If choosing a term to explain what some babies experience when receiving
bottles and then going to breast, I agree with the preference of "confusion"
over "nipple preference" or "breast aversion".   Imagine telling a
mom...well, your baby prefers the bottle...Mom thinks 'no problem, give him
the bottle' since moms want to do what baby prefers and even worse would be
to tell her the baby has breast aversion.  Eeks, the baby is actually angry
at me for trying to breastfeed, for sure I will quit.  I think confusion is a
term that means with understanding it can change.  Confusion means just
that....I would if I could, I want to, just can't figure it out, etc.  The
other two options imply denying the baby happiness.

However, the thought is that nipple confusion itself cannot be proven with
scientific studies and in fact is considered false by some. If the thought is
that first came the problem then the bottle, how does that explain babies
first received the bottle and then had difficulty breastfeeding? (Especially
since that is when the term started...babes were bottled and brought to
breast hours later....some had difficulties some did not.) Would they have
had breastfeeding issues regardless and it is just a coincidence?  And how
exactly would any study be able to assure nipple confusion does not exist
since it would require the same baby receiving two first methods of feeding.
Statistically we could say that when comparing different babies and different
feeding methods we see this nipple confusion is a notion "believed" but not
proven.  However, if we see each dyad as an individual situation we cannot
negate the reality that a particular baby and a particular mom after a
particular birth will or will not have issues making breastfeeding more
difficult, if the first feeds are at a bottle nipple (or not).  I see the
biggest hurdle of lactation science and studies is the process of research
itself and control groups and comparing situations when in reality so much is
varied by the dyad itself. This is why we have so many different opinions
about what will and won't work when we are looking at solutions.  Even though
we will most likely reach the point that we completely understand the science
of lactation, the breastfeeding itself will still be the art and we will
still need to hear from others what they have tried, what they have seen,
what the experience has taught them.

Pam MazzellaDiBosco, IBCLC   FL,USA

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