I second Susan Burger's observations about infants who refuse to
breastfeed.  I agree that they are not so much  confused as making a
decision based on their experience of feeding.  Any smart baby is going
to prefer a feeding method by which he actually gets food in the least
stressful way, and will make that preference known to his mom.
 I tend to think about/talk about "breast refusal" or "nipple confusion"
in terms of the skill deficit for breastfeeding, so that we can start to
work on building the skills the baby needs to bf effectively.  The other
important component of  "breast acceptance" is helping the mother to
present the breast in the ways that the baby expects instinctually.  The
more I learn about what cues baby's latching behaviours, the more I am
able to help older and older babies learn to breastfeed.  When a baby
has the skills to breastfeed, but has not learned to, I tell mom that he
will breastfeed when *we* can help him make sense of the breast.  (And
thanks to Diane W for helping me codify some of these expectations in my
own head!)

--
Catherine Watson Genna, IBCLC  New York City  mailto:[log in to unmask]

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