I would suggest, however, that a JHL on nipple confusion not be a
compilation of case studies.  Case studies mean nothing in this
context.  A proper research protocol needs to be established and
rather than 6 articles about how giving bottles to 3 babies did not
seem to, or seemed to, interfere with breastfeeding, perhaps some of
you LC's who work in a hospital with physicians who refuse to
understand the problems with bottles, set up a study that will define
the situation.

Avoid bottles if possible in all babies.

All cases get the help of an experienced lactation consultant.

If supplements cannot be avoided, babies are randomized into
supplementation with:

a. bottle
b. other method, which, I think, should include
                                                        i. lactation aid
                                                        ii. cup feeding
                                                        iii. finger feeding

And you will need numbers, and you will need time and followup.  The
above is just an outline, by the way.  Actually, it is high time this
study was done and done *properly*.

Jack Newman, MD, FRCPC