Q. Soon after my daughter was born, I started bottle-feeding her with expressed breast milk because breastfeeding was very painful for me. I have decided to try nursing again, but I'm worried I made a mistake by switching from breast, to bottle and now back to breast again. Is this harmful to my milk supply? And will switching back and forth confuse my daughter?

A. Congratulations on your decision to try breastfeeding again. It often takes a mother and baby at least a couple weeks of exclusive breastfeeding to establish a feeding rhythm that's comfortable for Mom and produces enough milk for baby. I want to reassure you that it's worth attempting to overcome whatever obstacles you may encounter to establish a good breastfeeding relationship.

New studies have shown that the length and frequency babies are breastfed correlates with the high cognitive skills and good health they experience as they grow. While it's true that your daughter may have initially been confused by the breast-to-bottle back-and-forth, you certainly need not worry that she has been harmed in any lasting way. What's important is that she was still getting your pumped breast milk. To get back to exclusive breastfeeding and lessen the use of supplemental bottles, try the following:

Teach baby a comfortable latch-on. Are you allowing baby to put too much sucking pressure on the nipple, rather than the areola (the darkened area surrounding your nipples)? This is the most common cause of painful nursing and may be why you've encountered problems. You need to get baby to open her mouth as wide as possible. Use your index finger to depress her lower jaw. When her mouth is open wide, quickly offer the breast while ensuring that her lips and gums are putting sucking pressure above your nipple. This not only makes latch-on less painful for you, but allows baby to get the most milk.

Another problem may be that baby's lips are tight or pursed while she nurses. This can lead to sore nipples. Try the "lower lip flip," a trick my wife (a lactation consultant) used on our babies. Once your daughter is latched on, take your index finger and flip her lower lip outward. This, in combination with baby's wide open mouth, should increase your comfort and nursing success.

Get consultation. It's now common for pediatric practices to have a lactation specialist either in their office or on call. Consider getting a positioning and latch-on consultation now, before any uncomfortable nursing habits develop  -- it may be one of the most worthwhile things you do as a new parent.

Gradually lessen the number of bottles. Once you've established an optimal milk supply and a comfortable latch-on, the occasional supplemental bottle is fine. However, I discourage supplemental bottle use unless absolutely necessary, as I find switching between breast and bottle can sometimes causes "nipple confusion," especially during the first month of life. When bottle-feeding, baby can suck any old way she wants and the milk still flows freely. If she's latching onto your breast, on the other hand, she must do it correctly in order to get fed -- thus the confusion. If out of necessity you must combo feed, try to hold off until your baby is past the newborn stage. Once she's older, the likelihood of nipple confusion will greatly decrease.

Think milk! Breastfeeding can be thought of as a confidence game. While nursing your baby, visualize your milk flowing. Imagine your baby properly latching-on and enjoying your milk, and imagine yourself enjoying your ability to nourish your child. It's amazing how focusing on these positive, motherly thoughts can help you produce more milk.

You may find our book, The Breastfeeding Book

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