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Subject:
From:
Diane Wiessinger <[log in to unmask]>
Reply To:
Lactation Information and Discussion <[log in to unmask]>
Date:
Sun, 27 Jun 1999 12:34:10 -0400
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> They then reported suddenly getting
>very sore nipples, and when I visited the baby's latch - which had been fine
>before - was now terrible. Small mouth, tongue back, etc. Sometimes it took
>a week or so to get the baby nursing well again.

Ah, that's another part of the equation that I think is easily
addressed at least some of the time.  I love the Robyn Noble & Anne
Bovey's article, "Therapeutic teat use for babies who breastfeed
poorly" in Breastfeeding Review (1997; 5(2): 37-42.  They suspect that
a lot of the nipple confusion we see today is a result of stubby
teats, probably like Playtex, and so-called orthodontic teats - and
that babies switched back and forth pretty readily in the old days.

I urge mothers to use an old-fashioned teat that tapers into as fat a
base as possible (heck, even the cheapest teats seem to work pretty
well for most babies), and to help the baby draw it w-a-a-y in.  Then
they finish flanging the baby's lips out if needed, and make sure that
the baby doesn't slip back onto the skinny part of the teat as the
feed continues.

The Munchkin wide-based teats seem to work especially well, and I just
discovered a virtually identical one by Johnson&Johnson.  Babies will
"cheat" on these if their parents don't use some pressure to hold the
bottle in place, sealing the corner of the mouth with what looks like
a pretty respectable 90 degree angle.  Ah, but put some pressure on
the bottle, and a bit more slips in, so that the baby has that lovely
140 degree angle Kay Hoover talks about.   If a baby has a prissy
mouth, I suggest that the mom try one of these.  One little girl whose
mom had *fat*, inverted nipples (way too fat for a shield), finally
latched on after she switched from finger-feeding to a Munchkin, tho
she had to graduate to the Munchkin by using an intermediate teat
first.  Her mom felt it was the wide, wide mouth on the bottle that
got her ready for the breast.

When a baby has a mouth this full of bottle, it's important (I think)
to keep him fairly upright and make sure he knows how to put pauses in
or to put the pauses in for him.  Because I suspect a lot of the
humped tongue we see is a baby trying to control an out-of-control
flow.  Put him back in control of the flow by sitting him up and
making sure there are pauses, and I think the tongue doesn't get so
"uptight".

You're right, I've seen sore nipples that seem to be related to
bottle-feeding, but with a little more attention to the bottle-feeding
technique it seems to resolve.  So I'm not so sure it's bottles in
general, but newfangled bottle teats and poor placement that make the
difference.

I wouldn't say that nipple confusion doesn't exist, but I suspect the
rate is greatly inflated through both breast and bottle
mis-positioning, and the use of odd teat designs that sound good in
ads but really aren't like mother herself.

Diane Wiessinger, MS, IBCLC  Ithaca, NY

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