bad precedence of wanting more than they need.

You can also use what’s called a supplemental nursing system, or SNS.  SNSs are generally a bottle type thing hooked to a long tube.  You put the milk in the bottle part, and then you can do one of two things with the tube.  First, you can use it on the breast, either by sticking it in a nipple shield (which you should only use if followed by a lactation consultant for sizing and to negate any potential complications that might arise) or by taping the end near the nipple so that the baby gets an extra boost of liquid while nursing.  This can be really helpful if you’re relactating or increasing a milk supply, if your baby needs to be supplemented but is nursing well, or if you have a preemie or baby with suck issues that maybe doesn’t milk the breast as effectively as they should be.  You can also use a SNS to finger feed your baby.  With that, you attach the tube to your finger, and the baby sucks the finger to get the milk.  A lactation consultant can even help you use this method to train or retrain your baby to suck properly.  SNS systems can be hard to clean, so please carefully read the instructions and check with a health care provider for any extra precautions you should take if you have a preemie or immune compromised baby.

If you have an older baby (4 months or so) that’s just now getting around to taking milk in another way, you can try forgoing bottles altogether and working on cup training or using sippy cups.  Sometimes the difference is interesting enough for an older baby who has rejected bottles.  As with any of the other methods, the goal is to allow your baby to learn and go at their own pace.  Be prepared for this to be a messier endeavor with an older baby who is starting to show some independence.  You will probably have to help them to hold and tilt the cup – they may not be content with the idea of you holding it all yourself, and you may have some spills in the process.

But what if none of these methods work for you?  Maybe your care provider is balking, or you are annoyed and uncomfortable with one or all of the methods, and you really, really just want to use a bottle.  In that case, instead of purchasing the reportedly $15 a piece Calma, I would try Fleur at Nurtured Child’s method of baby-led bottlefeeding.  In fact, any time you are bottlefeeding, you should use this method.  It is the ideal way to feed a baby from a bottle and encourage any care-takers that will be feeding your baby with a bottle to utilize this method as well.  In choosing a bottle, there is no really good evidence that I have seen showing that a certain bottle or nipple is better than another for breastfeeding.  There are a lot of nipples that are supposed to be similar to your breast in look and feel, but in my time in the bottle aisle, I never saw any that made me go, “That looks EXACTLY like my boob.  That one, right there, with the wide base and medium sized nipple!!”  My kids never really liked the wide bottomed nipples, although they are often touted as being awesome for breastfeeding babies.  When it all boils down to it, most of that is hype.  When selecting a bottle, select the one you think might work that is in your budget.

If you are giving milk due to a breastfeeding problem, be sure to discuss methods and supplements with a medical professional with good lactation training.  Ask a lot of questions.  If supplements are ordered, get a LOT of information on them.  Why do you need to supplement?  How long does your medical professional want you to supplement?  How much should you supplement?  How often should you supplement?  Can you use your own expressed breast milk?  What is the plan of action for weaning from supplementing?  If your baby isn’t nursing well at the breast, you will likely need to do some pumping along with the supplementing to keep your supply healthy while you work through the problem.  Find out how often you need to pump and how you should store your breastmilk – especially if your baby is hospitalized and you are transporting it.

There are other feeding options for more serious problems, such as cleft lip/palate as well. That type of situation needs to be followed very closely by a lactation professional and physician to ensure that the baby’s unique situation is being addressed.

If you are going to be separated from your baby for another reason – work, school, or just going out – remember to think of your magic number.  This is the number of times your baby breastfeeds in a normal day (and, yes, that can vary.  Just take an average.)  You want to be sure that you are replicating that amount of times by a combination of pumping and nursing.  This will help to keep your milk supply plentiful.

In the end, there is no product on the market that can magically be just like your breast and provide your baby the exact same experience.  Luckily, there are many options for your baby and your family that will help you to achieve your breastfeeding goals.

 

 
 Star Rodriguiz, IBCLC, is a breastfeeding peer counselor for a WIC in the Midwest and has just started her private practice as an IBCLC (her Facebook page is here, go “like” for great support).  She also sits on the  breastfeeding task force in her town, is helping her  community’s Early Head Start redefine  their breastfeeding support, and is the  driving force behind a local breastfeeding campaign.  In  the remainder of her free  time, she chases around her nursling and preschooler.
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Comments

  1. Workingmama says:

    I don’t know what to do! I am finally returning back to work. My baby is 9.5 months old and takes 98% of her nutrients from breast milk. She hates baby food/cereal but we are introducing her to table food. My problem is that she has only eaten at the breast. I have been successful in pumping for her but she won’t take it in any type of cup: hard top sippy, soft top sippy, straw style sippy, no sippy top. The only thing that kinda of works is “drip feeding” her from a straw but she gets bored after 1/2 an oz. what else can I do. I was avoiding putting her on a bottle just to have to take her off of it in a few months, but I don’t think she would even be interested in it, as she just wants to chew on whatever I give her. Please help. I return to work tomorrow and have failed at getting her to take a cup for a week now.

  2. Dear Star,

    While I agree with many of your points, it seemed to me you did not try out the Calma nipple. My 4 month old gets approximately 3 expressed bottles a week, and I will only use this nipple. My favorite part about it is that he has to really suck to get it to work. I can see his cheeks pucker up like they do on me. I love that it does not leak at all. If I were to improve it, I’d design it in such a way that it simulated let down and non let down. I’d recommend to all bfing moms. It is pricy, yet I’ve done perfectly fine with just one.