Nipple confusion has a medical definition.  It was proposed by Marianne
Neifert, Ruth Lawrence, and Joy Seacat in an article that appeared in J
Peds, 1995,126(6):S125-129.  They make the point that you can't call it
confusion if the baby has an inability to breastfeed normally.  That's
called feeding dysfunction.  Usually there is something wrong with an
organism who can't take in normal amounts of food to sustain robust growth.

 When we adopt a stray pup or kitten who is frail, crying, and vulnerable to
infection as the result of poor nutritional status, the first thing we do is
begin to provide calories for growth recovery.  If we have a nursing animal
around the house we can try to foster the stray.  Otherwise we are forced to
ask the vet for the most appropriate formula to keep the orphan alive.
Those of us who specialize in practices with complicated situations daily
receive referrals asking for intervention help with very fragile babies and
mothers with unusual physical or health issues.  Human milk is the ref.
standard for recovery from malnutrition ( Graham, G et al:  Protein
Requirements of Infants and Children:  Growth During Recovery from
Malnutrition, Pediatrics 1996,
97(4): 499-505.)  But until we have more human milk banks, formula is all we
have to work with until (and IF) we can get mom's milk supply built up.

I simultaneously work to improve own mother's milk supply (which is often
very compromised -- sometimes unrecoverably so), and to improve bfg.
management and latch.  However, those are secondary to immed. protection of
the infant's nutritional status.

I had a ph. call from a mom yest. with a two week old not back to birth
weight.  Baby gained (as per 2 naked weights on same scale at pedi office)
only 1 oz in 7 days.  Baby is 'gassy and colicky' when awake, but choses to
sleep most of the time (to conserve energy).  I would NOT explain that
infant's fussing as colic but as hunger.  This dyad needs immed.
intervention before milk supply involutes for this lactation (per M.
Woolridge on the subject of 'acquired milk insufficiency').

Barbara Wilson-Clay BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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