previous page: IV-B. Survey of Pumping Successes
page up: Breast Pumps FAQ
next page: V-A. Supplies--Carriers

IV-C. Nipple confusion survey


This article is from the Breast Pumps FAQ, by bweiss@cs.arizona.edu (Beth Weiss) with numerous contributions by others.

IV-C. Nipple confusion survey

The breastfeeding/bottles poll, given in the four questions below,
was answered for sixty different babies:
|> ----------------------------------------------------------------------
|> 1. My baby first had bottles
|> a. before three weeks of age
|> b. between 3 and six weeks of age
|> c. between six weeks and 3 months of age
|> d. after 3 months
|> 2. (Before the age of three months) my baby
|> a. did not have troubles with breastfeeding due to nipple confusion
|> b. did have troubles with breastfeeding due to nipple confusion
|> 3. (After six weeks of age) my baby
|> a. refused to take a bottle later on
|> b. took a bottle without any problem later on
|> 4. (After six weeks of age) my baby
|> a. did
|> b. did not
|> wean him/herself to a bottle without being encouraged to do so.
|> ----------------------------------------------------------------------

Standard advice is to avoid introducing bottles before a baby is 3 weeks
old, to avoid dooming efforts to breastfeed by nipple confusion, but
then to be sure to introduce a bottle before the baby is six weeks old
to ensure that the baby WILL take a bottle when it's important for
him/her to do so. Another issue is that it's often very upsetting for
mothers committed to the benefits of breastfeeding when their babies
decide to forgo the breast altogether in favor of bottles; the question
is whether the time of first bottle introduction has any effect on this.
Hypothesis 1: bottles introduced too early (usually taken as < 3 weeks
after the baby is born) lead to the trauma of nipple confusion (which
often dooms breastfeeding).

Results: 33 had bottles in first 3 weeks. Of these, 9 had nipple
confusion, or 27%. Out of a total of 60 babies, 10 had nipple
confusion, or 17%. Only one respondant of the 27 (or 4%) whose first
bottle experience was after three weeks indicated nipple confusion when
the first bottle was after the first three weeks; that baby had the
first bottle after 6 weeks but before 3 months, took a bottle later, and
self-weaned to a bottle (i.e., gave up the breast without being
encouraged to do so).

Conclusion: Bottles introduced too early often do lead to nipple
confusion, and nipple confusion can almost always be prevented by
avoiding bottles in the first three weeks. However, there is a 2/3
chance of avoiding nipple confusion even if you allow bottles to be
introduced tooearly. (I personally do not consider these odds good
enough to allow early bottles, when you consider how horrible the nipple
confusion experience can be.) There will now be some interest in
comparing first-week bottles to bottles first introduced at two weeks,
etc.; someone *else* may volunteer to take that poll. :-)
Hypothesis 2: bottles should be introduced by the age of six weeks to
prevent total rejection of bottles later on, such as when the mother
returns to work.

Of the 14 babies who rejected bottle-feeding, 6 (43%) had their first
bottle before three weeks, 1 (7%) between 3 & 6 weeks, 3 (21%) between
6 weeks & 3 months, and 4 (29%) after three months. Of the 41 which did
not reject bottle feeding (not counting 5 respondants with non-a, non-b
answers to question 3), 25 (61%) first had bottles < 3 weeks, 7 (17%)
first had bottles 3-6 weeks, 6 (15%) first had bottles 6 weeks to 3
months, and 4 (8%) had their first bottles after three months.

		+ bottles	-bottles
< 3 wks.	43 %		61 %
3-6 wks.	7 		17
6 wks.-3 mos	21		15
>3 mos.		29		8

Conclusion: Babies first given bottles before the age of 6 weeks had a
23% chance of rejecting bottles altogether in favor of the breast;
babies first given bottles after the age of 6 weeks had a 50% chance of
rejecting bottles altogether. Introducing bottles by 6 weeks does help,
but is far from fool-proof.
Hypothesis 3: Date of bottle introduction affects whether the baby later
rejects the breast altogether in favor of bottles.

13 babies weaned to the bottle (rejecting the breast altogether) without
being encouraged to do so by their mothers. In most but not all cases
this was traumatic for the mother who felt that it was best to continue
breastfeeding. Of these, 6 (46%) had early bottles at < 3 weeks, 1 (8%)
had its first bottle at 3-6 wks, three (23%) started bottles at 6 wks
to 3 mos, and 3 (23%) first started bottles after three months. Of
non-self-weaners, 27 (60%) had <3wks, 7 (16%) 3-6 wks, 6 (13%) 6 wks-3
mos, and 5 (11%) > 3 mos.

weaned breast
46% 60%
8 16
23 13
23 11

Conclusion: the ones who self-weaned to bottles were more likely to have
had first bottles late! This is a surprising result, and, as with the
two questions above, I have run no statistical tests to determine
whether the figures are significant.
Overall conclusion: Bottles should be introduced after three weeks but
before six weeks. Secondary conclusion: it would be interesting to
fine-tune a poll to see whether three weeks is indeed the lower cut-off
for these effects, or if it's actually two weeks or even one. Caveat:
Polls such as this one in which not everyone in a population answers the
qeustions are frequently untrustworthy due to self-selection; a better
approach would be to apply the poll to everybody who gives birth in a
certain hospital, for example. HOWEVER, these are the only solid figures
of any sort that are available anywhere, as far as I can tell, so the
results are the best ones in existance.

Anyone wishing to subject these data to further torture may e-mail me
for more details.

Paula Burch


Continue to:

previous page: IV-B. Survey of Pumping Successes
page up: Breast Pumps FAQ
next page: V-A. Supplies--Carriers