Cindy's client has a baby with a stellar weight gain, which may be a
clue. Also, the pacing of the flow achieved by the shield.

Is it possible this baby has learned to hump the tongue and thereby pinch
nipple as a coping mechanism for a slightly stronger MER/more copious
supply than baby can handle without trying to stem the flow a little?
What about consistently triggering the MER 3 full minutes before latch is
attempted, and always using an anti-gravity position such that the milk
leaves the breast in a trajectory more like a drinking fountain, with the
baby's oronasal passages always above, rather than being "under Niagra
Falls" with the oronasal passages in a dependent position to the nipple.
Or a least, a neutral gravity position, after triggering the initial MER
a full 3 minutes before latching.

It would be interesting to see what 48 hours of a consistent trial of
this would bring as far as changes in the baby's coping mechanism.
Perhaps relieving the baby's need to protect himself from the flow would
protect nipples from the trauma thereof.

Jean
************
K. Jean Cotterman RNC, IBCLC
Dayton, Ohio USA

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