Deb writes, ".. 6 day old ABM/bottle fed baby. Mom decided yesterday that she wanted to bf - stated she had not put baby to breast .. I'm reviewing in my mind my nipple confusion/nipple preference speech that I will probably have to use. First try, baby latches and breastfeeds like a pro with a good pattern and swallows and proceeds to do 20 minutes plus on each breast..Go figure." Deb, you just described exactly why I have a problem with the Dx of "nipple confusion". The first time this happened to me was when I saw a two week old exclusively bottle-fed baby (EBM in the bottle) who had never ever been to the breast. Baby latched first time and breastfed like a dream, never looked back. Ok, so I know nipple confusion exists, and that bottles are more likely to cause it in *some* babies, but this is not an all-or-nothing thing and I think blaming the bottle per se is just too easy, and stops us looking further. The bottle can sometimes be a *consequence* of difficulty latching to the breast - to blame the bottle or pacifier is to miss the point IMHO. Thanks for sharing your observation. Pamela Morrison IBCLC, Zimbabwe