Women with nipples that are too long to fit in the baby's mouth have a real
problem.  The baby often cannot access available milk because they cannot
locate jaw compressions on the globe of the breast.  I have seen babies grow
poorly and milk supplies decrease precipitously with this anatomic
variation.  Careful positioning that tips the chin in close is important,
but the only cure that I know of for these "fit" problems is to try to
protect the milk supply while the baby grows into the size of the nipple.
Lengthening of the palate with infant growth and increased age is a
recognized phenomenon in the dental literature.  The elongation of the skull
and the forward growth of the mandible are rapid in the first 4 months
postpartum.  The trick is finding a pump that accommodates these nipples.
Physics of milk removal require that there be some space around the nipple
inside the flange so that negative pressure can act on the surface of the
nipple tissue in order to remove the milk.  This is why larger diameter and
longer shaft pump flanges are so critical.  If the woman doesn't have a good
pump with a large enough flange, no wonder she can't get any milk.  Hand
expression is certainly worth teaching her, but in a long term stituation,
an effective electric pump would be a useful and time-effective assist for
any stressed mother.

Barbara Wilson-Clay, BS, IBCLC
Austin Lactation Associates
LactNews Press
www.lactnews.com

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