Nipple confusion: myth or reality?

The suckling mechanism at the breast acts on intracranial pressure to allow the skull to mould: "The pressure of the tongue on the palate during suckling and at rest enables the cranial bones to move and shift."

Breastfeeding also helps to shape the palate and support its harmonious growth, which is vital for good health: "From an anatomical perspective, the palate is nothing other than the foundation of the upper airways. Optimal palate growth will therefore allow sufficient space for the permanent teeth, better ventilation of the sinuses, nostrils and ears via the Eustachian tube."

Suckling at the breast supports healthy jaw development (maxillary bones and facial muscles). Facial shape is genetic, but breastfeeding engages so many muscles that it has an enormous impact on the face and jaw…

"Babies are often born with a receding chin (retrognathia). Suckling therefore allows it to be brought forward, aligning both jaws. Ultimately, the facial shape of babies, children and adults depends not so much on the genetic code inherited from their parents, but on the suckling they did (or did not do) during the first 3 years of their life! Everything is shaped in the first 3 years of life!"

Suckling at the breast requires the child to breathe through their nose, which is the most efficient form of breathing and the one that brings the most oxygenation to the brain. It is the only one that activates the vagal system, the body's relaxation system. 

A bottle-fed baby can hold their breath and breathe through their mouth.

"The longer breastfeeding continues, the better the cerebral programming of breathing will be. Sucking one's thumb or a dummy is therefore also a compensatory mechanism that the baby or child has developed to improve or preserve nasal breathing."

Baby no longer knows what to do with the breast and nibbles ineffectively.
They become agitated at the breast and appear to refuse it.
They pinch at the breast or "peck like a woodpecker" - latching, releasing, re-latching, and releasing again.

Please note there are other reasons that may explain why your baby becomes agitated at the breast - for example, a very fast flow, an ear infection, reflux... If in doubt, consult an IBCLC to help you reach the right diagnosis.

Tensions that may stem from undetected ties (lip, tongue, cheek), restricting tongue mobility
Tensions from pregnancy and birth that have not been resolved
Jaw/tongue size incompatibility
Prematurity
Difficulties coordinating sucking and swallowing...

The first step is to explore the causes rather than pointing the finger at one container or another.

Baby will mechanically feed less. Milk production will then decrease.
But above all, behind this "nipple confusion" lie sucking difficulties, often caused by tension:
"To compensate and relieve these tensions, these babies (and children) will have a constant need to suck (a thumb, a dummy, the breast). They are trying to make up for the lack of contact between the palate and the tongue through their thumb, a dummy, or the breast. They are seeking to ease their tension."
Did you know ? If the tongue does not press against the palate, it cannot stimulate the parasympathetic system responsible for calming. 

Thumb or dummy sucking, or always having the breast in the mouth, are compensations for the work the tongue is not doing. The dummy compensates and the baby breathes through the nose whilst sucking, but when they fall asleep with the dummy or thumb in their mouth without actively sucking, they may breathe through the mouth (the teat keeps the tongue in a low position)…

The child is in a seated or semi-upright position, not lying down, and above all take your time and allow them to pause. 

Round and long teats are preferable. Flat and short teats, which try to mimic the breast — so-called "physiological" teats — should be avoided, as they will force the baby to pinch.

This way, they will have more control over what they take, and will be able to refuse the milk. 

A bottle given vertically to a baby lying in your arms will inevitably cause milk to drip onto the baby's tongue, triggering the sucking reflex (so the baby has no choice but to keep suckling even if they are not hungry). Archaic reflexes are involuntary actions (sucking is one of them).

Remove the source of the confusion immediately and try other alternative feeding methods as mentioned above. Put baby back to the breast and seek support from an IBCLC lactation consultant.

Try a cup, or breast milk flans (breast milk thickened with agar-agar), which your baby can eat with a spoon.
Your child can also eat table foods in your absence and make up for it when you return (mornings, weekends…)
Reintroduce night feeds to compensate.

here are a few tips to help your baby enjoy feeding at the breast again:
- You can use breast compressions to help the milk flow a little faster. You can also hand-express to stimulate your let-down reflex.
- Choose a quiet, dimly lit spot for breastfeeding, so your baby isn't distracted.
- Avoid forcing it and try again a little later.
Above all, trust yourself and put your baby to the breast as often as possible — without watching the clock!