In a message dated 4/20/2005 10:07:38 AM Pacific Standard Time, 
[log in to unmask] writes:
Several of the peds laughed at the idea
of nipple confusion and want studies to prove that it actually exists.
There are no studies that "nipple confusion" exists, but there is one study 
by Cindy Howard et al. that indicates infants fed more than 2-3 supplementary 
bottles vs using a cup, will be less likely to be exclusively breastfeeding 6 
weeks later.  The study is a superb RCT.

Howard CR, Howard FM, Lanphear B et al. Randomized Clinical Trial of Pacifier 
Use and Bottle-Feeding or Cupfeeding and Thei Effect on Breastfeeding. 
Pediatrics 2003; 111(3):511-518

If you don't want peds to laugh, try talking about "flow preference":  some 
infants learn to prefer the faster flow through a bottle.

There is also the very old study:
Davis HV, Sears RR, Miller HC & Brodbeck AJ. Effects of Cup, Bottle and 
Breast Feeding on Oral Activities of Newborn Infants. Pediatrics 1948; 2:549-558

Nancy
Nancy E. Wight MD, IBCLC, FABM, FAAP
Neonatologist, Sharp Mary Birch Hospital for Women and Children's Hospital
Medical Director, Sharp HealthCare Lactation Services
San Diego, CA
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