I think that there are at least two things going on with nipple confusion, continuing on with the recent thread on Lactnet about A----t nipples and silicone nipple shields. The first is the difference between artificial nipples or teats used with bottles compared to the mother's nipples, that is hardness and size etc., but, and here is my observation, and secondly, a discrepency between the constant flow of milk with a bottle compared to the variable rates of flow in the breast. I see the baby fuss and cry with attempts to latch him on if he's had bottles, and if we succeed in actually latching him on I see a frustration that I perceive to be because the breast milk is not coming at the constant rate of the bottle. There are risks with any alternative method of feeding the baby. However, I think I'm seeing more successes when it comes to weaning the baby off finger feeding and onto the breast, compared to the baby, a week old who was given bottles for a couple of those days. I haven't used nipple shields very much so I really can't comment on these, however, at least at the breast, with a nipple shield, that baby would be familiar with the changing rates of flow of mother's milk and not be vulnerable to this additional cause of frustration. Kathy Bodden, RN, BScN, IBCLC