I am so glad to see the different opinions on nipple confusion.  This
difficulty is so intensely challenging.  Linda Smith's message was of course
brilliant.  But Fiona Coombes brings up something I have wondered - whether
it is the labelling that we are "confused" by - whether this is
"nipple-confusion" or "suck-confusion".  I am beginning to suspect there are
different degrees or types.  I see babies in the first days of life who
behave as if they are "nipple-confused" when no bottle or teat has ever been
offered.  Thus they cannot be confused by the difference between breast or
bottle - they simply cannot latch - would this be suck-confusion?  Then
there are the babies who have been exposed to bottle-teats (is this a cause
or a consequence of a latching difficulty?) who we would then term
classically nipple-confused.  I also occasionally work with babies whose
mothers struggle to breastfeed them first, and resort to a bottle (or nipple
shield) later as a last-resort method of feeding.  These babies may
subsequently latch to the breast several days or weeks later as if they have
been breastfeeding all their lives.  The conclusion I have to draw from this
is that the longer, firmer teat on the bottle or shield "teaches" the baby
how to "suck", so that he is subsequently able to form a teat from the
shorter breast in the normal way we would expect and thus breastfeed.

There's obviously more to this whole topic than we have explanations for at
present.  I am one of the people who doesn't believe in "nipple-confusion" -
probably because I don't agree with the assumption that bottles (with teats)
are always to blame - it is too easy to assume that all you have to do is
eliminate the baby's exposure to bottles and the problem will go away.  My
observation is that it is the baby's inability to obtain stimulation to the
palate which is the the most likely cause of "nipple-confusion" (although I
concede there are other causes).  A teat or a shield can easily provide this
stimulation, and this is why they are effective.  Babies of mothers with
protruberant "easy" nipples are unlikely to be confused by bottles, whereas
babies whose mothers have short/flat/inverted nipples are definitely at
risk.  Oh, that we could issue each mother with a set of A....t nipples!

Pamela, Zimbabwe (hoping someone will educate me further).