I recently had a conversation with another mother at a play date about the concept of "nipple confusion." Our conversation went a little something like this.

“I offer one bottle a day, especially in the car,” I told a fellow mother at a playdate.

“You do?” she responded in surprise. “I thought you said you nurse until they are about 18 months old.”

“I do breastfeed for a long time,” I told her. “But I offer a bottle or pacifier, too.”

She looked at me like I was cheating; that if I claimed to be a breastfeeding mother, it should be exclusive. I was a fraud if I didn’t nurse for every feeding or suckling need.

“What about nipple confusion?” she wondered.

“After my first child, I didn’t worry about it,” I responded.

Since then, I’ve been contemplating the validity of nipple confusion – the concept that infants suffer confusion between artificial and real nipples. The idea is that they prefer bottle feeding over breastfeeding when using both.

Proponents of breastfeeding, such as Dr. William Sears, wholeheartedly believe nipple confusion is not only real, but can cause premature or unwanted weaning.

But others, including Marianne Neifert, say there isn't enough scientific data to support this idea. I've heard from other experts, including my pediatrician, who say they’ve never seen a case of nipple confusion in 25 years of practice. Instead, a multitude of factors contribute to the length of time a mother breastfeeds, including socioeconomic status and age, to name a few.

When I had my first child, however, I did believe in nipple confusion. I trusted the breastfeeding authorities because I was determined to breastfeed. I never offered my daughter a pacifier. I refused to introduce a bottle until she was about 4 months old – and when I did, she arched her back and screamed in rejection. It took several months and numerous bottles before she accepted one.

This made her infancy downright miserable sometimes. I was nervous to leave her – even to take care of myself and go get a haircut or attend a yoga class. I feared she’d be inconsolable. Driving in the car almost always meant she’d cry. I was anxious and felt alone in her care-taking.

I believed breastfeeding or bottle feeding was an either/or proposition, and that doing both would literally derail the former.

Boy, was I wrong.

With my second, third and fourth child, who was born last February, I ignored the notion of nipple confusion and offered both bottle and pacifier about a week after birth. I keep bottle use to one feeding per day in order to maintain good milk supply. Having the option of using a pacifier or bottle has made breastfeeding work better for me. I’ve nursed each child well over the recommended 12-month target – and I hope to do the same with baby No. 4. My children have always been hard to wean, which is another matter, but it’s because they’ve always preferred nursing to anything else.

All in all, parents should know the jury is still out on whether nipple confusion is even real. In the mean time, much stress and many tears can be avoided with the help of bottles and pacifiers. At least, it did for me. In my experience, it's best to take a moderate approach when it comes to nipple confusion and breastfeeding. I encourage my fellow moms to nurse when it makes sense and offer a bottle or pacifier when it doesn’t.


Laura Johnson Dahlke, a mother of four, wrote this guest blog for Johnson Dahlke has a particular interest in writing about women’s issues relating to pregnancy, childbirth and mothering and has published work on the topic several times. Most recently, her essay “‘Every Father Feels Himself a Joseph’: Men Writing Their Childbirth Experiences,” was published in the September 2014 issue of Women’s Studies: An Interdisciplinary Journal.

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