Long nipples can be a real problem for some babies.  If their oral "reach"
is such that they can't get jaw closure back over the lactiferous sinuses in
the breast, then the baby is just nipple sucking.  This doesn't stimulate
the milk supply, and the baby gets just the let down or slow drips of milk.
I've seen babies fail to thrive with nipples like this and it is a fit
problem that must be managed with breast massage, hand expression, and
pumping in order to protect the milk supply until baby grows and can get
further back over the breast.  The mother you describe also seems to have
unusual breasts.  I have seen small breasts and large, long, tubular nipples
that worked just fine as far as milk production was concerned, but this
breast type is also suspicious for insufficient glandular tissue (see the
Huggins article in Current Issues in Clin. Lact. 2000).  History taking will
be important here.  Did the mother have normal adolescent development?  Did
her breasts change during preg?  Did she exper. and engorgement phase
postpartum?  Was it a significant engorgement phase, or just something very
low level and mild?  Does she have a hx of thyroid problems?  Any
infertility or other hormonal issues?  A feeding tube device doesn't get the
baby any further back over the sinuses.  It is a way to deliver supplement
at the breast, but you can't count on  it stimulating the milk supply in
this situtation.

Barbara Wilson-Clay, BSEd, IBCLC
Austin Lactation Associates
http://www.lactnews.com

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