Breastfeeding: Does your baby have nipple confusion after introducing a bottle?

My baby is four weeks old. For two weeks I have been giving him breastmilk followed by formula, because he does not seem to be satisfied. (This was my doctor's suggestion.) My baby now seems very frustrated with my nipples. He sucks for a while then get very cranky and bops his head on my breast and then just cries. I then stop nursing and give him a bottle. I really want to continue to breastfeed. Is this nipple confusion? If so, what can I do to correct it?


Debbi Donovan

Debbi Donovan is a Board Certified Lactation Consultant, as well as a retired La Leche League Leader. For more than a decade, Debbi... Read more

It is difficult to say exactly what is going on without knowing the specifics of your particular situation. It sounds as if your physician was worried about insufficient milk supply. To help this situation turn around, I would recommend working with a Lactation Consultant in addition to your baby's health care provider.

Nipple confusion does not occur in all babies, but it does seem to be more common in babies combining bottle feeding and breastfeeding before four weeks of age. Sucking from a bottle is different than nursing at the breast, and some babies find it difficult switching from one to the other in those early weeks.

Since your baby may be receiving a good portion of his calories from supplemental feeds at this time, any decrease in supplementation must be done gradually to avoid compromising his health.

Expressing your milk following a feed, using a hospital-grade electric breastpump with double pump kit, between 6 and 10 times every 24 hours, will quickly help to build your supply. Pump for 10 to 15 minutes per session (if double pumping). You can expect to express less than one-half ounce of your milk following breastfeeding.

Your baby needs to be nursed at least 8 to 12 times a day, every two to three hours, with a four hour stretch at night. You will need to wake your baby if he sleeps longer than this. The more you nurse (and pump), the more milk you will make.

Continue to nurse your baby prior to offering him a supplement. If you are giving him 10 ounces a day now, spread that amount over six nursing sessions (a little less than two ounces each), rather than finishing off each feed with supplement. This will allow him to experience at least two exclusive breastfeedings a day. Approximately every four days, decrease supplement amount by about two ounces and monitor your baby's output. Weekly weight checks will serve to reassure you that your baby's weight gain is within the proper range. (Most physicians do not charge for this service.)

In the first six weeks, you know your baby is getting enough milk when:

  1. He loses no more than 10 percent of his birth weight and regains it within the first two weeks
  2. He nurses at least 8 to 12 times each day
  3. He is gaining between four and eight ounces a week
  4. He is having at least six to eight good, wet diapers and at least two bowel movements each day.

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