Ds is 7 now so it's a while ago, but he went between breast, bottle (and syringe) from day one. Syringe was suggested by the midwife when he was about 12 hours because he was having trouble latching and it was a good way of getting colostrum into him, after that he managed to latch for short times but was pretty badly tongue tied and ripped my nipples quite badly so when I got home (4 days old) I bought a pump and bottle, I continued to go between the syringe, breast and bottle until his tie was cut a couple of days later then stuck with the breast until my nipples healed up. We had no issue with nipple confusion at all.