Rushing into the fray again :

When a baby isn't sucking well at the breast for more than 24 hours or I hear
sounds that concern me at the time he is trying to latch on - or when a mom
comes to me after whaterver time and says baby's suck hurts, or I see a
macerated nipple, I do a suck check.

(Thought I'd explain my parameters for those who think that we who DO put
fingers in baby's mouth do it to EVERY baby NO MATTER WHAT the symptoms.)

Have found three movements primarily:   bunching of tongue in the back, pushing
the finger out with the tip of the tongue, or erratic tongue movement.  Some of
these are also accompanied with a very sensitive gag reflex.

What I consider the classic "nipple confusion" movement is the bunching of the
tongue in the back.  Currently, though, thanks to the "most like mother herself"
advertisement, I'm also finding the pushing out with the tip of the tongue when
that particular short-nippled nipple is used.

"Nipple confusion" movements are different from those caused by baby sucking his
finger in utero - when I usually find a sensitive gag reflex and a lack of
interest in opening mouth wide no matter how much we try with the skin to skin
and breast proximity.  (I describe this to the moms as:  "open the cafeteria and
let the baby smell the pork chops"- a particularly delicious smell - in my
opinion, as I'm not a vegetarian  -  here in PR where we season our foods with
garlic and oregano).

What we call it (nipple confusion, suck preference, etc.)  doesn't matter - but
we need to  agree on a definition for each of these findings and terms so we can
explain our evaluations and recommendations.

Just as the term "formula" has been condemned but we can't seem to get the
general public to use ABM, we may be stuck with "nipple confusion".  One concern
I have is that "nipple confusion" causes a great deal of guilt in the mom.
Today I saw one who was so grateful that I described it as "nipple confusion
related to finger-sucking".  It made all the difference in the world in her
face, her posture and her willingness and resolution to work towards a solution.

Surely everyone agrees that erratic tongue movement, bunching of tongue in back
or pushing nipple out with the tip occur - along with dozens of other
uncoordinated movements that cause difficulty in breastfeeding.  For the lay
community, they will be bunched under "nipple confusion" unless we change/define
new terms.

Jeanette Panchula, BSW, LLLL, IBCLC, RN
Puerto Rico
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