I seem to remember posting on this quite a while back-or mayby I'm
thinking of a talk I gave at a WI LLL Conference.
I firmly believe that "nipple confusion" is a catch-all phrase for a
number of potential problems when babies are asked to learn two skills
at once that are different but with some similarities.  For each
difference between nursing at the breast and taking milk from a bottle,
there is a possibility of a problem.  A baby who has gotten an
artificial nipple may show one or more or none of the following:

1. rate confusion - flow of milk from the breast varies while with a
bottle you always get "y" amount of milk for "x" amount of suction until
it's empty.  These babies do fine at breast, but get a little "antsy"
when the flow slows down.  Breast compression can help overcome it until
baby accepts the variation.  If supplementing must be done, Haberman can
avoid/reduce this one since you can vary the flow.

2. shape confusion - bottle nipple touches "s" spot immediately whereas
it takes a few sucks to enongate the nipple/areolar tissue to stimulate
the same spot.  Maximizing the amount of breast tissue that emnters
baby's mouth while latching can reduce it.  If artificial nipple is
used, encouraging baby to draw the nipple in over several sucks instead
of immediately putting it all the way in baby's mouth may reduce this
difference.  Cup feeding eliminates baby geting used to any feel in back
of mouth while feeding.

3. flow confusion - baby gets "instant gratification" with a bottle
whereas it may take a few sucks to "prime the pump" at breast and
stimulate MER.  Stimulating MER before latching may help overcome it.
Haberman at "short line" initiially or finger feeding/supplementer
withoug releasing milk flow until after a few sucks may reduce its
occurance

4. texture confusion - fleshy human nipple and rubber/slilcone/whatever
artificial nipple certainly don't feel the same in baby's mouth.  Finger
feeding is at least flesh, although not quite the same overall feel as a
softer breast.  Cup feeding again avoids any texture in baby's mouth.

The list could go on and on.  As you can see, each difference may or may
not lead to a kind of confusion or preference.  We generally can't
predict ahead of time which if any will bother a particular baby.  Each
method of alternate feeding has potential benefit and potential
problems.  Closely watching baby's behavior if (s)he has been fed other
than at breast and is having problems going back to breast can give us
clues of what aspect may be giving the problem.  Then we can choose the
most effective way of overcoming it and reducing further problems if
alternate feeding must continue.

Winnie

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