Choosing Bottles and Nipples for your Breastfed Baby

Oct 26, 2001 (Updated Jan 28, 2003)

The Bottom Line Combining BREAST and BOTTLE can work! It doesn't have to be an all or nothing venture.

What follows definitely has to do with using reusable bottles, but it perhaps has more to do with combining bottles and nursing and avoiding Nipple Confusion while Breastfeeding. I do realize that this isn't strictly 'On Topic' ... but since Epinions won't be paying a penny per click, I don't really feel that I'm cheating them out of anything by posting this here, and if the information can be helpful to a nursing mom who is starting to prepare for going back to work, or who just wants to introduce a bottle to her breastfed baby, then I personally think that it is 'on topic' enough to be legit.

Choosing Bottles and Nipples for your Breastfed Baby

Nursing moms are often warned not to introduce a bottle TOO SOON or else the baby may begin to prefer the bottle over the breast, and the moms milk supply may never become properly established. And this truly is GOOD advice. However, at some point the majority of nursing moms WILL want to introduce a bottle, either because they are going back to work, or just to be able to leave the baby with a sitter for an occasional evening out, etc.

Therefore selecting the best type of bottle and nipple for their needs becomes an important and potentially confusing issue. In my opinion there are not 'absolutes', even among long term nursing moms, lactation consultants and professionals you'll get different advice about which bottles/nipples are best and why ... just like anything else having to do with our babies, the best thing is to know your own baby, respond to his or her cues, and do what works best for your situation. But you CAN at least start the trial and error process armed with a bit of information and possibly a point in the right direction.

(There are probably dozens of types of nipples out there ... I will only outline a few of the more common or more popular.)

Avent Bottles and Nipple - these are the most highly touted of all bottles/nipples among many groups of nursing moms. The bottle is sort of short and squabby to accommodate a wider than normal silicon nipple. The Avent Nipple is supposed to be shaped more like a natural breast and the nipple portion itself responds to the baby's sucking more like a human nipple does ... by being drawn back into the baby's mouth along the tongue instead of remaining fairly stationary and at the front of the mouth and lips. Avent also has a special variable flow design which allows the baby's sucking to control the flow of the milk, a more vigorous suck produces a faster flow, and slower suck produces a slower flow ... much like when the baby is nursing, and unlike standard bottle nipples that have either small, medium or large holes which only respond slightly to a change in the baby's sucking. Most nursing moms and LCs seem to agree that these are the least likely to lead to Nipple Confusion in most babies. (more on this later)

Orthodontic Nipples - these are available in both rubber and silicon from various baby product manufacturers. They are the 'funny' shaped nipples that fit standard baby bottles. The one's I am most familiar with are from NUK by Gerber but I believe other companies also make these. The lower portion of this nipple is a bit wider and more bulbous than a standard nipple, but not so much so as the Avent style. Then there is a slight indention and an orthodontically shaped nipple tip which is supposed to be engineered to fit nicely into the baby's mouth. (My son preferred these nipples when he was a baby.)

Standard Silicon or Rubber Nipples - these are the 'old fashioned' but still perfectly functional cylindrical nipples that come standard on most bottles. Unlike the Avent nipples or even the orthodontic nipples, they truly do not mimic the human breast's nipple when the baby sucks. They do not draw 'into' the mouth in the same way. Most breastfeeding experts warn that along with the Playtex style nipple, these are the most likely to lead to problems with Nipple Confusion (again, more on this later)

Playtex 'standard' Nipples - there are some who will disagree with me on this, and again, if something works for your baby then I'm not saying it is 'wrong' ... but ... in my opinion these are possibly the worst type nipples to use with a breastfed baby. Or at least the 'short nubby' type are ... Playtex has introduced various longer styles and orthodontic styles which are probably better. But I'm thinking of the type that are most commonly used with their disposable bottle system ... which have a wide flat base and a short stubby cylindrical nipple tip. The baby must grasp this tip with his lips and gums ... which is absolutely something that you DO NOT want him doing with your breast. You want the baby to take as much of your natural nipple into his mouth as possible while nursing, so you certainly don't want to be teaching him to latch on to just the very tip and clamp down ... which I feel is what these short nubby nipples do. These are possibly the MOST likely to lead to Nipple Confusion in my opinion.

Rubber or Silicon? - I think this may be more of a 'personal' choice issue than anything else. Most brands offer both ... though Avent is an exception ... so if your baby refuses one, try the other. Some moms prefer the clear silicon, both because it just looks nicer and cleaner and it's easier to see if there is any milk dried inside ... and because they are much longer lasting. Rubber nipples need to be replaced fairly often (every few months) because they begin to 'break down' and become gummy from repeated HOT water washings and sterilization. BUT!!! Some babies seem to prefer the rubber nipples ... perhaps because they are a bit softer and more pliable, or perhaps even because of their dark color ... sounds silly I know, but a friend swears her baby liked them because they looked more like her!

Flow Speed - if you aren't using a variable flow nipple such as those offered by Avent, you should definitely start with a NEWBORN or slow flow nipple. Milk does not just 'pour' from a mother's breast, the baby has to work a little to get it, they are used to this, and you will want to try to mimic this as much as possible. Using a faster flow nipple could cause baby to choke or strangle ... or if the baby gets used to the fast flow of milk from a bottle, he may become unhappy with the slower flow from the breast and refuse to nurse. Most bottle manufacturers will provide 'guidelines' for when to move up to faster flow nipples ... 3 mths, 6 mths, etc. For breastfed babies, if you are continuing to combine breast and bottle and aren't wanting to make a complete switch to bottles, you should just keep using the newborn or slow flow ... there is no need to change at any certain age. Breasts don't develop larger 'holes' as baby gets older, so why should his bottle nipples?

Nipple Confusion - what is it? and how to avoid it ...

What is Nipple Confusion? It is a problem that arises when a breastfed baby is given an artificial (rubber or silicon) nipple and must try to learn to nurse both from his mother's breast and the bottle nipple. While seemingly similar, these two feeding methods require COMPLETELY different mouth and tongue motions and swallowing skills.
In breastfeeding the baby needs to take as much of the nipple and areola into his mouth as possible to 'pump' the milk from the milk ducts. In bottlefeeding he uses his lips to grip the tip of an artificial nipple. Some nipples do better imitate a natural breast, but none are quiet the same. In breastfeeding the baby must place his tongue BENEATH the nipple and uses it to help create the 'vacuum' needed for nursing and to pump and swallow the milk. In bottlefeeding the baby must place his tongue in front of the nipple and places it over the tip of the nipple to help stop the flow of milk while he swallows.

In breastfeeding the baby removes milk from the breast by a combination of sucking and pumping the milk from the milk ducts. When the baby stops sucking & pumping the milk stops flowing. In bottlefeeding the milk flows fairly readily from the nipple once an initial suction is created and then the baby simply controls the flow by placing his tongue over the holes in the nipple.

This is not to say that either feeding method is 'wrong' ... only that they are VERY different and that a baby must learn whichever method he is to use ... and expecting a tiny baby to learn both methods and to be able to switch back and forth between the two can be extremely frustrating to both baby and mom.

In Dr. Jack Newman's article More & More Breastfeeding Myths he discusses nipple confusion as NOT being a "myth": (text from his articles is in italics)

9. There is no such thing as nipple confusion.

Not true! A baby who is only bottle fed for the first two weeks of life, for example, will usually refuse to take the breast, even if the mother has an abundant supply. A baby who has had only the breast for 3 or 4 months is unlikely to take the bottle. Some babies prefer the right or left breast to the other. Bottle fed babies often prefer one artificial nipple to another. So there is such a thing as preferring one nipple to another. The only question is how quickly it can occur. Given the right set of circumstances, the preference can occur after one or two bottles. The baby having difficulties latching on may never have
had an artificial nipple, but the introduction of an artificial nipple rarely improves the situation, and often makes it much worse. Note that many who say there is no such thing as nipple confusion also advise the mother to start a bottle early so that the baby will not refuse it.

In his article Breastfeeding—Starting Out Right he goes on to say ...

3. Artificial nipples should not be given to the baby. There seems to be some controversy about whether "nipple confusion" exists. Babies will take whatever method gives them a rapid flow of fluid and may refuse others that do not. Thus, in the first few days, when the mother is producing only a little milk (as nature intended), and the baby gets a bottle (as nature intended?) from which he gets rapid flow, he will tend to prefer the rapid flow method. You don’t have to be a rocket scientist to figure that one out, though many health professionals, who are supposed to be helping you, don’t seem to be able to manage it. Nipple confusion includes not just the baby refusing the breast, but also the baby not taking the breast as well as he could and thus not getting milk well and /or the mother getting sore nipples. Just because a baby will "take both" does not mean that the bottle is not having a negative effect. Since there are now alternatives available if the baby needs to be supplemented (see handout #5 Using a Lactation Aid, and handout #8 Finger Feeding) why use an artificial nipple?

In his article How to Know a Health Professional is not Supportive of Breastfeeding he goes on to say ...

5. S/he tells you that there is no such thing as nipple confusion and you should start giving bottles early to your baby to make sure that the baby accepts a bottle nipple. Why do you have to start giving bottles early if there is no such thing as nipple confusion? Arguing that there is no evidence for the existence of nipple confusion is putting the cart before the horse. It is the artificial nipple, which no mammal until man had ever used, and even man, not commonly before the end of the nineteenth century, which needs to be shown to be harmless. But the artificial nipple has not been proved harmless to breastfeeding. The health professional who assumes the artificial nipple is harmless is looking at the world as if bottle feeding, not breastfeeding, were the normal physiologic method of infant feeding. By the way, just because not all or perhaps even not most babies who get artificial nipples have trouble with breastfeeding, it does not follow that the early use of these things cannot cause problems for some babies. It is often a combination of factors, one of which could be the using of an artificial nipple, which add up to trouble.

But what if your baby has already been given bottles? Perhaps in the hospital against your best wishes ... or perhaps because of a condition which prevented the baby from nursing for a while? Is all hope lost? Absolutely Not!

Babies CAN learn to breastfeed after being bottlefed, or to combine both breastfeeding and bottlefeeding. Some suggestion are ...

* If at all possible delay introducing the bottle until the baby has WELL established nursing and latch on skills. Some professionals recommend introducing the bottle between 2-4 weeks others say to wait 6 weeks. My personal suggestion would be to wait till as close to 4 weeks as possible.

*If baby must receive supplements early on, use a Supplemental Nursing System, feeding cup, medicine dropper or spoon to feed baby.

* Avoid the use of pacifiers which only further enforce the "tongue in front" nursing.

* Pump or hand express a bit of milk before attempting to latch baby on so that your milk is READILY available, as it is with a bottle, and baby doesn't become frustrated waiting for let down.

* If baby is already showing signs of nipple confusion from early bottles, attempt to nurse frequently, but be prepared to offer expressed milk using some method other than a bottle if your baby is not able to nurse efficiently.

* Be sure baby is latching on properly - taking the entire nipple and as much areola into his mouth as possible. DO NOT allow baby to suck on just the tip of your nipple ... he will not get milk, and you will end up with sore nipples. If baby is latched on improperly, use your finger to gently break his suction and try again.

* Seek 'in-person' help from a local lactation consultant or LaLeche League leader if one is available. But be sure to find a support person that you feel comfortable with ... working with someone who makes you tense or upset will only make matters worse.

* And finally ... Be patient with yourself and your baby. It is common to face challenges with nursing ... and it doesn't mean you or your baby are a failure ... it simply means that it will take extra effort and patience to make things work for you.

I wish you ALL the best ...



P.S. If you're nursing your baby, or considering nursing if you are expecting ... you may also find some of these Epinions of interest -

If your breasts didn't come with a user's manual ...
(Opinion on So That's What They're For!: Breastfeeding Basics) -

LANSINOH - a nipple's best friend! -

Cue Feeding Your Newborn -

Breasts?!?!? They're NOT just eye candy and advertising tools!!!! (nursing in public) -

Talking to the Boss about Pumping, etc. -

A Good Pump is worth its weight in GOLD ... or more! -

TFBB ~or~ Oh Wow! I'm not the only parent whose been through this! (Opinion on The Fussy Baby Book) -

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