Actually, what people commonly refer to as “nipple confusion” is not exactly that. Rather, it is a different coordination of the suck, swallow and breathe combination when bottle or breastfeeding. When an infant sucks at the breast, he receives milk, and when he stops sucking, the flow of the milk stops. This result is not the same when bottle feeding. A bottle nipple allows milk to flow continuously when it is tipped. In order to swallow and breathe, babies stop the flow by holding the nipple opening with their tongue so they do not choke. In the early weeks of life some babies have a difficult time trying to coordinate the two different sucks, hence the term “nipple confusion”.
My suggestion to avoid these issues is to exclusively breastfeed for the first 4 to 6 weeks after birth before introducing a bottle. After that point, slowly introduce the bottle at non-critical times where you could breastfeed if the baby rejects the bottle. If you decide to bottle feed because you’re not ready to breastfeed in public, you have to return to work or you just want to give daddy a chance to bond with the little one, be sure you have given your baby opportunities to test it out in advance. Just like learning to breastfeed, sucking from a bottle nipple will take some practice, although less so once a baby is accustomed to feeding from the breast.