You're right that if the baby is only transferring 6 ml., the mother needs to supplement and the SNS is a fiddly piece of equipment, but a good idea to keep this baby learning about this particular breast.  Getting the baby bigger and stronger is important -- It does sound like a job that the baby needs to grow into.  And it's easier to woo a baby along into the learning process if there's milk there, so perhaps the first focus would be treating the pump like a fussy baby and wedging lots of pumping sessions into the day to take advantage of these early weeks to build supply (and with three children, she needs practical strategies).

Helping the mother see that, in the wide range of normal nipples, that when  nipple has a narrow base, it's a challenge for a baby to reach past that and draw in breast tissue as well.  But try to make her feel that she's on some common ground -- each mother baby team is figuring out how they "fit."  And this is a common problem -- sometimes it's referred to as a "doorknob" nipple or just that it has a narrow base.  There is a picture in the always useful "Breastfeeding Atlas."

Perhaps working on an exaggerated off-center latching approach --in the Rebecca Glover mode.   starting with the baby upright, waiting until she's looking for the breast, which encourages her to open wide.  Nose to nipple, with the chin anchored on the breast, so the baby isn't grabbing the nipple out of the air.  Waiting for the baby to tip her head back and reach up, before snugging her body in.  And it's this "drag and drop" -- that the lower jaw is dragging out on the areola, and the areola folds into the mouth first (hooking that lower jaw out away from the nipple base) and the nipple drops in last.  If the mother is laying back somewhat, gravity helps the baby stay dug on, with the jaws splayed into a wide mouthful, chest in and chin up --and not sliding away to pinch around the nipple base.

Margaret Wills, IBCLC, Maryland



> Date:    Tue, 7 Jul 2015 21:23:47 -0700
> From:    Melinda <[log in to unmask]>
> Subject: Shallow latch due to "grape" nipple
> 
> PTP
> Moms third baby (8day old) and all had problems with latch/inadequate intake. She comes to me to try to avoid "the downward spiral" that occurred with other babies. 
> Nipples Undamaged, erect, and areola elastic. No ties. Supplementing now with feeding tube, but just got an SNS
> BUT her nipples are different than Ive seen. It looks as though a small grape was glued to the end of the areola. This nipple is not too small or large for baby, but baby latches on only to this rounded nipple. during observation of feed, she latches well onto this distinct firm nipple but no areolar tissue is grasped  I'm not sure how baby can possibly get more than this nipple in her mouth ! No wonder she transferred only 6ml with feed. 
> Does anyone think a nipple shied could help in this circumstance? Just thinking it might help draw more of areola into her mouth.
> Melinda Harris-Moultin ARNP iBCLC Olympia WA

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