> 
> From:    Melinda <[log in to unmask] <mailto:[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
> 
> 
> Sent from my iPad
>            ***********************************************
> Hi, Melinda!

I had a case like this recently. I described mom’s nipples as “light bulb nipples”. Hers were easily as big around as 2-3 thumbs pressed together. This was her 1st baby, so there was no history to help us decide if this was a hormonal change, or perhaps a lesser-known form of edema. She did have a hospital birth rife with interventions, so I was leaning toward edema. We attempted RPS techniques that attempted to start at the tip of the nipple, as well as cherry juice and other diuretic-oriented dietary changes. We did resort to nipple shields because they made the latch more manageable for baby, and this was a step forward as mother had been supplementing with pumped milk and bottles when I came to her. I believe the baby needed the use of shields until about 4 or 5 weeks postpartum, when mom’s nipples were completely normalized and the baby’s mouth was bigger. Mom did retain larger nipples than average once normalized, but the distinct bulbous shape was gone, leaving me to continue to assume it was some form of edema. Baby went on to exclusively breastfeed with no aids after this initial difficulty. if you think of it, I’d love to hear how your case resolves!

~Jacqui Gruttadauria, BSW & Lactation Counselor
(Recently relocated from Detroit area to Eugene, Oregon - where my skills are hardly needed as every mom here seems to breastfeed for several years as the norm!)
> 
> 
>> 


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