Breastfeeding: Overabundant supply or nipple confusion?

I think that my six-week-old baby has "nipple confusion." After about five minutes of sucking she gets very frustrated and is unable to suck properly. I've been using a pacifier on and off because she cries a lot in public. She is healthy and is gaining weight well -- nearly a pound a week! Is this nipple confusion, and if so, what can I do?

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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

I don't think this is nipple confusion. Though I believe that nipple/suck confusion does exist, and it could be playing a part in your situation, it sounds like you have a very abundant milk supply, which is impacting the way your baby nurses.

You said that your baby averages 16 ounces of weight gain each week. Typical weight gain is between four and eight ounces a week. This was my first clue that you have a great supply!

My second clue was your daughter's fussiness about five minutes into the feed. By this time your milk is ejecting, and your baby may be finding it difficult to handle the milk flow. Does she gulp, sputter or choke, or pull away and fuss several minutes into the feed? Or does she fall asleep several minutes after starting a feed? Often this type of behavior makes a Mom think that she doesn't have enough milk. In your situation, assuming you haven't been supplementing, we know this isn't the case, with your daughter's excellent weight gain.

Babies whose moms have a very abundant milk supply often are very calmed by sucking on a pacifier. With a pacifier they don't have to worry about a deluge of milk coming their way. They can relax and suck. Until you get this situation under control, I wouldn't advise weaning your baby from the pacifier. She needs a way to calm herself right now if nursing is frustrating her. (Watch your baby. As you see that nursing is becoming more relaxing for her, you can begin weaning her from the pacifier, and allow her to satisfy her nutritional and sucking needs at your breast. Continued pacifier use may interfere with the breastfeeding relationship.) While still using the pacifier, there's no need for her to substitute the pacifier for you. When she sucks on the pacifier, hold her next to your breast, as you do when you nurse. Let her relax and comfort herself in your arms. One of the main goals is for her to be happy and relaxed at your breast.

If you feel that your overabundant milk supply may be the problem for your baby, a way that you can help to bring your supply to a more manageable level is by adjusting your baby's pattern of feeds. Begin by allowing her to nurse at one breast per feed, expressing only enough milk from the "unused" breast for comfort. At the following feed, offer the other breast and continue to follow this pattern for all her feeds. Your breasts should adjust to this new feeding pattern within about three or four days and at that time you probably won't have the need to express milk from the "unused" breast.

If you have noticed that your little one does have difficulty handling the milk flow as your milk ejects, gently remove her from your breast at that time, comforting her, and catch the spray of milk in a cup or a diaper. Put her back to your breast as the flow begins to slow. You may notice that your milk ejects more than once during a feed.

Choosing a position for the feed where you are somewhat reclined, such as sitting back in a recliner, or lying on your back or side in bed or on the couch may also be of help. (Gravity will be on your side.) My best wishes for peaceful feeds!

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