I call early nipple confusion a "problem with nipple recognition" when I
speak to parents. I tell them that because of the bottles (of supplement,
for jaundice, etc.) the baby is having trouble "recognizing" where dinner is
supposed to be coming from. Sometimes we've used finger feeding or a
supplementer at the breast to help transition back to the breast. For some
babies the issue seems to be flow (too much or too little), for others it
seems to be the firmness of the nipple and where it touches in the mouth.
[This also applies to the moms with "flat nipples" or inverted nipples -
even if no bottles have been given.]

I avoid the word "preference" because new moms are unsure enough without
some breastfeeding professional telling them their baby prefers a bottle
nipple vs. a special part of mom's anatomy meant just for them.

Later nipple confusion - say at 2 months after bottles have been
introduced -as someone posted earlier- I believe is a combination of a "flow
issue" and as more bottles are given, a "milk supply issue" as well.

My 2 cents.
Gail S. Hertz, MD, IBCLC
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