Tiffany, nipple confusion is a broad topic with much debate.  I have  done a 
couple talks on this subject and have read many different theories.  
There is definitely an issue with the newborn who gets the first  
introduction of an artificial nipple prior to breastfeeding and mom has  challenging 
nipples.  This is a baby who has a very sensitive suck stimuli  and now needs a 
long firm object to respond to.
Next comes the rate of flow.  Bottles always  flow faster, therefore giving 
larger amounts than a mother's breast ever  would.  Some babies may then want 
this response when going to the breast  and are not happy when it does not 
happen.
I truly believe the best approach in the early days for giving babies milk  
other than from the breast should be either the spoon, cup, or paladai.   These 
methods allow the baby to control their intake and not introduce a long  firm 
stimulation into their mouths.
The later issue on "nipple confusion" where you have a baby who is  
exclusively breastfeeding and then offered a bottle and refuses to take it is a  
complex picture.  Most babies have no problem going back and forth with  breastfeedin
g and bottle feeding.  Some of the issues for the baby is  separation from 
mom.  I hate hearing stories of how parents and health care  providers talk 
about how to get a baby to "take a bottle".  The association  of feeding should 
always be pleasant and babies are very aware when it is a  confrontation and 
battle.  I tell parents to always keep feedings fun and  low key.  Use imitation 
and praise when introducing a bottle to a  baby.
My last point is that babies never have to have a bottle.  Babies can  go 
from breast to cup and do just fine.
Tell moms to establish the breastfeeding, enjoy their babies and there is  
always a way to keep their babies fed once that times come when they will be  
away.
Ann Perry, RN IBCLC
Boston, MA

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