As the mother to a premature infant, I did not get the joy of the first latch in the hours following my son's birth.  At 27 weeks, he entered the world, was brought to the bedside for a quick photo, and then worked away while I was brought to recovery. It would be weeks before he would breastfeed.  Would be even know what to do? I wondered.

All of my siblings and I had pacifiers and there was no confusion on our part. As the oldest of five, I had witnessed breast and bottle feeding. Still, what if there was something to it? What if a child could become confused and simply not eat? Compound the issue further in my case - my son was having a pacifier while a feeding tube was in place. Couldn't he confuse the feeling of fullness while sucking on the pacifier for the real deal?

I was filled with anxiety. Even after that first appointment, it would be another three weeks before breastfeeding would become a possibility, and then, only after pumping. He had intermittent feeds with a bottle, too.  Given that breastfeeding (not pumped breast milk) gives your child antibodies, as well as good bacteria, I was determined to breastfeed my child.  His prematurity and the absence of gut bacteria (we were both out on heavy antibiotics) strengthened this resolve.

The first time, he simply let my nipple sit in his mouth. I expressed a little and tried again.  Faint sucking for a minute or two. Every time he took it out, I waited a couple seconds and tried again. When he fussed, we were done.  It took two weeks of patiently trying. As they reduced the amount he received by tube, and I started a bit late to make sure he was truly hungry, he started doing better.  Now we breastfeed successfully every time.

 I won't say that nipple confusion does not exist; however, I don't think that we fully understand it. Correlation is not causation. We cannot assume that because a pacifier or bottle was used a baby will be confused.

Instead, I would question how a pacifier, nipple, or bottle was introduced by the nurse or other caregiver.  I had been advised not to force from my son; he was learning from every interaction. A forced pacifier, breast, or bottle can impact willingness to accept them.  And again, this may be mere correlation, and not causative.  Please do not think I am saying every baby with nipple consisting was traumatized.  All I mean to say is, given my experience in which a child should have nipple confusion, there is none.