On 1/13/00, Winnie said:

< For those who are convinced a baby can't handle a
large nipple, have you seen the British video "Breastfeeding: Coping
with the First Week"? (or something close to that.  It's at work and
I'm at home, so I can't check for sure.)  A baby that looks close to
newborn is latching beautifully on a nipple that looks twice the
diameter of the average nipple!  While some babies have trouble
latching to large nipples, others can surprise us.  Once the mom is
helped to latch effectively, some baby may handle a large nipple.
Assuming that a large nipple will automatically be a problem is like
the nurse who says "This mom has sore nipples, but she's a redhead"
and never checks to see if there is another reason for the soreness.>

Agreed. But remember that they may be a red flag for other reasons. If
such a baby never feels anything in his mouth BUT his mother's own nipple
in the early weeks, he knows nothing different, and other things being
equal, he will "work at it" the best way he knows how. I believe it is a
far different story if he gets even ONE rubber nipple (or appropriately
tubed finger) that gives him any kind of feeding satisfaction .

I think it is fair to present this concern to the mother (and father)
prenatally if one has the chance. However, 2 recent experiences taught me
that on hospital "turf", parents are in a vulnerable time and place, and
might as well save their breath as to request "NO RUBBER NIPPLES" at some
institutions. Most HCP's, especially unconvinced nurses,  will give the
baby a "fake" nipple whenever it jolly well pleases their habit patterns.
THEY are in CONTROL, thank you.

Another very real consideration is the placement of that particular
mother's milk sinuses. Placement can differ, even between the two breasts
of the same mother. Among thousands of nipple-areolar complexes I have
examined by palpation, I found only one mother with the sinuses in the
nipple itself. In others, sinuses are close behind the base of the
nipple, and depending on the strength of the mother's MER and the length
of the baby's mandible and tongue, may not present as a milk transfer
problem.

However, it is not unusual for sinuses to be 2-3 cm. or more behind the
base of the nipple. It is important to closely assess adequacy of milk
transfer, by the baby, and by a pump, if used to maintain stimulation.
Efficient removal by pump may require a larger flange.
Breast compression of the upper ducts, and any other way to stimulate the
MER (such as neck massage and back rubs) may be important until the
baby's jaw and tongue grow large enough to effectively compress and
massage the sinuses.

This can often seem to require extra hands. A father who wants to "help"
with the feedings and who has had the need and method carefully
explained, can make a great (and enjoyable) contribution to milk transfer
when mom feels she needs it.

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

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