Pat,
I used to be a true believer in nipple or suck confusion--that is until I
became a lactation consultant and worked with many, many babies. In all my
years as a NICU staff nurse I felt that the main reason premie babies, and
even sick term sick babies, did not latch was because they were "nipple
confused".  I had quite a few arguments with my colleagues about this.. As my
knowledge base increased I became aware of all of the other reasons that
babies do not latch or breastfeed effectively--inelastic nipples, oral
abnormalities in the infant, dysfunctional sucking patterns, etc. So what I
know now is that in the vast majority of cases the the baby who doesn't latch
is the baby who cannot latch.

So what is the role of bottles in breastfeeding difficulties?  I've refined
my thinking to the extent that I no longer believe that the problem is nipple
confusion per se.  I do think that many baies become rapidly accustomed to
the fast and steady flow of the bottle and become very impatient with the way
milk flows from the breast--i.e. in a pattern of ebb and flow.  We have NICU
graduates return to our outpatient clinic after basically bottle feeding. Mom
may still have a good supply and yes the baby will latch, but darn it all,
that breast doesn't work like the bottle and the hungry baby has very little
patience with it. They also get used to an overfilled tummy (so common in the
bottle fed baby) and are not satisfied with the very normal amount of milk
they can get from a breastfeeding.  In our hospital, we LC's  are trying our
darndest to convince our nursing and medical colleagues that if we can just
get breastfeeding well established in our small and sick premies, some
bottles later on won't make such a difference.

Interestingly, all of our premies get pacifiers, and I have seen no impact
from this on our babies" ablilities to latch and breastfed.  Early, frequent
bottles, however, is the end of breastfeeding for most premies, even when mom
maintains a good supply.

I think if we want to convince those making feeding decisions of how bottles
interfere with breastfeeding we need to  be able to make some explicit,
logical, understandable arguments. I think the idea of nipple confusion came
about when the full term baby would not latch after bottle feeding.  What we
forgot to notice was that in many cases the baby got the bottle in the first
place because she couldn't latch  The fact that she still couldn't latch
after bottle feeding was often due to the original difficulty and not
necessarily to nipple confusion.  "Nipple confusion" is a catch all phrase--I
think we need a clearer explanation of what is really happening.

Kathy Boggs, RN, IBCLC
Mountain View, CA

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