I like the short teat wide base nipples, because they more closely mimic
the shape of the breast.  The anterior tongue is supposed to cup the
breast by lifting and grooving slightly, and the posterior tongue is
supposed to groove more strongly to stabilize the nipple and form an
area to collect the bolus of milk.  I have photographed through some of
the wide base and short teat nipples while they are in baby's mouth, and
this is exactly the tongue configuration we see.

There is a lot of info in the OT and speech literature about having a
long teat to encourage tongue grooving, and that may be correct for
bottle feeding babies.  The long teat also encourages a smaller gape and
a tighter lip seal.  For breastfeeding, a larger gape and wider lip
position is more important.  Also, Donna Ramsay's new work shows on
ultrasound that the depression of the posterior tongue is more important
to removing milk from the breast than the compression of the anterior
tongue is.  If the mouth is mostly closed on a narrow teat, the tongue
does not have much room to depress, whereas if the mouth is open on a
wider base and the posterior tongue is raised to the smaller teat (as it
would be on the widening-as-you-go-back breast), there is lots of room
for posterior tongue depression.  So I am looking at the totality of
sucking when recommending the wide based, short teat nipple.  I don't
care as much about valving because I teach moms to hold babies sitting
and bottles horizontally with the nipple only half full of milk (and
half full of air) to neutralize the effects of gravity and the pressure
of fluid in the back of the bottle on the fluid in the nipple.

I also teach parents to help baby's "latch" onto bottles by extending
their heads and opening wide, to further reinforce breastfeeding
behaviors.
Catherine Watson Genna, IBCLC  NYC

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