Heather, and Jennifer,

I too have had a problem with the terminology of "nipple confusion".
Recently, my colleagues have been using the term "nipple preference". I
am speaking only about rubber feeding nipples, not pacifiers.

I don't quite understand if the doc in question doesn't believe that
babies can express resistance against latching after experiencing feeding
with a rubber nipple, or doesn't he believe there is any long-term effect
on breastfeeding?

Retrospective "research-based" proof about the long-term effect is one
subject that could possibly win more support of docs and nursery nurses.
One legitimate question seems to be "Does it happen often enough and does
it cause enough long term effects to justify finger feeding or cup
feeding for EVERY baby that must receive EBM or ABM?"

I agree that in the best of all worlds, preventing the problem with
skin-to-skin and all else that you mention would be the ideal goal. But
in the US at least, BFHI is slow and difficult in coming. There is a
long, long way to go before nurses with multiple responsibilities for the
baby's immediate well being can be persuaded to routinely use anything
but a bottle to get calories into a baby in the NICU promptly, within the
time available to them.

Proof about the short-term effect is another thing, entirely. Just
watching a baby refuse the breast is proof enough that it can exist. The
problem seems to be that this happens after the mom and baby go home, so
that the nurses (and doctors) don't see it and have to deal with it
personally. It's often grandma, or auntie, and their bag of tricks almost
always contains rubber nipples. (And not every mom has an LC to "bat
clean-up".)

My bias is that it isn't the RUBBER nipple that confuses the baby. (Those
are always exactly the same - predictable - quick association of reward
with little or no effort.)

I think it is the MOTHER'S  nipple, and the changing character of the
sensation the baby perceives within the its mouth with every feeding,  at
least in the first 7-10 days or so, its "latchability" or "lack of easy
latchability",  that confuses the baby, or makes it prefer the
predictable one that doesn't require work. Especially if it begins to
associate breast refusal with immediate reward of a rubber nipple.

In defense of hospital personnel, and well meaning relatives and friends,
I think there is more than one way to avoid this problem. It is my
experience that the occurrence of  this behavior can be reduced by
teaching the mother to trigger the MER before attempting to latch,  to
provide "instant gratification".  Going one step further and teaching
mothers deep softening of the areola before latch is another. I classify
this as anticipatory guidance.  No need to go to the bother of a pump.
"The hand is quicker (and more effective) than the pump."

I have also never heard either term used when the mother of an older baby
tells me her baby "refuses to take a bottle." That situation seems to be
another whole story just as upsetting to some mothers, for different
reasons.

Just MHO.

K. Jean Cotterman RNC, IBCLC
Dayton, Ohio

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