Nipple Confusion - articles needed

[MandaAnda]

My practice educator has asked me for some articles that I had regarding nipple confusion (for what it's worth, I don't really believe there's a problem with breast and bottle once breastfeeding is established), and I can't seem to find them.

I know whether or not nipple confusion exists can be a very hotly debated topic, so I do look forward to what everyone has to say.

What I most need though is articles - so if any of you have access to them, could you post links, sections of articles or even references here? Many thanks!

[rn/writer, RN]

I have long been skeptical about the topic of nipple confusion in most kiddos. Many of the moms and babies I have cared for do just fine using both breast and bottle.

Problems occur when the bottle is used so often that supply diminishes (or never comes in properly to begin with). And using regular-flow nipples can condition baby to not want to make the effort to breastfeed. These difficulties can be handled by making certain that bottle usage is limited and that bottles are offered with slow-flow nipples that mimic the more natural flow from the breast.

Another pitfall is that you have to limit the size of bottle feedings initially. Breastfed babies shouldn't be taking two ounces at a crack while waiting for mom's milk to come in as it stretches the tummy prematurely. Then the baby will not be satisfied with the lower-volume colostrum. Again, the solution is fairly simple. Breastfeed first, and then limit baby to 15-30cc by bottle afterward.

In my practice there are a number of moms who use both breast and bottle right from the start. Unless there are extenuating circumstances, most moms and babies do very well, especially when they expect to be successful.

I, too, would be interested in any research out there--pro or con--regarding this hot-button topic.