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Thread: Nipple Confusion all of a Sudden

  1. #1

    Default Nipple Confusion all of a Sudden

    So, I have a 4 1/2 month old and have been back at work for about a month and a half. I work part time Monday through Wednesday. My baby girl gets two bottles a day on the days I am at work. Up until now, I have had no issues going from bottle to breast. Just recently, it seems like she has gotten the hang of bottle feeding and is now having issues breastfeeding. Tonight I went to feed her before bed and I could tell that she was not sucking enough to get any milk flowing and she was just in tears and then I was in tears. This happened to me with my first and I my milk declined so much that I had to stop. I was able to pull it together and do my best to calm her down and finally was able to get her to suck enough to get a meal. I am so frustrated and really don't want to quit, but I also don't want to go through this again. It just broke my heart last time and it is really hard to stay calm when your baby is wailing every time you go to feed them. I really don't know what to do. I am using the lowest flow nipple that I can with the bottles I have. I am currently using Medela. I think I should switch bottles, but I don't know what the best one is for this issue. Any advice on that? I just know that now I am established with how much she eats, I don't have a fast let down anymore since I am not bursting with milk. What should I do? I am trying to increase the amount of milk I have as well because it does seem like she wants more, so hopefully that will help. I just don't know what to do about this and don't know how to handle her getting so upset when it's not coming out fast enough for her. How do I remedy this problem? I am really frustrated and upset myself and don't want to quit. Your advice is appreciated.

  2. #2
    Join Date
    Jun 2009
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    Default Re: Nipple Confusion all of a Sudden

    Hi I am so sorry you are having this upsetting concern.
    First I will say that 4 months is a notorious age for babies being fussy about nursing, crying at the breast, nursing weird, etc. This is called the 4 month fussies and happens even to babies who have never had a bottle. In other words it is normal. But, a problem arises when mom gives a bottle because she thinks baby is refusing to nurse and will go hungry. If your baby is gaining normally, they are getting enough milk. If baby does not want to nurse at a particular time, try comforting another way and try again later. If your baby is not happy with the milk flow, they are going to have to learn to get over it like all other babies, because most mothers see a reduction in flow rate at some point. It is not going to hurt anything to increase your production but it may not help either. The basics of milk production is frequent and effective milk removal. Also be sure you are being careful to be well hydrated. To help milk flow be a little faster when baby is nursing you can try breast compressions.


    So, it may not be nipple confusion. But what if it is? The sad thing is how common that is. Nipple confusion is something that seems to happen all of a sudden, but in fact the steps to it begin with the first bottle baby gets. Breast refusal is much more likely to happen the "more" a baby is given bottles. More means, the bigger the bottle, the more often the bottles, and the longer a baby gets bottles, the more likely baby will eventually start down this road to breast refusal.

    So baby needs to have two bottles a day when you are at work. That is not very much. (of course it depends how long you are at work) How large are the bottles? If the are very big, that may be part of the problem.
    I am using the lowest flow nipple that I can with the bottles I have. I am currently using Medela. I think I should switch bottles, but I don't know what the best one is for this issue. Any advice on that?
    Yes. it is not about the nipple or the bottle but about how the bottle is given. Paced bottle feeding technique and positioning is very important and if done correctly does much more to keep a bottle more like breastfeeding than a slow flow nipple does. But there is more to it- to avoid breast refusal issues, it seems to help if baby is fed when baby wants to eat, and a small amount at a time, which is more like breastfeeding. I will link info on bottle feeding the breastfed baby below.

    The other side of the coin is how much baby nurses. Try to gently encourage baby to nurse often whenever you are together. Take advantage of days off, nights, etc, to encourage baby to nurse for food and comfort. If a baby gets three bottles a day and nurses 7 or 8 times, baby is less likely to see bottles as the norm than if they are getting 3 bottles and 3 or 4 nursing sessions, if that makes sense.

    If your baby is gaining normally on what you make then you make enough milk. I know it is hard to see baby upset but if you give in and offer more bottles that is going to lead to more bottles and it all snowballs. At this point, you can most likely turn this around. I will also link a good article on encouraging baby to nurse: http://kellymom.com/ages/newborn/nb-...ack-to-breast/

    Bottle feeding the breastfed baby. http://www.llli.org/docs/00000000000...astfedbaby.pdf

  3. #3

    Default Re: Nipple Confusion all of a Sudden

    I really appreciate the reply so quickly. It is encouraging to hear that it could also just be the "4 month fussies". I have not given any bottles to her and luckily know that is not the answer. So far, I have not even thought to go down that road. Tonight was the worst bout we have had with this, so I got on here to get advice to nip it in the bud. It's also nice to hear that the baby need to "get over it". I have that feeling too, but it's good to have that validated.

    Yes, thankfully, I am able to feed her before I leave and feed her as soon as I get home. The bottles that she has been eating have been about 6 oz. I cannot pump that much when I am away, so I am unsure if that is too much or not. I can tell you that I know she used to choke quite a bit when learning how to eat from a bottle and now seems to have the hang of it, so she may be over eating?? I just learned about paced feeding and have sent a video to my caregivers to watch and will make sure they understand what to do. I have also decided to try a slower flow bottle (from what I can glean from the internet). It just felt to me like she was not sucking hard enough to get any milk flowing. I figure if I can make it harder with a bottle, then maybe it will be easier to move back to breast.

    I typically nurse her every three hours during the day and she usually wakes up once very early in the morning. It comes out to about 6 times a day. I will try to nurse her more often, but I feel really unsure about exactly what I am supposed to be doing. She kind of fell into the every three hours at around 2 1/2 months or so and I have just stuck with it and she gains weight and always seems satisfied. Should I try every two hours? I don't feel like she really has any hunger cues anymore as she likes to put everything in her mouth and doesn't cry (which I know is a late sign of hunger), because no matter what, I feed her at the three hour mark. I am not sure how to fit naps in there and then also, what happens when she is back with her caregivers? I have a set schedule (she lead the way when I figured it out) for them that she also follows at home. I'm not super strict with it, but that is just how she likes to operate. What I am trying to say is that she set the schedule and I just wrote it down for them. It's pretty spot on, she gets tired at about the same time every day and again, not sure about eating, but I just feed her every three hours since that is what she fell into after the newborn stage.

    I refuse to give her bottles when I am home, so she only gets two bottles three times a week. It's encouraging to me that I was at least able to get her to finally eat once she calmed down a bit and figured out to suck harder. I just don't want this to become the norm and it always seems to be the worst Wednesday nights (the last day that I work for the week). She is still gaining well, but again, this just started, so I am not sure how quickly it would effect things if she wasn't getting enough. I do try to monitor her weight gain just so I feel better about things (especially when she is being so fussy and weird).

    Thank you for the links! Hopefully, the paced bottle feeding technique will help and the slower flow nipple. Let me know your advice on what I should be looking for with hunger cues now. I also think that will be helpful for my caregivers since I have no idea what to tell them to look for. Thank you again!!

  4. #4
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    Default Re: Nipple Confusion all of a Sudden

    The bottles that she has been eating have been about 6 oz. I cannot pump that much when I am away, so I am unsure if that is too much or not.
    Those are large bottles, which makes me suspect baby is getting too much at once, which is not the same as too much overall. The basic rule of thumb is that baby needs about 1 to 1.5 ounces per hour of separation*, meaning an 8 hour separation, baby would need about 8-12 ounces total. Generally speaking by 4 months, meal size is between 2 to 4 ounces each time. Even if baby took more at the breast, it might help if meals with bottles were kept smaller and more frequent rather than larger and less frequent.

    *This assumes baby also nurses at least once or twice overnight. If baby is taking a long stretch of not eating overnight (more than 6 hours or so) that may mean that either baby will need more than the general rule of thumb during the workday from bottles, (and that may increase chance of eventual breast refusal) or baby should be encouraged to nurse a little more often overnight so they get enough without the increased risk of eventual breast refusal. Weight gain is typically a good measure and as long as that is normal, all is well. Unfortunately, when a baby has to get bottles most days due to separations, more than the usual amount of care with how often baby nurses and how much baby nurses overnight may need to be taken.

    It comes out to about 6 times a day. I will try to nurse her more often, but I feel really unsure about exactly what I am supposed to be doing.
    Basically a baby cannot nurse too much, so it never hurts to offer more.

  5. #5

    Default Re: Nipple Confusion all of a Sudden

    Unfortunately, when a baby has to get bottles most days due to separations, more than the usual amount of care with how often baby nurses and how much baby nurses overnight may need to be taken.
    So, it sounds to me like you are suggesting that I offer more during the day and maybe wake up in the middle of the night and do a dream feed? My goal is to breastfeed a year and maybe more if I can make it. Is this going to be something that I will need to do for the duration of my breastfeeding journey? Thank you for all your help!!

  6. #6
    Join Date
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    Default Re: Nipple Confusion all of a Sudden

    My goal is to breastfeed a year and maybe more if I can make it.
    Here is an article written specifically for moms with this goal: http://www.llli.org/nb/nbjanfeb06p4.html

    So, it sounds to me like you are suggesting that I offer more during the day and maybe wake up in the middle of the night and do a dream feed?
    What I am saying is that in my experience, the babies who nurse longer are the ones who nurse more. Who are encouraged to nurse for all the reasons a baby nurses- food, drink, comfort, companionship, and even for fun- and who have access to mom and the chance to nurse as much as possible, day or night.

    Whether or not you might want to try nursing your child overnight depends entirely on your specific situation. What you might think about is- How long IS baby sleeping, routinely, without nursing? Are sleep lengthening techniques used (separate room for baby, pacifier, swaddling, top offs, sleep training of any kind.) What happens if you try nursing baby at night? How would it work for you? What about sleep arrangements? Some moms try bedsharing for example and in many cases that leads to baby nursing more at night (although not always.) Etc. etc. It all depends on the individual situation and what is going to work best for you. I guess what I was saying is that if you want, you can try nursing baby more often, including overnight, as it certainly is not going to hurt breastfeeding and it may help. We are so often cautioned to never in any way disturb a sleeping baby, when in fact it is not going to do any harm to do so.

    However I did not say anything about dream feeding. I actually avoid that term because I believe it is poorly defined. When I was new to motherhood 14 years ago, dream feeding simply meant that when a baby and mom slept beside each other, whether for a nap or part of the night or through the night, and there was easy access to the breasts, baby would naturally stir and mom would also, and positions would adjust so baby could latch and nurse, all with mom barely waking and baby barely waking. Research has shown this pattern in bedsharing, nursing mothers and babies. And this is also my personal experience with "dreamfeeding." But since then I have seen it used to mean something different, for example, when a baby is deemed to be a "poor gainer" or "poor eater" and that is a situation that is very complicated because most of the time, in fact, baby is eating and gaining just fine and there is no need to worry about making baby eat more by making a point of feeding them in their sleep. So I just try to avoid the term to avoid misunderstanding. Also, If you want to try nursing baby overnight it can be when baby and/or you are entirely awake too.

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