Hi All, Coach Smith back again to comment on "nipple confusion."

Let's get back to basic anatomy and physiology. Babies use a very complex
set of muscles to suck, coordinating dozens of tongue and jaw muscles with
swallowing and breathing. Over 60 separate muscles and 6 cranial nerves are
involved in the suck-swallow-breathe triad. These nerves pass through tiny
channels between the skull bones which, as we know, are moved around during
birth. Furthermore, all muscles need adequate hydration, oxygen, and
nutrients via blood flow and intact innervation (both sensory and motor) to
perform properly. The suck-swallow-breathe muscles must contract in a very
sophisticated sequence.

Muscle response patterning is a well-established principle - that's why
your piano teacher or the golf pro (etc.) nags on and on about "good
technique." Once a muscle group "learns" to make a certain movement,
changing or modifying that movement is far more difficult than learning it
right in the first place. Habit is part of the picture; skill development
is another part;  neural pathway establishment and reinforcement is part;
and avoiding injury/pain plays a role. If you doubt this, try driving a car
with different controls, or try using a different utensil for eating.

Consider what happens to the baby during many births: immediately upon
exiting mom's body, he opens his mouth to take in a huge gulp of air and
instead encounters a blue plastic tube that gets rammed down his throat. To
protect his airway, the tongue thrusts and humps forward in response to the
noxious superstimulus. Presto - immediately a muscle contraction pattern is
established that is counterproductive to the tongue peristalsis needed for
good breastfeeding. "The first cut is the deepest," and the pattern will
tend to be repeated.  And, depending on the circumstances, things can go
downhill from here!!

Yes, nipple confusion exists, call it what you will. It won't go away any
more than any other principle of neuromuscular physiology will go away just
because the consequences of disobeying physiology is inconvenient.

Yes, some babies are very skilled/coordinated with oral movements and can
go from breast to other devices easily and smoothly. So what? Just because
a procedure doesn't compromise ALL babies doesn't justify its universal
use!! SOME babies can't. Therefore, "First, do no harm" should apply to all
objects placed in the infant's mouth except the breast, IMHO.

Yes, some babies are NOT confused - they are UNABLE to suck/swallow/breathe
in a coordinated manner and need additional skilled and respectful help.

And YES, this entire subject needs to be looked at FAR more closely and
comprehensively from many perspectives, IMHO. Please document and write up
the babies you see who can't/won't suck well, including the birth and early
feeding history. A bottle may temporarily solve the immediate problem of
"feeding the baby" but we haven't solved the problem of WHY a normal baby
can't suck normally (at breast).

Linda J. Smith, BSE, FACCE, IBCLC
Dayton, Ohio USA
Bright Future Lactation Resource Centre
http://www.bflrc.com