Dear Tammy,

Does she have a milk supply problem as well as small nipples?  Frequent
pumping  will keep her supply up until baby is latching and sucking well
and help bring out nipples.  Use the pump or inverted syringe to pull out
nipples just before feeding.

Good latch is important regardless of nipple size.  Gently squeezing
breast to make a "nipple sandwich" make get more of the breast into the
mouth in order to stimulate the suck.  She could also try leaning over
baby from above while nursing - gravity will bring  more tissue forward.

Lots of skin-to-skin, carrying baby in sling, bathing/nursing may
encourage baby to go to breast.

Use of the nipple shield is not necessarily counterindicated if it is the
only way the baby will latch after all other measures have failed.  It
can be a better alternative than weeks of pumping and giving EBM by cup,
fingerfeeding, etc.  However, you need to make sure she is putting it on
properly so that the breast tissue is right up inside the shield where
baby can compress it to get milk and stimulate production - pull all
around the "areola" part of the shield and put it over nipple so that
when she withdraws her fingers from the shield, the breast tissue is
pulled up into the shield; another way is to evert the shield first and
then turn it back as it is pulled over nipple.

Keep a close eye on wet diapers, stools, wgt. gain - baby needs to be
fed.

Helping friends is such an awkward position to be in sometimes. You may
want to refer her to an experienced LC or LLLL in your area.  Good luck.

Sharon Knorr
Lactation Consultant Services
Rochester, New York
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