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