I think that there are at least two things going on with nipple confusion,
 continuing on with the recent thread on Lactnet about A----t nipples and
 silicone nipple shields.

The first is the difference between artificial nipples or teats used with
bottles compared to the mother's nipples, that is hardness and size etc.,
 but, and here is my observation, and secondly, a discrepency between the
constant flow of milk with a bottle compared to the variable rates of flow in
the breast.  I see the baby fuss and cry with attempts to latch him on if
he's had bottles, and if we succeed in actually latching him on I see a
frustration that I perceive to be because the breast milk is not coming at
the constant  rate of the bottle.

There are risks with any alternative method of feeding the baby.   However, I
think I'm seeing more successes when it comes to weaning the baby off finger
feeding  and onto the breast, compared to the baby, a week old who was given
bottles for a couple of those days.

I haven't used nipple shields very much so I really can't comment on these,
however, at least at the breast, with a nipple shield, that baby would be
familiar with the changing rates of flow of mother's milk and not be
vulnerable to this additional cause of frustration.

Kathy Bodden, RN, BScN, IBCLC