<< When mothers hear that the baby has "imprinted" on a bottle nipple or that
 the baby has a "nipple preference" they (in my experience) seem to see it as
 a bigger problem. >>

I agree, I like to approach the baby who is having trouble latching in a
gentle positive manner. I don't like to put a label on the problem and say,
"well, your baby can't latch because he's nipple confused."  Instead, I prefer
to encourage mom that baby can learn to latch and breastfeed with enough
patience and persistence.  I usually use the analogy of driving an automatic
verse a stick shift.  When we learn to drive a stick shift, we usually stall
the engine several times till we get coordinated and before we are smoothly
shifting gears. Or, I use the analogy of the first time we tried to ride a
bicycle without training wheels when we were about five years old. To bottle
feed is like driving an automatic.  Feeding at breast takes more coordination
and skill like the stick shift or learning to ride a bicycle for the first
time.  Most babies can learn to build their skills so long as mom has good
supply (to keep them interested and reward them for their effort) and uses
good positioning and attachment skills along with lots of patience and gentle
determination.

I see moms in ped office on day 3-5.  I hate to hear that LC or a nurse in
hospital has told mom her baby can't latch because of "nipple confusion,"
"bubble plate" "flat nipples," etc. I like to keep things positive, "Baby's
not latching, oh, he can learn to."  Lets get pumping and protect supply so
he'll have more interest in latching and then we can feed colostrum/milk to
baby by finger feeding while learning to latch.  Like Dr. Jack says a few
sucks on a finger and then over to breast and we have a latch many times.

I tell moms breastfeeding is a learned skill for baby and for mom. I tell them
that the baby is often times doing one dance and mom another and we have to
practice till both are doing the same dance.  If mom's confidence is
undermined by labeling "not latching" too early on she's likely to give up too
soon without a really good try.

I do see babies sometimes that do seem to be "impaired," having no suck
reflexes or extremely weak suck. Since, I work with peds, it's easy to have
them take a closer look for UTI, heart, or other problem.  If this goes on for
a week or more with no known health reason, I refer to a local OT and we work
together with good results.  But, it is soooooo important to keep the mother
motivated while buying some time till baby is able to learn to feed at breast.
Keeping mother motivated takes lots of positive reinforcement.  Just my
experience.

Warmly,
Pat Lindsey, IBCLC
Pediatrics Plus
Orlando, FL