Pat wrote, "unfortunately the babies who have the potential to become nipple confused don't come with labels!" Thanks Pat. Point taken :) However, I usually see that they may come with any one or more of the following risk factors: high arched palate, receding upper gum, short/retracted tongue, more than usually receding chin. Their mothers may come with flat/inverted nipples, inelastic breast tissue or poor latching techniques. Then again, sometimes it's a *learned* behaviour (over a period of time); there may be a very low milk supply, or a slow/inhibited letdown reflex. I see this as a higher/reduced risk sort of thing rather than an absolute. The babies can act "confused" *before* they have had bottles as well as *after* they have had bottles. If bottles are routinely given before breastfeeding then of course we can call it "nipple-confusion". Bottles and teats are not used in our hospitals. So I see babies who have demonstrated demonstrated a difficulty with breastfeeding and the mom then gave a bottle after she got home in order to feed the baby by *any* means. This is a "latching difficulty", not "nipple confusion", and continues to be a latching difficulty until the original cause is addressed and resolved. I see "nipple confusion" as a symptom of *another* difficulty - a consequence, not a cause. It's too easy a label, too wide a definition, like "low supply". Hence my problem with it. Pamela Morrison IBCLC, Zimbabwe