My general opinion is that nipple confusion is a bunch of hooey. I'm not a doctor or a lactation consultant, but I think the majority of children will be able to transition between the breast, bottle and pacifier if given the opportunity at the right time. (And my pediatrician agrees, thankyouverymuch).
I've certainly read and heard about kids who refuse all bottles, or only take one obscure bottle or pacifier, but I don't think that will be true for most.
Let me tell you about my experience with the Girl (or, a case series of 1).
We didn't start a bottle or pacifier until about 3 weeks old. We chose not to give her a pacifier in the hospital, but really it was just a snap decision. "Do you want her to have a pacifier or not?" they asked. Not, we said. There was no good reasoning behind this decision. It did help, however, that the Girl was so content and didn't require much pacifying.
We were fortunate that she latched and fed well pretty quickly. By the time we were home from the hospital most feedings went OK, and by the end of the first week we were on our way.
We introduced the bottle at about 3 weeks. Despite much hemming and hawing on my part, she did just fine - sucked it down. She did fine when we changed bottle types on her about a week later - didn't even act like she noticed. Once baby is feeding effectively (baby is gaining weight and peeing and pooping well), I wouldn't hesitate to introduce a bottle. My breastfeeding class said for Mom to leave the house when Dad gives the first bottle of breastmilk because the baby can smell the Mom. Again, I vote hooey.
I held off on the pacifier until after the bottle. Again, not for any good reason, but because she didn't really seem to need it. Eventually it came to be that the Girl liked to wake from her naps early and it was a little difficult to get her back to sleep. The pacifier really seemed to help with these sleep transitions.
She still transitions among all three with ease.
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