I did not want to write a tome in one posting, so I add the following on
my previous posting on nipple confusion.

Nipple confusion is not an all or nothing thing.  But a bottle teaches a
baby that he need not open up his mouth wide in order to get reward.  A
wide mouth as the baby comes on to the breast is important to a good
latch, and a good latch is the key to successful breastfeeding, but it
is obvious that babies can do just fine with a poor latch if the mother
has an abundant milk supply.  Now there is often a big price to pay for
this poor latch--sore nipples, frequent and or long feedings, colic in
the baby, blocked ducts and mastitis.  There is, also, a limit to
adaptability, and we sometimes see babies latching so poorly that even
when the mother has milk for triplets, the baby loses weight.  A poor
latch is not only due to the use of bottles, not by any means, but
artificial nipples can make a bad situation worse.

Thus many people say that babies will do both and accept both.  And some
do, especially when the mother's milk is abundant.  But the range of
nipple confusion is not limited to breast refusal.  As noted above, lots
of other problems may occur as a result of a less than ideal latch.

Nipple confusion: the tendency of babies who have received artificial
nipples to latch on less well than they could otherwise have, with
resulting difficulties in breastfeeding.  These difficulties may be
severe or minor.  That is why, if we all had the skills of a Chloe
Fischer, there would not be nipple confusion, because we could help the
babies to get latched on well despite the use of the artificial nipples.

Jack Newman, MD, FRCPC