I enjoyed the expertise of Barbara Wilson-Clay's presentation on Saturday in Austin, TX.  The entire seminar was very informative!!
I am also concerned about suck-deprivation in our NICU, so we do allow pacifiers for developmental needs of our infants.  I have not experienced so much of a problem with nipple confusion from infants who have used a pacifier as I have from infants who have been bottle fed.  I would like to try cup feeding our breastfed babies to see if our  mothers' success rates with breastfeeding increases - 2 areas  (a)  exclusive breastfeeding at discharge and (b) duration of breastfeeding.  I am in NIDCAP training with Linda Lutes ( Oklahoma Infant Transition Program )  .  She has taught me the importance of sucking as it promotes flexion, which promotes autonomic, motoric and state stability in our infants.  We have some mothers who have heard the recommendation of AAP and different sources to  avoid pacifiers and bottles for first 2 weeks of establishing breastfeeding.  These recommendations seem to refer to healthy full term infants.  I always remind the parents that their infant needs some special care, or they would not be in our unit.  Then I list several things that we as staff and they as parents can do to decrease their babies stress level and get them home more quickly.  One of these interventions I emphasize to parents is a pacifier.  
One question I have asked Linda Lutes is if it is necessary for infants' development to have consistent nutritive suckling opportunities in their parents' absence, or will the non-nutritive suckling be sufficient along with the nutritive suckling at breast when parents are present.   I didn't feel that I received a very definitive answer, but she seemed to think that non-nutritive suckling would be good and also offering finger-feeding for nutritive suckling.  As Barbara pointed out on Saturday, I'm not sure that finger-feeding is much different than bottle feeding when it comes to nipple confusion. Fingers are hard like bottle teats and do not elongate  and compress like a breast.
Any thoughts out there?  Thanks to everyone who has been assisting me in my "quest" for information and knowledge.  
Dani Hudspeth RN IBCLC
Baylor NICU - Dallas
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