Pamela,
>I share your scepticism about nipple confusion.
>Simply blaming the bottle for a latching difficulty is to stop looking for
>other causes.

I think one of the most obvious problems with the straight "nipple
confusion" theory is that often the baby was given a bottle *because* he
couldn't latch on.

>I think the confusion is partly due to our terminology.  In the US the word
>"nipple" refers both to the teat on a bottle, *and* the nipple on a breast,
>am I right?

Good point. Here in UK, I hear a lot of HCPs talk about nipple
confusion, but to them, the only nipple is the one attached to the
mother - a bottle has a teat, not a nipple. I get so used to talking
American, I forget :-)

>My observation is that the baby is more likely to be
>demonstrating confusion and frustration because he simply can't feel the
>*breast*-nipple on his 'S' spot.  This is indeed nipple-confusion -
>confusion about the *real* nipple.

I wonder if another problem with the term "nipple confusion" is that
implies human babies are mentally "muddled up" and reinforces the idea
that newborn's don't know what they need or want. Mothers often react to
the "nipple confusion" argument, used to discourage them from using
bottles, with words to the effect of "Are you saying my baby is stupid?"

>We need to stop blaming the bottle and start paying closer
>attention to the breast/nipple shape and the mother's latching technique.

This is difficult. My fear is that if we (breastfeeding advocates) start
saying nipple confusion doesn't exist, HCPs are going to become even
more casual about using a bottle for every known problem with
breastfeeding.
>
>Incidentally, Anna, I think the WHO (and my Ministry of Health) concern
>about bottles and teats relates to their ability to harbour bacteria and the
>difficulty that women in poor environments with no running water would have
>in washing, cleaning and sterilizing them.  In any situation where babies
>are not breastfed direct then *cup-feeding* is heavily promoted because cups
>have no nooks and crannies, are easy to keep clean and don't need to be
>sterilized.

Thanks for the clarification. However, I know you don't have to go to a
3rd world country for this to be a problem - when I was training as a
nurse in a deprived part of Wales, the ward would be full of babies with
gastro-enteritis, often from incorrectly sterilised bottles. I've even
known mothers line up a row of bottles in the cot, so the older baby
didn't wake them if he wanted a feed in the night (or even in the day).
--
Anna H. Breastfeeding advocate, would-be writer and bottle-phobic
http://www.ratbag.demon.co.uk/anna/

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