Well, this hasn't come up for a while.  Look, I think that there has
been a lot of confusion about nipple confusion.  I don't think there is
any doubt that such a thing exists.  And I don't think that there is any
doubt that occasionally it can occur after one bottle.  That's because,
even though I take everything with a grain of salt, I also listen to
what the mothers are saying.  And many say:  The baby took the breast,
then he got a bottle and he refused to take the breast.

Babies are not complicated.  They will go where they get milk.  If they
get milk from a bottle they will go there, and if they don't get it from
the breast, they will refuse the breast.  They are unlikely to get milk
from the breast in the first few days *unless* they are well latched on.
To put it as nicely as I can, a nurse who would give a one day old
"breastfeeding" baby a bottle of formula wouldn't know a good latch if
she fell over it.  Thus, the reason most mothers "don't have enough
colostrum" is that the baby is not latching on properly and not getting
the milk available.  So the baby goes to the breast, and gets virtually
nothing.  He goes to a bottle and gets reward.  Am I just too thick to
understand, or can this lead to preferring the bottle?  Dr. Pavlov?  Dr.
Skinner?

May I again suggest the Immediate Postpartum Breastfeeding Decision
Tree, which appeared in JHL of June 1996?  There are, however, two
problems with this tool, as I see it.  One is that it requires staff who
are helping women with breastfeeding to know something about
breastfeeding (really, how strange, how daring, how absolutely radical
an idea) and how to know the baby is latched on well and getting milk.
Secondly, it requires evaluation and correction of breastfeeding (latch,
compression) *before* jumping to supplementation.  Unfortunately,
altogether too many "helpers" jump from "problem" to supplementation,
and think they are supportive of breastfeeding because they used a cup
or a lactation aid rather than a bottle.  AARGH!

Jack Newman, MD, FRCPC