I would like to add my personal experience to this thread on nipple confusion. My first child was born with a large tracheoesophageal fistula, IUGR and a VSD. She was in NICU for two months and had a very rocky course with every complication. She was unable to eat orally and was fed by gastrostomy after the first few weeks. The gastostomy malfunctioned and she vomited ebm fed by bottle after the tube was removed. She had liver malfunction and marked jaundice from the TPN. She was not gaining weight because any fluid increase would put her into CHF. Her head was bald from iv sites and she had gone through cutdowns on every extremity. She also had a tracheostomy. Her only oral exposure up to the age of 8 weeks was a bottle and a pacifier. The surgeon was hesitant to let her nurse but to everyone's surprise she went to the breast like a prize winner and only then did she "get out of the woods" and start to grow. She never exhibited nipple confusion and I am so grateful that she never had trouble breastfeeding because she was so sick and weak and I was so scared. It was a wonderful gift that I will always cherish. Sometimes against all odds these little ones can really surprise us! Roberta Cricco-Lizza RN MPH MS