I find nipple confusion to be a term that is not very specific. It can mean different things to different people and there are some (not me) who think it doesn't exist. The first things that pop into my mind are tongue retraction, lack of breast compression, and unwillingness to open wide for the breast. Now I'm getting more interested by what Ann quoted about Wolf and Glass said about incorrect sucking action with the Haberman bottles. What aspect of the sucking action is affected? I've actually seen many babies go on to fully feed from the breast with supplementation from Haberman bottles who have not had Cleft palates. The common denominator that seem to be low oral tone, infants that are not compressing the breast, or mothers with acquired low supply that resolve it with pumping. The two cases where no alternative feeding devices have seemed to work are two babies that I have seen that, for lack of any better description, seem to do what I call the fish squirt. Both these babies suffered from weight loss of > 10% initially. One had low oral tone and a moderately tight frenulum, the other could have hung from the breast with his mouth alone. Initially both lacked rythmicity at the breast and were essentially staying on the breast around the clock, with the occaissional 10-20 minute break when they were inconsolable. As they gained back birth weight their feeding behavior changed. They would take a large bolus of milk in their mouths (whether from breast alone, tube on the breast, fingerfeeding, Haberman or Avent bottle) and squirt half of it back out the sides of their mouths. Having seen that this developed over time, and one had very good oral tone, I am suspicious that lack of a seal was not a problem, that these babies were deliberately not making a seal. The rate of flow seemed to make no difference in their behavior. I have actually had a mother, much to my complete and total surprise and against both my and my colleagues repeated suggestion to use the SNS, get her baby completely back on the breast from a low supply situation using a Avent bottle, which I find to be a very fast flow. She worked diligently at pumping and her baby went from transferring only about 0.5 ounces from the breast to complete feeding at the breast. The key was that she kept pumping and built up her supply and attended breastfeeding support group every week where she worked on her latch. I would have laid bets that she would have been bottle feeding expressed breast milk and I was so pleased when that didn't happen. None of these were babies that had initial problems latching onto the breast. Time for dinner so my random thoughts will have to stop now. Susan Burger, PhD, MHS, IBCLC *********************************************** To temporarily stop your subscription: set lactnet nomail To start it again: set lactnet mail (or digest) To unsubscribe: unsubscribe lactnet All commands go to [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