I call early nipple confusion a "problem with nipple recognition" when I speak to parents. I tell them that because of the bottles (of supplement, for jaundice, etc.) the baby is having trouble "recognizing" where dinner is supposed to be coming from. Sometimes we've used finger feeding or a supplementer at the breast to help transition back to the breast. For some babies the issue seems to be flow (too much or too little), for others it seems to be the firmness of the nipple and where it touches in the mouth. [This also applies to the moms with "flat nipples" or inverted nipples - even if no bottles have been given.] I avoid the word "preference" because new moms are unsure enough without some breastfeeding professional telling them their baby prefers a bottle nipple vs. a special part of mom's anatomy meant just for them. Later nipple confusion - say at 2 months after bottles have been introduced -as someone posted earlier- I believe is a combination of a "flow issue" and as more bottles are given, a "milk supply issue" as well. My 2 cents. Gail S. Hertz, MD, IBCLC [log in to unmask] *********************************************** The LACTNET mailing list is powered by L-Soft's renowned LISTSERV(R) list management software together with L-Soft's LSMTP(TM) mailer for lightning fast mail delivery. For more information, go to: http://www.lsoft.com/LISTSERV-powered.html