There are several different phenomena that I have seen folks refer to, using the same term for all of them, and often placing the full blame on the rubber nipple. I am guilty of wondering what the big deal was when this phrase first became popular, as I was accustomed to the casual use of rubber nipples in the hospital for years, and seldom saw (or seldom recognized) babies who could not latch. I guess I just drug out the old fashioned nipple shields if need be. When the phrase "nipple confusion" first came into use, I often said to myself "It's not the rubber nipple that's confusing the baby! The rubber nipple is predictable, always the same shape and size and delivers milk at the same speed each time. In the first few weeks. It's the mother's nipple(-areolar complex) that seems changed each and every time the baby attempts to latch. More engorgement, more nipple distortion, more subareolar tissue resistance every day, yea, every hour! And the baby's jaw/tongue is often just not strong enough to deal with it unassisted." That's what got me thinking in the vein of postpartum "latchability" - of teaching the mother to make the human nipple-areolar complex more capable of "distorting to conform to the geometry of the infant's mouth." (Michael Woolridge) Pat said: <Most the babies I see whose mother thinks the baby has nipple confusion actually has "breast aversion" from a stressful experience involving either poor positioning and latch or trying to force the baby to take the breast or inability to get milk.> I agree that the "breast aversion" is a very important point. Unfortunately, this often develops from people who are the most well-meaning and determined to "make breastfeeding succeed", not realizing that they have begun to make the breast a battleground. Also, this is how some babies react when the engorgement makes them feel "as if they are up against a brick wall". I also prefer the term "flow-rate preference" for some infant reactions I see or have heard mothers describe during the early weeks. It is very common for new parents, and families who have bottlefed for generations, to allow the baby to continue wolfing down a bottle without pause in the belief that this behavior obviously proves how hungry the baby must have been. When I get the chance, I try to reframe their thinking to see this as a defensive, stressful effort to coordinate sucking and swallowing with adequate breathing. If and when they feel a bottle is necessary, especially in the case of sitters or daycare, I encourage them to insist that bottles be given slowly with frequent pauses in a pattern more like the pulse-trickle-trickle of breastfeeding. Along with that, I explain how the baby might be more accepting if mom triggers the MER several minutes before attempting to latch, and uses breast compression if the baby gets frustrated later. If this has been the main problem, the baby will usually accept the breast and keep at it. So once again, I think it's important to recognize how misleading semantics can sometimes be. Parents have often heard this term prenatally because someone has tried to warn them as if to "indoctrinate" them in advance, and many get the idea that it's hopeless once "it" happens. Jean *********** K. Jean Cotterman RNC, IBCLC Dayton, Ohio USA *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html