Someone asked whether I was minimizing the risk of nipple confusion or flow
preference when I make the statement that the baby who won't nurse is a baby
who can't nurse.  This is a complicated issue, and to me, these behaviors
all exist on a spectrum ranging from mild to severe.

I think that what people call nipple confusion is often not confusion at
all.  It is an impaired baby who can't feed normally (ie at breast.)  People
can quibble over the semantics of a word like "impaired"; it's just the word
I am playing with while I try to figure this out, and I'm open to a better
one if anyone has a suggestion.  What I am trying to get at is "sub-optimal"
"not-normal"  "less than perfect."  It can be temporary as in the
drug-zonked or jaundiced infant, or really serious and permanent like the
child with neurological damage from birth asphyxia.

  If an infant anywhere along this sub-optimum, at-risk spectrum gets a
bottle, they are often so relieved to be able to suck on something and get
results that they throw huge fits when people try to force them to go back
to something they can't manage.  So the bottle is not the primary problem,
the impairment is. The baby is not confused, but making a smart survival
decision.  If you can fix the original problem,  protect the milk supply and
keep your options open while time heals it,  often baby can be transitioned
to breastfeeding via a variety of methods.  That's our job:  analyze the
problem, fix it if we can, protect the milk supply, and assist in the
transitioning.  But feeding the baby comes first, and you can do it however
works best for the baby.

Not that I like early introduction of bottles for no good reason.  Certainly
the early exposure has some risks -- most of them probably psychological and
for the mother.  Babies DO do some imprinting early on, and studies show
differences in the ways these babies use their tongues.  The Scandinavians
are worried about fingers going in the mouths of infants during imprinting.
Yet how many of us ignorant new parents stuck our fingers in our babies
mouths during the first few hours of life?  I know we did in our family.  If
it were all that easy for a normal baby to be "confused", we'd all be
extinct.  However, its a romantic idea to assume that in other times
everyone breasttfed perfectly because they knew how to do it and had no evil
bottles to confuse anyone.  Babies are very vulnerable, and died like crazy,
and I suspect many of them died from feeding dysfunction, because inability
to feed is a SYMPTOM of a compromised organism.

Ideally, mom and baby should experience no separation, no interventions
unless medically called for, and bottle use should be delayed so the milk
supply can be brought in at optimal levels.  However, lots of babies get
early bottles and do fine nursing.  What about working moms who go back at
4-6 wks pp and baby gets bottles all day and nurses at night?  How come they
do so well?  I think it's because there isn't anything else going on.  These
are normal babies, normally producing moms, and everyone makes the switches
well.  It's the NOT-normal moms and babies who are at risk for what is
commonly mis-termed "confusion."  And for those who are worried about
telling mothers that they have "Not-normal" babies, I am NOT suggesting that
at all.  Why worry anyone over something that is probably temporary?  I
simply point out why the baby can't nurse, and try to predict how long it
will be before things are going well.  What's sad is many women I see who
are scared to death they have given their babies a permanent condition
called nipple confusion, which means that now they aren't going to be able
to breastfeed.

Hope this helps.


Barbara Wilson-Clay BSEd., IBCLC
Private Practice, Austin Texas
Visit the "LactNews-On-Line" Web Page
http://www.jump.net/~bwc/lactnews.html