The dangers of a dummy

Fears and worries surrounding the birth of a new baby are notoriously plentiful. There seem to be so many potential obstacles to their health, happiness and general well-being. A flick through a magazine or a quick chat on the phone with a friend, and suddenly the possibilities are endless: are they losing weight, developing too slowly, under-stimulated? Have they asthma, colic, eczema, allergies, pneumonia . . . There are any number of alarming options. So how about "nipple confusion" as a source of concern? This is what happens when the infant becomes confused between two sucking techniques - one for sucking milk from a bottle, the other to suck milk from the breast. Yes, babies suck anything you put near their mouth, but can there actually be some confusion about what is and isn't Mum's tender loving breast, you might wonder, aghast.

Not exactly. They know what the breast is, but the can't always move from breast to bottle and back again.

Very young infants who have been feeding wonderfully can suddenly start mouthing very strangely at the breast, as if they don't quite know what they should be doing any more. They may pull away and cry bewilderingly at every feed. But give them the bottle they had earlier and they'll feed contentedly. This can be devastating for a mother who is very anxious to feed her baby herself. In fact, what happens is not that the baby prefers the bottle, but that they cannot make the switch from one technique to the other and back - they get confused. Mothers may be encouraged to give the baby a bottle of glucose and water between feeds in the early days, or to get the da up to do one of those night feeds. All of which is fine once breast-feeding is established - but if an artificial nipple is introduced too soon, there can be problems, says Margaret McGuigan of La Leche League, the breast-feeding advice and support organisation.

"The baby has to use a very particular technique to get milk from the breast. They cup their tongue around the breast, pressing it up against the palate, which elongates the nipple. The back of the baby's tongue drops to form a sort of grooved passageway for the milk to flow down. The baby swallows and rests his or her lips against the nipple as a seal, while taking a breath.

"As we all know, if you hold a bottle full of milk upside down, it begins to drip. The same thing doesn't happen with a woman! In fact, the technique the baby uses to suck also stimulates hormones in the mothers body which leads the milk being `let down'.

"With a bottle, the milk flows out with far less effort from the baby. Babies actually have to use their tongues to block the milk flowing in too quickly. "Babies are very individualistic. There are babies who will switch comfortably between bottle and breast from very early on, but there are babies who after just one bottle feed will refuse to come back to the breast. They can't see how to get the milk to flow, and it all seems like too much of an effort."

Soothers and nipple shields used early on can also cause nipple confusion - because they have such a different shape to the real thing. "If the baby isn't on the breast properly, the mothers' nipple can become quite sore and she may use a nipple shield. "But, again, this has a very different shape to the actual nipple, so that when the baby comes back to the breast he or she is unable to suck correctly." According to McGuigan, during the first four to six weeks, while the baby is getting the hang of the technique, the mother's body is learning to provide milk in accordance with the baby's needs, and establishing adequate flow.

"At this stage it is quite important that mothers feed the baby themselves. It can seem like a bit of a killer at night, and most of us would give anything to have a bit of sleep, but feeding raises levels of prolactin in the mother's body, a hormone otherwise known as the mothering hormone. "The function of prolactin is to stimulate milk supply. The baby's sucking causes the release of prolactin, so the more the baby sucks, the more milk there is.

"Mothers feeding during the night for the first few weeks can find it easiest to just have the baby in the bed with them. Of course you do wake up, but you don't have to get up, and there is less sleep disruption." Prolactin, McGuigan adds, is "nature's stress buster - it helps mothers relax. This in turn helps babies feel relaxed, and feeding can be a lovely time. Some mothers do feel a noticeable difference in themselves while they feed, but other mothers feel very anxious and don't notice the prolactin having any major effect. Women are all quite different."

ULTIMATELY, if mothers are going back to work or they want to express milk and share feeds with their partners, introducing a bottle teet when breast-feeding has been established is very unlikely to lead to nipple confusion, says McGuigan. "It is just a question of time, it may seem hard in the beginning, but it doesn't last."

If the baby does develop nipple confusion early on, it is possible to sort the problem out. "If there is a problem like this, mothers should contact their local La Leche League leader for support and assistance," McGuigan says. "It can be hard work sorting it out, but it can be done."