Jack makes a great point about artificial teats being the experimental
model.  We absolutely need to make sure we don't expose infants to such
things due to ill-conceived or meaningless hospt. or birth center routines.
However, I do want to point out that at present, no formal definition of the
term nipple confusion exists, so it is very difficult to discuss the issue
with many health professionals.  It is the same problem which hampered
research which failed to define "breastfeeding" accurately.  Nomenclature is
a bit of a hang. So working on a formal definition and looking at the issue
formally in experimentally designed studies is worth doing.

Jack, you have hinted before, and came right out and said it about Chole
Fisher, that  having such good skills can over-come nipple confusion.  Maybe
we should also be studying a way to duplicate her techniques.  Techniques
can be taught, and by willing students they can be learned.

I continue to wonder about non-nursing babies who are described as nipple
confused.  In the very early post-partum, the issue seems to me to be that
of imprinting:  Avoidence of what Mavis Gunther described in the 1950's as
the "super-sign stimulus."  Also, I still think the most at-risk babies are
babies whose mothers lack nipple protactility. (They compete poorly with the
super sign.)   And I think there are babies who probably would have been (in
earlier eras) the non-viable ones, who for congenital or birth injury
reasons are not normal feeders. In modern times, the presence of lots of
birth meds complicates a lot too. Personally, I think nipple confusion is
like one of those airplane disaster chains-of-events.  Everything has to
happen exactly wrong to overcome the normal, which is to go to breast and
suckle beautifully.  This, of course, supposes that birth attendents and
helpers know how to assist with physiological positioning.  Head shoving and
neck flexing are powerful disincentives for baby to overcome while trying to
swallow.

I think the observations people have about this issue are important, and
hopefully the theorizing leads to attempts to define and to research designs.

Barbara

Barbara Wilson-Clay, BS, IBCLC
Private Practice, Austin, Texas
Owner, Lactnews On-Line Conference Page
http://moontower.com/bwc/lactnews.html