Dear All:

I think the reason nipple confusion gets met with disbelief is that many moms can go back and
forth between breast and bottle, whereas we all have experience with those babies who have
difficulties shifting.  Rather than using the term "nipple confusion", I try to describe the exact
problem baby seems to be having when I send my pediatrician reports.  I have found the
following:

1) tongue retraction
2) clamping with tongue or with gums
3) difficulty grasping or compressing the breast (we all know those babies who hang their lips
open waiting)
4) frustration when the flow is too slow or too fast (we all know those babies who scream when
the flow isn't exactly to their liking)

I'm sure you all can add to the list.  I try to be specific about what's going on and then analyze
what might help the baby develop skills at the breast.

And then there are those adaptable babies that manage to suck milk out of anything you dish out.

I've stopped calling it nipple confusion - and do use flow confusion - but I still think that the latter
term is just as fuzzy as the first even if its a little more accepted by HCPs.

Susan Burger, MHS, PhD, IBCLC

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