Dear Carol,

I think you are right to counsel parents that there is no firm age for
introducing a bottle, but that breastfeeding needs to be going really well
first, for a good period of time.  I think you are also right, unfortunately,
about how concerned young parents seem to be about introducing a bottle and
going back to work.  I have counselled several moms now who are quite willing
to settle for the second best (they are very intelligent, know all the
benefits, one even had major allergy history in family) because they have
already figured on going back to work.  It's a complex problem, seems to have
a lot to do with their self-image as much as what they want for their baby.

But I did want to comment about those moms you see who tell you they have no
nipple confusion even though they introduced the bottle at one week, etc.  My
education and experience has been that nipple confusion can manifest itself
in many degrees, from outright refusal, to decreased stimulation of the
breast, to delayed rejection of the breast in favor of the bottle.  I have
also noticed a connection between early introduction of a bottle or pacifier
and biting.  When a mom tells me she sees no problems when she introduced the
bottle, I see that she sees more benefit than risk, and overlooks the more
subtle problems until they are out of hand, i.e., baby has weaned to bottle
or biting is a major problem that leads to weaning, too.  I don't see many
instances where bottle use does not lead to early weaning, but unfortunately
that is not a problem, sometimes even an advantage to these moms.  They just
don't "get it".  Some days breastfeeding counselling is so discouraging, not
because of the formula reps or the weird docs, but just because of the moms
who can't make the connection with themselves as mothers of a very needy,
helpless, trusting human being.

Oh, well, thanks for listening.
Ann Davis, LLLL, Dayton, Ohio
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