It is very fashionable, lately, to say that nipple confusion is a myth.   We are, after all, in the business of debunking many of the myths and superstitions of both breastfeeding and bottlefeeding, and replacing them with current information, understanding and vocabulary. 

In fact, many babies are not troubled by switching back and forth, at any time.
And in many more there is no confusion, it's preference:  they know what is easier, once they've been given a bottle.  (And we have been exposed to articles about bonding to particular teats).

But there are also the instances where babies have disorganized sucking/suckling mechanisms for hours, or days or months, and to be given a bottle, which needs totally a different kind of work, before they have organized suckling, may radically (or permanently, if mom is not willing to invest time and energy) impede their ability to learn to get milk from the breast.

I think that this is really a quibble over terminology.  Nipple confusion may 
not be a cognitive mental confusion, perhaps, but certainly there is a kinetic
 confusion.  And I, for one, am content to use this term until someone 
comes up with a better one.

Sincerely,  Chanita, San Francisco