Pat  Gima asks whether "impaired" is a short-hand term to describe
neurological  dysfunction, or whether I also use it to describe the
temporarily non-nursing baby.  She also asks how my most recent post jibes
with regard to my past attempts at trying to come up with an explanation for
the phenomenon we call "nipple confusion."

I think babies are hard-wired to breastfeed.  Many things can interfere with
this, and often do:  prematurity, difficult birth (today compounded with
exposure to meds), illness, congenital defects, mis-fit with maternal
anatomy, and mis-management of early feedings.  Some of these conditions are
short-lived; some are not going to wear off.  But for whatever reason, they
result in abnormal feeding, or increased work of feeding, or inefficient
feeding.  This is impairment, not confusion.  Babies in these circumstances
who do better on a bottle and begin to prefer the ease and quick flow have
some imprinting issues, but imprinting in humans is rather easily overcome
so long as the alternative feeding method is within the baby's ability to
perform.  If the baby is weak  or small or ill or disorganized or impaired
in some other way, then the strong preference for the bottle's easy flow is
a smart survival choice, not confusion.

It has been my experience (repeated many times) that time and growth heal
many feeding-related problems, and unless there is permanent neurological,
or extreme sensory defensiveness, the baby's feeding ability will improve.
If mother has a protected milk supply, and if the infant has been maintained
with even token breastfeeding, it is not difficult to transition the baby to
breast.  If there is balking (once baby is strong enough) a few days with a
newborn small size nipple shield is generally enough to trick the baby to
accept the breast.  Once the baby makes the realization they can get
sufficient milk out of the breast, they fall in love with nursing just as
one would expect.  This process can take months, days or hours, depending on
how seriously impaired the infant's feeding ability is, and what its'
primary cause is.

It isn't normal not to eat.  If we had a cat, an old grandmother, a toddler
who stopped eating, we wouldn't call that confusion.  We'd call it a big
problem, and we'd intervene with whatever kind of feeding the animal or
person could manage.  We'd look for the reason the problem was happening and
try to fix it.  If it was going to just take time to recover from, we'd make
it as easy as possible for feeding to take place, with the ultimate goal
being a full return to normal methods of taking in nutrition.

Hope this explains what may have appeared to be contradictory comments.  I
think this is a spectrum of behavior type thing, with all sorts of
subtleties, which is why I so appreciate the work of the feeding theorists
like Wolf and Glass, Bosma, Palmer, etc.

Barbara

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