Do we have research to show that all healthy normal babies can easily switch 
back and forth between breast and bottle? In evolutionary terms, it doesn't 
make sense to me - babies would evolve to breastfeed, not to alternate 
between feeding methods.

I have certainly seen babies over the years who nursed well and gained well 
and who developed problems when given bottles. Yes, I've also been able to 
help many babies make the transition from bottle to breast. But I am 
suspicious of a blanket statement that if a baby doesn't easily go back and 
forth between the two, there must be a problem.

I know that when I started out helping breastfeeding mothers, more than 25 
years ago, medical people felt that bottles could not interfere with 
breastfeeding. It was the observations of mothers and people working with 
mothers that created this theory of nipple confusion - seeing babies who, 
after being given a few bottles, changed their way of sucking and latching. 
Or who seemed unable to figure out what to do with a breast if they had 
bottles before breastfeeding.

In our local hospital, mothers of premature babies are told they must give 
their babies bottles before breastfeeding, and they usually leave the 
hospital doing both. I frequently get calls from these mothers, as they have 
significant problems in getting the baby to latch and suck well at the 
breast. Now, certainly, these babies are premature and more likely to have 
problems. However, we do have a few mothers who will refuse to give their 
babies bottles and either supplement at the breast or have any supplement 
given by gavage. Those babies breastfeed so much better when they are 
brought home - the difference is quite noticeable.

Finally, I use the word confusion because I think it is less upsetting to 
mothers. It is very upsetting emotionally for a mother to find that her baby 
who has been given bottles now doesn't seem to know what to do with her 
breast, or latches painfully, or lets go and cries because it isn't the firm 
nipple with milk dripping out of it that he was expecting. To say the baby 
"prefers" the bottle nipple says to many mothers that the baby is rejecting 
her nipple and her breast - that he doesn't want to breastfeed. It feels 
very personal. So I try to reassure mothers that the baby DOES want to 
breastfeed, that her nipples and breasts are just perfect, but he's just a 
little confused right now and we'll help him figure it out.

Teresa Pitman 

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