I have to weigh in again on this issue. I wonder if the term NIPPLE confusion is the problem. That is, I have begun questioning if that is really the problem. Going back to the example one person gave of babies being "tested" with bottle teats before being allowed to breastfeed and then going to breast as if it were a bottle (small mouth, tongue retracted, etc.) I don't think those babies were confused at all! They had learned what to do on a bottle (imprinting, if you will) and were simply trying to do it again for the next thing they were supposed to suck on! Is that confusion? I am not so sure. When I have seen this (and I have), I use a nipple shield to ease the baby onto the breast with a stimulation and feel (if you will) that is similar to what the baby appears to be looking for. Once the baby settles at breast (with shield) and suckles well and relaxes (and this is usually VERY obvious), we then offer baby next breast without the shield and most of the time, they go back on breast as if that was all they had ever had. I view this as learning to be creative in order to help baby see what would be preferred--in this case, opening mouth wide, and recognizing the softer warm and pliable breast and nipple as what he really wants to suckle. Do we overuse devices? Sure we do, which means (to me, anyway) that often we are not quite as creative as we might be if we didn't have them to use as crutches. Don't get me wrong. I find nipple shields very handy sometimes, but they certainly are not a panacea for all problems and whenever ANY device is used that way, it tends to create more problems than it would solve if used judiciously. In observing experienced LCs and wannabes, the biggest difference I see between them (and I suspect this is probably true in ALL professions) is that the more experienced use FEWER gadgets and gizmos, are more patient, observe more while saying less (and thus do not overwhelm the mother with words or recommendations), and seem to know when to make a suggestion or use something to help the baby and mother over a given hurdle. The wannabes are too quick to want to jump in, love the notion of trying this tool or that one, and clearly by doing so are showing me their desire to LEARN without realizing that this may not always be in the best interest of the mother. If you are wannabes, please do not take offense at the above characterization. I am generalizing, but that is what I have observed. And, there are people who have been in the field a long long time who do use lots of gadgets. But in general, the more experienced do not. They have moved to what I consider to be a "purer" form of lactation consultation, in the sense that they are offering recommendations to the mother in a consultative manner rather than intervening in a more obvious "let me take over this experience" sort of interaction. How is this related to the issue of nipple confusion? I simply wonder if what we are attempting to describe is poorly named, is a gathering of multiple situations which have some things in common, but also many differences, but that by lumping them all together under one term has served more to confuse US than to enlighten and assist our clients and their babies. Anyone else have any thoughts on this? mailto:[log in to unmask] "We are all faced with a series of great opportunities brilliantly disguised as impossible situations." Kathleen G. Auerbach,PhD, IBCLC (Ferndale, WA USA) [log in to unmask] WEB PAGE: http://www.telcomplus.net/kga/lactation.htm LACTNET archives http://library.ummed.edu/lsv/archives/lactnet.html