Just my .02 worth on this topic.   Someone said,

"<<Confusion' happens when the  baby *chooses* the productive bottle over the
non-productive breast.>>
It's not nipple confusion, it's preference.  The baby wants milk, if he can't get if from the breast because of low supply, severe engorgement or poor latch or positioning, then he PREFERS the bottle.  He's not confused, he's smart."

This doesn't only happen because mom's supply is low, it happens all the time to babies given a bottle, just because mom's milk doesn't flow freely the second her nipple is in the baby's mouth, as happens with a bottle.  I think I could make a case for calling this confusion.  It would go something
like, baby will latch to the breast but he expects the milk flow to begin immediately, as it does from the bottle nipple (this could also apply to baby at breast with SNS, then without), so he pulls off and cries because he's 'confused' about  why the milk isn't coming out the same way.  It's just
semantics, whether we call it confusion or preference.  My concern, however, with the wording is that if you use the term "preference", some  mothers will hear you to say that the baby 'prefers' the bottle and feel bad that they are 'forcing' him/her to stay at the breast.  Or worse yet, when
explained this way routinely, mom's may get the message that, if given a choice, their baby might 'prefer' the bottle, giving the bottle an edge as a feeding choice.  With the prevailing comfort level our society has with bottle feeding, I could envision this wording leading to pumping and giving
EBM in bottle exclusively or weaning to formula in a bottle, to honor the baby's "preference" in some situations.  If you use the term "confusion", moms get the message that baby just doesn't understand what is going on, so it would be best not to introduce a bottle and "confuse" the baby or that we
just need to resolve the 'confusion' by ...whatever the plan is.  To me, this sounds like a better message to send to moms, especially those who are 'giving this a try' and not completely convinced it is the best thing for their baby.  We all want the best for our children.  Unfortunately, our
society is still not convinced that breastfeeding is the best in most cases, as we all well know!  Wording can be very important in subtle messages that we send.

Marsha

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Marsha Glass RN, BSN, IBCLC
Mothers have as powerful an influence over the welfare of future generations as all other earthly causes combined.
John S. C. Abbot
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