> An interesting question arose yesyerday in my nursing clinical.   One of
> the students did an extensive (she stated) lit search on nipple confusion
> and could find no studies actually documenting this event.

Lee-Ann
This is indeed a frustrating area lacking in clear-cut research based
evidence. The best work I am aware of was done by John Neil, an
obstretician and IBCLC in Melbourne who was using ultrasound to look at
the sucks of babies with feeding difficulties.  He identified a type of
suck (on the breast) which was only seen in (some not all) babies who had
used bottle teats. He presented at the ALCA Conference in Hobart last year
and showed a video that was nearly ready for release.  He was to have
spoken at ILCA this year but has made major changes in his life and is not
pursuing this work any more. Having seen his video, I am convinced suck
confusion exists.

In the absence of controlled studies, to find evidence for suck confusion
you need to look in other fields.

Elsie Mobbs, a psychologist and Assoc Lecturer of Medicine at the
University of Sydney wrote a thesis on imprinting and one teat
preference. She presents her work from time to time in Australia. She
says that it should not be unexpected to find human infants expressing a
"one teat preference", because imprinting on a particular nipple/teat is
common across all mammals and is probably an evolutionary survival
strategy. She says that thumb sucking is evidence for imprinting in
humans. However, imprinting on a thumb, dummy or teat is a pathology -
humans are the only mammal that can survive when the biological object,
the mammalian nipple, is not chosen for the imprint.

A group of dentists in Japan are studying the myoelectric activity of the
muscles used during breastfeeding and bottlefeeding.  Their work confirms
several other ultrasound studies which show that there are definite
differences in tongue position and in the muscles typically used to feed
from a human nipple compared to an artificial teat

Personally, I think there is enough evidence - both from clinical
observations and the studies described above - to be very wary about
risking suck confusion. As Jack would say, the onus should be for the
other camp to prove that no harm or confusion comes from introducing an
unnatural object at an impressionable age, when the whole system is
geared up for the survival strategy of learning to feed.