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Can one bottle really create a problem?

Would a bottle disrupt this baby's breastfeeding ability?
Would a bottle disrupt this baby's breastfeeding ability?
Photo courtesy of L. Radcliff

A common debate in obstetrical settings is whether the breastfed baby must be exclusively fed at mother's breast to ensure success, and if so, how long the mother should avoid introducing a bottle. This debate has resulted in a good deal of confusion for new parents. Some health care providers tell them that "nipple confusion" has never been validated, and they claim that giving a few bottles should make no difference to the babies. For example, one local Fresno mother recently reported that she was told in the hospital that as long as she offered her baby the breast first, and then gave a bottle, her baby would not have any problems going back to the breast again. Other practitioners urge mothers to avoid any artificial nipples during the whole time the baby is breastfed, saying that even one bottle given at any age can make their baby refuse to breastfeed. As in most debates, the truth may lie somewhere between the two extremes.

A look at the literature on this subject reveals that bottles are indeed linked to a few challenges to the breastfeeding relationship, especially if they are introduced early in the baby's learning curve. Clinical research has shown that feeding supplemental bottles of formula within the early postpartum period may lead to lower milk supplies and earlier weaning. Studies have also indicated that the way a baby sucks on a bottle is different than his effort at the breast. The bottle's faster flow rate can lead baby to develop a passive sucking pattern,  often causing an ineffective milk transfer when baby applies the same pattern to breastfeeding. Another adaptation that some baby's make after using a fast-flowing bottle, is a subtle tongue-thrust. This may be baby's method of stopping the flow periodically to take a breath. That same tongue-thrust at breast will cause baby to lose his latch. An additional challenge is the more rigid nipple on the bottle, which may be more stimulating to the baby's palate. For some babies, this rigidity leads to significant difficulty in baby's navigation skills while breastfeeding. It is as if the baby opens wide and then waits for something firm to touch the roof of the mouth. Mother's soft nipple, then, is not recognized as easily by the baby. Yet another concern is that the baby's gut, which at a cellular level still has "loose junctions," or spaces between the cells, may be compromised by foreign proteins and other components found in artificial baby milk. Research has linked this issue to a wide array of subsequent illnesses, such as diarrhea, cow's milk allergies, and even diabetes.

For all of these reasons, it is generally considered best practice to avoid introducing the bottle to a breastfed infant until the milk supply is well established, and his feeding skills at breast are consistent and reliable. Because babies are all unique, it is impossible to tell ahead of time which ones will easily overcome the interferences from bottle feeding and which may be steered off-course by one ill-timed artificial nipple. Most babies eventually become very confident little breastfeeders in time, and at some point, they can even latch on in the dark, without help.  This often occurs between the first and second month of life. If supplementation is needed for medical reasons before that time, a lactation consultant can lead the mother and baby toward their breastfeeding goals.


  • Genevieve Hinson 5 years ago

    This is great information. My child was early and in the NICU so we went about it a bit backwards. So glad nursing went well once she was strong enough to do so. She did get a bottle when I went back to work and now refuses it but still likes to nurse. She's a year now and folks ask me when we're going to wean. Was a bit startling and I have no answer. Figure we'll figure it out when she and I are ready. And I don't see that happening soon.

  • Tess Johnson 5 years ago

    Thank you for commenting, Genevieve. I, too, had a preemie who began her feeding career on a tube, and then a bottle (briefly), then finally, the breast. Luckily, it was always breast milk. Thank goodness she and I both had the patience and determination to hang in there until she was mature enough to feed consistently. She nursed for 14 months. I remember watching her carefully to see if that brief episode on a bottle caused a sucking problem...she did "purse" her lips tighter than my firstborn, so it may have been a factor.

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