Cheryl,
In the case study I presented the baby was *below* birth wt. at a month. He
was literally starving. He never showed any signs of nipple confusion--when
he pulled off the breast and demanded more food, he had already been
breastfeeding for 20-30 minutes. This is not nipple confusion; this baby at
no time ever refused the breast, before or after he was supplemented. Once he
was supplemented he began to demand enough food to meet his hunger and growth
requirements, a pretty good survival tool if you ask me.  I work in a large
teaching hospital where we get referrals for very difficult breastfeeding
problems. It has given me the perspective that not all breastfeeding problems
can be fixed by nursing more freuqently or by fixing the latch. This baby was
latching well and breastfeeding more or less continuously round the clock.
It wasn't that he was gaining slowly--he wasn't gaining at all.  The first
rule of lactation consulting is to feed the baby.  None of us like formula
and darn I wish we never had to use it, but I'm not going to watch a baby
starve.  Starvation is an evil worse than formula.  As this baby  caught up
on his growth, he breastfed more effectively and mother's milk supply
increased.

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