For "tight babies" and moms with large nipples, I supplement at the breast
with an SNS and have mom pump after each feed. Eventually, the problem
seems to resolve itself...often once mom's milk is in and established.

I find that the "tightness" is often associated with hunger and a "fear" of
not getting anything. Once the SNS provides flow, baby relaxes and get more
breast in the mouth.

My biggest problem with these moms and babies in delayed lactogenesis, as
baby doesn't empty ducts and mom is not stimulated to make milk. Pumping is
very important to make sure milk comes in.

Susan Keith-hergert RN, MS, CPN, IBCLC
Cincinnati

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