Why wouldn't a baby want to nurse?  I suspect that imprinting is a critical
issue, and that the time and course of first feeds are really important.
However, humans have a lot of built-in flexibility in their behavior. If a
baby is merely "confused" a determined mother can easily over-come the
damage done by early artificial teat exposure.  Certainly once breastfeeding
is learned many babies go effortlessly back and forth from breast to bottle
as is evidenced by the babes of working mothers.  Problems certainly ensue
when a nervous or ambivalant mother is easily discouraged by baby's balky
behavior at breast and gives up too soon. These moms need simple reassurance
that patience and persistance will overcome this.  Our job is to give good
advice on techniques for preserving milk supply and for coaxing infant back
to breast. You can take teats and pacifiers away from these babies to kind
of push them back in the direction of seeking satisfaction from the breast.

For the babies who don't respond, I believe its not a matter of won't nurse,
but CAN'T nurse.  These babies have something wrong with them. Or maybe
their mothers have some anatomical problem, or their two anatomies don't
fit. I have a lot of difficulty feeling right about depriving these infants
-- esp. for long periods of time -- from the one activity most effective in
helping babies achieve state organization:  sucking.  My greatest qualms
about cup feeding come from this reservation.  I'm not sure I agree with
deprivation when the infant may lack the capability to do what we wish him
or her to do.  There is all sorts of research showing better growth, and
greater calm in NICU infants allowed to pacify on soft, air-filled
pacifiers.  I've had extensive experince with 2 infants (which spanned many
months) who were deprived of early, pleasant oral experiences and who have
required tons of physical therapy to correct feeding problems.

Pacifiers and bottles are just tools.  They have certain uses.  They can be
over-used, and used inappropriately,but they can also be very useful
theraputically. All through human history people have handed stuff to babies
to chew on.  All through human history some babies haven't been able to
nurse.  If their mothers couldn't somehow figure out a way to pour enough
milk into them, they died.  I suspect most did, as it was probably a lot
harder to keep that milk clean.

Barbara Wilson-Clay, BSE, IBCLC
priv. pract. Austin, Tx

PS Check out the conference page:  http://moontower.com/bwc/lactnews.html.